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Introduction: The use of active methodologies in health education has been widespread in recent years, in order to overcome the difficulties faced by students in the first years of academic life. Objective: To report an experience of creating and using 3D biomodels in the learning of Human Anatomy, for students of the 1st period of the Pharmacy and Nursing courses at the Federal University of Piauí. Experience report: 65 students participated, all duly enrolled in the discipline of human anatomy, from the 1st period of the respective courses of the aforementioned university. Then, they were divided into groups responsible for an anatomical piece, making a total of eight pieces. The teachers tried to choose bones that were more difficult to obtain in their real form, such as: the sphenoid, the ethmoid and the small bones of the hand, respecting the bordering impression dimensions of the equipment. The pieces were presented in the classroom and through creative videos produced directly by the students on social networks. All models were made using a 3D SLA/LCD printer using light-curing resin. Conclusion: This experience proved to be effective for bringing a playful perspective to learning with detailed structures, close to the real ones. It was a dynamic approach that enabled greater understanding and retention of the content. In addition, propagation in virtual environments contributed to the dissemination of knowledge quickly and practically, reaching a large audience and increasing the probability of encouraging new projects and activities in the same area. Introducción: El uso de metodologías activas en educación para la salud se ha generalizado en los últimos años, con el fin de superar las dificultades que enfrentan los estudiantes en los primeros años de la vida académica. Objetivo: Relatar una experiencia de creación y uso de biomodelos 3D en el aprendizaje de la Anatomía Humana, para estudiantes del 1º período de los cursos de Farmacia y Enfermería de la Universidad Federal de Piauí. Informe de experiencia: Participaron 65 estudiantes, todos debidamente matriculados en la disciplina de anatomía humana, del 1º período de los respectivos cursos de la referida universidad. Luego, se dividieron en grupos responsables de una pieza anatómica, haciendo un total de ocho piezas. Los profesores trataron de elegir huesos que fueran más difíciles de obtener en su forma real, tales como: el esfenoides, el etmoides y los huesecillos de la mano, respetando las dimensiones de impresión aledañas del equipo. Las piezas fueron presentadas en el aula ya a través de videos creativos producidos directamente por los estudiantes en las redes sociales. Todos los modelos se realizaron con una impresora 3D SLA/LCD con resina fotopolimerizable. Conclusión: Esta experiencia demostró ser efectiva para traer una perspectiva lúdica al aprendizaje con estructuras detalladas, cercanas a las reales. Fue un enfoque dinámico que permitió una mayor comprensión y retención del contenido. Además, la propagación en entornos virtuales contribuyó a la difusión del conocimiento de manera rápida y práctica, llegando a una gran audiencia y aumentando la probabilidad de incentivar nuevos proyectos y actividades en la misma área. Introdução: A utilização de metodologias ativas no ensino da saúde, vem sendo bastante difundida nos últimos anos, com o intuito de superar as dificuldades enfrentadas pelos alunos nos primeiros anos da vida acadêmica. Objetivo: Relatar uma experiência de criação e utilização de biomodelos em 3D no aprendizado da Anatomia Humana, para os alunos do 1º período dos cursos de Farmácia e Enfermagem da Universidade Federal do Piauí. Relato de experiência: Participaram 65 alunos, todos devidamente matriculados na disciplina de anatomia humana, do 1º período dos respectivos cursos da referida universidade. Em seguida, foram divididos em grupos responsáveis por uma peça anatômica, perfazendo o total de oito peças. As professoras procuraram escolher ossos mais difíceis de se obter na sua forma real, como: o esfenoide, o etmoide e os pequenos ossos da mão, respeitando-se as dimensões de impressão limítrofes do equipamento. As peças foram apresentadas em sala de aula presencial e através de vídeos criativos de produção direta dos alunos nas redes sociais. A confecção de todos os modelos foi realizada em impressora 3D SLA/LCD usando resina fotopolimerizável. Conclusão: Essa experiência se mostrou efetiva por trazer uma perspectiva lúdica para o aprendizado com estruturas detalhadas, próximas às reais. Foi uma abordagem dinâmica que possibilitou maior compreensão e fixação do conteúdo. Além disso, a propagação em ambientes virtuais contribuiu na disseminação do conhecimento de forma rápida e prática, alcançando um grande público e aumentando a probabilidade de incentivar novos projetos e atividades na mesma área.

Introdução: A utilização de metodologias ativas no ensino da saúde, vem sendo bastante difundida nos últimos anos, com o intuito de superar as dificuldades enfrentadas pelos alunos nos primeiros anos da vida acadêmica. Objetivo: Relatar uma experiência de criação e utilização de biomodelos em 3D no aprendizado da Anatomia Humana, para os alunos do 1º período dos cursos de Farmácia e Enfermagem da Universidade Federal do Piauí. Relato de experiência: Participaram 65 alunos, todos devidamente matriculados na disciplina de anatomia humana, do 1º período dos respectivos cursos da referida universidade. Em seguida, foram divididos em grupos responsáveis por uma peça anatômica, perfazendo o total de oito peças. As professoras procuraram escolher ossos mais difíceis de se obter na sua forma real, como: o esfenoide, o etmoide e os pequenos ossos da mão, respeitando-se as dimensões de impressão limítrofes do equipamento. As peças foram apresentadas em sala de aula presencial e através de vídeos criativos de produção direta dos alunos nas redes sociais. A confecção de todos os modelos foi realizada em impressora 3D SLA/LCD usando resina fotopolimerizável. Conclusão: Essa experiência se mostrou efetiva por trazer uma perspectiva lúdica para o aprendizado com estruturas detalhadas, próximas às reais. Foi uma abordagem dinâmica que possibilitou maior compreensão e fixação do conteúdo. Além disso, a propagação em ambientes virtuais contribuiu na disseminação do conhecimento de forma rápida e prática, alcançando um grande público e aumentando a probabilidade de incentivar novos projetos e atividades na mesma área.

Summary The favelas studies became a constant in university researches given the relevance of studying this urban phenomenon. This article has as purpose to identify the forms of territorialisation present in the Arvoredo Community (Favela do Siri) and how they relate to the social and environmental conflicts experienced by its residents. The occupation located in an Environmental Protection Area (dunes) it’s located in the city of Florianópolis and the case study will be analyzed based on empirical and theoretical evidences. The presented results bring the various faces of the territory as the exercise of power and are identified and portrayed under the bases of the socioenvironmental conflicts. Resumen Los estudios en favelas se han convertido en una constante en las investigaciones de universidades dada la relevancia de estudiar este fenómeno urbano. Este artículo se propone identificar las formas de territorialización presentes en la Comunidad del Arvoredo (Favela del Siri) y cómo se relacionan con los conflictos sociales y ambientes vividos por sus habitantes. La ocupación situada en área de preservación permanente (dunas) se encuentra en la ciudad de Florianópolis y el estudio de caso será analizado con base en evidencias empíricas y teóricas. Los resultados presentados traen las diversas caras del territorio como el ejercicio de poder y son identificados y retratados bajo las bases de los conflictos socioambientales. Resumo Os estudos que envolvem as comunidades segregadas em favelas são constantes nos meios acadêmicos por envolverem um número crescente da população. Eles se constituem também no maior desafio urbano dos países latino americanos, cujo fenômeno carece de compreensão e soluções. Este artigo se propõe a identificar as formas de territorialização presentes na Comunidade do Arvoredo (Favela do Siri) e como elas se constroem nos conflitos sociais e ambientais vividos pelos seus moradores. A ocupação é situada em APP - Área de Preservação Permanente (dunas), localizada na cidade de Florianópolis e o estudo de caso será analisado com base em evidências empíricas e teóricas. Os resultados apresentados trazem as várias faces do território como exercício de poder e é identificado e retratado sob as bases dos conflitos socioambientais.

Desde a década de 90, a quantidade de áreas privadas protegidas tem aumentado no mundo todo, contribuindo para a conservação da natureza e protegendo a biodiversidade, as paisagens e, em alguns casos, até mesmo valores culturais associados ao uso de recursos naturais. As motivações que levam os proprietários a converterem suas terras em áreas protegidas ainda são pouco estudadas, a despeito de quanto isso pode ajudar no desenvolvimento de políticas públicas que promovam a criação de novas RPPNs. Neste estudo, apresentamos os resultados de uma pesquisa centrada nas motivações dos proprietários para criar as Reservas Particulares do Patrimônio Natural (RPPNs) federais em suas terras no estado de Santa Catarina. Iniciando o trabalho a partir de dados oficiais do Instituto Chico Mendes de Conservação da Biodiversidade (ICMBio), consideramos a totalidade do universo amostral do estado, ou seja, 67 RPPNs federais. A verificação realizada mostrou, porém, que apenas 65 delas estavam legalmente estabelecidas. A maioria destas RPPNs (63) foi visitada, e os proprietários ou gestores de todas as 65 reservas legalmente constituídas foram entrevistados sobre as motivações que tiveram para criá-las. Os resultados apontaram 16 razões principais divididas em seis grupos de motivações: conservacionistas, conservacionistas/econômicas, econômicas, psicossociais, defensivas da propriedade e impostas. As respostas foram mais frequentes para motivações conservacionistas (41) e psicossociais (18), o que significa que os proprietários decidiram criar as RPPNs para contribuir com a conservação do patrimônio natural e também pela satisfação pessoal. A defesa da propriedade foi apontada por 15 proprietários como sendo a motivação para criar as reservas. Trata-se de uma defesa contra estradas, Pequenas Centrais Hidrelétricas ou invasão da área. As motivações conservacionistas/econômicas, econômicas e impostas foram apontadas, respectivamente, por 11, 6 e 4 proprietários de RPPNs. Ao final, alguns aspectos legais e éticos relacionados à criação de RPPNs para outros fins que não a conservação da biodiversidade são discutidos.

Dissertação de Mestrado em Gestão O presente relatório sobre a atividade profissional consiste na elaboração do Plano de Negócios e tem como finalidade a obtenção do grau académico de Mestre em Gestão conforme previsto na recomendação do Conselho de Reitores das Universidades Portuguesas (CRUP) respeitando o disposto na alínea a) do nº 1 do artigo 20º do Decreto-Lei n.º 74/2006, de 24 de março e a alínea a) do n.º1 do artigo 45º do Decreto-Lei n.º 115/2013 de 7 de agosto. Na preparação do Plano de Negócios recorreu-se a diversa literatura académica e experiência profissional e para a sua elaboração à análise dos dados contabilísticos, entrevista com o promotor e ao estudo do meio envolvente Os conhecimentos académicos advêm da Licenciatura em Gestão, concluída em 1997 ao abrigo do sistema de graus anteriores ao Processo de Bolonha. A experiência profissional que permitiu aplicar na prática os conhecimentos académicos, resume-se essencialmente a 16 anos do exercício de funções, sendo 8 anos como inspetor tributário e 8 anos como diretor financeiro. O resultado mais importante a retirar deste trabalho, prende-se com a utilização de indicadores económicos para avaliação do Plano de Negócios para validar a intenção de investimento por parte do promotor. Face ao exposto, somos da opinião que a decisão de investimento por parte do promotor deve ser tomada com base no parecer elaborado no estudo de viabilidade apresentado no plano de negócios. This report concerning a professional activity consists of the development of a Business Plan and has the purpose of an attainment to a Master’s Degree in Management, as recommended by the Council of Rectors of Portuguese Universities, under the provisions of article 20(1)(a) of Decree-Law No 74/2006, of 24 March, and article 45(1)(a) of Decree-Law No 115/2013, of 7 August. Regarding the preparation of the Business Plan academic literature and professional experience was used. Analysis of accounting data, an interview with the promoter and the study of the environment were also considered. Academic knowledge came from a Degree in Management, completed in 1997, under the previous degree system before the Bologna Process. The professional experience that allowed to put in practice the academic knowledge, consists mainly of 16 years of professional activity: 8 years as a Tax Auditor and 8 years as a Chief Financial Officer (CFO). The most important result from this work regards the use of economic indicators to assess the Business Plan, in order to validate the promoter's intention of investment. In view of the above, we are of the opinion that the investment decision by a promoter should be based on the opinion stated by the feasibility study report of the Business Plan.

This study identifies, characterizes, and represents children’s and adolescents’ perceptions of urban risks, using participatory mapping and Participatory Geographic Information Systems. Children and youth identified risks and georeferenced them using tools like CyberTracker, Google Earth and Google Maps embedded in a website. Data analysis showed that risk situations identified by the participants are real and concrete concerns, contextualized in their daily lives. This kind of study can be a starting point for community joint actions that include young people to help solve problems—from policy reviews, to effective structural and design changes, to general awareness-raising., info:eu-repo/semantics/publishedVersion

Introduction: Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. Objective: To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. Methods: We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate® analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0–188.0) days. Results: The median value of platelet aggregation was 16.0 U (11.0–22.5 U) with a maximum of 41.0 U and a minimum of 4.0 U (normal value according to the manufacturer: 53–122 U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5 U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A – platelet aggregation

Background: Clopidogrel requires oxidation dependent on the cytochrome P450 enzyme 2C19 (CYP2C19) to form its active metabolite. The importance of loss-of-function alleles (particularly CYP2C19*2, 681G>A) in poor platelet response to clopidogrel is well recognized. Objective: To investigate the prevalence and prognostic impact of the CYP2C19*2 allele in a local acute coronary syndrome (ACS) population. Methods: We performed a prospective, longitudinal study of 95 patients admitted for an ACS between March and October 2009 to a single coronary care unit. Patients aged under 75 who survived hospital stay and for whom clopidogrel was prescribed were included. At discharge, CYP2C19 was genotyped using a commercially available kit. Patients were divided into two groups: Group A (non-carriers, normal metabolizers, CYP2C19*1/*1), n = 69; and Group B (carriers, slow metabolizers, CYP2C19*2/*1 or *2/*2), n = 26. The primary endpoint was a combined outcome of cardiovascular death, non-fatal myocardial infarction or re-admission for unstable angina; median follow-up was 136.0 (79.0–188.0) days. Results: The median age of the population was 62.0 (51.0–68.0) years, and 83.2% were male. The CYP2C19*2 (A) allele had a frequency of 14.2%. There were no differences between the groups with respect to demographic data or history of cardiovascular disease. Coronary anatomy, left ventricular ejection fraction and renal function were also similar. The groups were also homogenous with respect to GRACE risk score (118.0 (95.0–136.5) vs. 115.0 (96.0–133.0), p = 0.68), medical treatment and percutaneous revascularization during hospital stay. Event-free survival was higher for Group A (94.0% vs. 75.0%, log-rank p = 0.010). Three readmissions for MI were documented, all in the slow metabolizers group. Conclusion: In our ACS population, the CYP2C19*2 allele was a medium-term prognostic marker. Resumo: Introdução: Polimorfismos no complexo enzimático P450, como CYP2C19*2, 681G>A parecem estar na base de fraca resposta ao clopidogrel. Objectivo: Caracterizar a prevalência e o impacto prognóstico do alelo CYP2C19*2(A) numa população local de doentes com síndrome coronária aguda (SCA). População e métodos: Estudo longitudinal, prospectivo, de 95 doentes admitidos por SCA entre Março e Outubro de 2009. Foram incluídos doentes com idade inferior a 75 anos, que sobreviveram à hospitalização, e que tiveram alta medicados com clopidogrel. Foi determinado o genótipo do alelo CYP2C19 no momento da alta hospitalar. Foram criados dois grupos; grupo A (metabolizadores normais, CYP2C19 *1/*1) n = 69 e grupo B (metabolizadores lentos, CYP2C19 *2/*1 ou *2/*2) n = 26. No seguimento foi analisado um resultado combinado de morte cardiovascular, enfarte agudo do miocárdio não fatal, e readmissão por angina instável (tempo mediano de seguimento: 136 (79–188) dias. Resultados: A idade mediana da população era de 62,0 (51,0–68,0) anos, e 83,2% eram do género masculino. O alelo CYP2C19*2(A) teve uma frequência de 14,2%. Não existiram diferenças entres os grupos relativamente a dados demográficos, e antecedentes cardiovasculares. A anatomia coronária, a fracção de ejecção ventricular esquerda e a função renal eram semelhantes. Os grupos eram também homogéneos relativamente ao score GRACE (118,0 (95,0–136,5) versus 115,0 (96,0–133,0), p = 0,68), tratamento médico e taxa de revascularização percutânea durante hospitalização. No final do seguimento clínico a sobrevida livre de eventos foi superior para o grupo A (94,0% versus 75,0%, log rank p = 0,010). Foram documentadas três readmissões por enfarte agudo do miocárdio, todas no grupo B. Conclusões: Na população referida, o alelo CYP2C19*2 (A) foi um marcador de prognóstico a médio prazo. Keywords: CYP2C19*2, Clopidogrel, Acute coronary syndromes, Prognosis, Palavras-chave: CYP2C19*2, Clopidogrel, Síndrome coronária aguda, Prognóstico

Resumo: Introdução: A anemia tem sido associada a um pior prognóstico, e particularmente a uma mortalidade mais elevada em diversas condições patológicas. Contudo, poucos estudos analisaram especificamente o seu impacto a curto e a longo prazo, em doentes com Síndrome Coronária Aguda. Este artigo tem como objetivo analisar a associação entre diferentes quartis de hemoglobina na admissão hospitalar e o prognóstico a curto e a longo prazo em doentes com síndrome coronária aguda. População e métodos: Estudo retrospetivo de 1303 doentes consecutivamente admitidos com síndrome coronária aguda numa unidade de cuidados intensivos coronários, procurando analisar a associação entre os níveis basais de hemoglobina e a morbilidade e mortalidade intra-hospitalar e num seguimento clínico de 12 meses. Esta população de doentes foi dividida em quartis de concentração da hemoglobina ([Hb]): Q1: 1, e os preditores de mortalidade no follow-up foram: idade ≥ 69,5 anos, classe Killip na admissão> 1, diabetes mellitus, existência de depressão do segmento ST no ECG de admissão hospitalar e uma concentração de hemoglobina inferior a 10,8 g/dL. Discussão e conclusões: Em doentes com síndromes coronárias agudas, os valores mais baixos de hemoglobina encontram-se frequentemente associados a outras comorbilidades, mas por si só, a anemia parece ser um preditor independente de mortalidade um ano após uma síndrome coronária aguda. Abstract: Introduction: Anemia has been shown to be associated with a worse prognosis, especially higher mortality in various pathological conditions. However, few studies have specifically examined its impact in acute coronary syndrome (ACS) patients. The purpose of our study was to assess the association between different quartiles of hemoglobin on admission and short- and long-term prognosis in patients with ACS. Methods: We performed a retrospective analysis of 1303 consecutive ACS patients admitted to a coronary care unit and analyzed the association between baseline hemoglobin and morbidity and mortality, in-hospital and at 12-month follow-up. The population was divided into groups according to quartiles of hemoglobin concentration (Hb): Q1: 1 at admission. The independent predictors of long-term mortality were age ≥69.5 years, Killip class >1 at admission, diabetes mellitus, ST-segment depression on admission ECG and Hb

Introduction: Anemia has been shown to be associated with a worse prognosis, especially higher mortality in various pathological conditions. However, few studies have specifically examined its impact in acute coronary syndrome (ACS) patients. The purpose of our study was to assess the association between different quartiles of hemoglobin on admission and short- and long-term prognosis in patients with ACS. Methods: We performed a retrospective analysis of 1303 consecutive ACS patients admitted to a coronary care unit and analyzed the association between baseline hemoglobin and morbidity and mortality, in-hospital and at 12-month follow-up. The population was divided into groups according to quartiles of hemoglobin concentration (Hb): Q1: 1 at admission. The independent predictors of long-term mortality were age ≥69.5 years, Killip class >1 at admission, diabetes mellitus, ST-segment depression on admission ECG and Hb 1, e os preditores de mortalidade no follow-up foram: idade ≥ 69,5 anos, classe Killip na admissão> 1, diabetes mellitus, existência de depressão do segmento ST no ECG de admissão hospitalar e uma concentração de hemoglobina inferior a 10,8 g/dL. Discussão e conclusões: Em doentes com síndromes coronárias agudas, os valores mais baixos de hemoglobina encontram-se frequentemente associados a outras co-morbilidades, mas por si só, a anemia parece ser um preditor independente de mortalidade um ano após uma síndrome coronária aguda. Keywords: Acute coronary syndrome, Hemoglobin, Risk factors, Mortality, Prognosis, Palavras-chave: Síndromes coronárias agudas, Hemoglobina, Factores de risco, Mortalidade, Prognóstico

Introduction: There is still debate concerning the impact of left ventricular end-diastolic pressure (LVEDP) on long-term prognosis after an acute coronary syndrome (ACS). Objective: To assess LVEDP and its prognostic implications in ACS patients with left ventricular ejection fraction (LVEF) ≥40%. Methods: We performed a prospective, longitudinal study of 1329 ACS patients from a single center between 2004 and 2006. LVEDP was assessed at the beginning of the coronary angiogram. Patients with LVEF >40% were included (n = 489). The population was divided into three groups: A — LVEDP ≤19 mmHg (n = 186); B — LVEDP >19 and ≤27 mmHg (n = 172); and C — LVEDP >27 mmHg (n = 131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results: Mean LVEDP was 22.8 ± 7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p 19 ≤ 27 mmHg (n = 172) e ; grupo C — PTDVE > 27 mmHg (n = 131). O resultado primário desta análise foi a readmissão por insuficiência cardíaca congestiva (ICC) no ano seguinte à SCA. Resultados: A PTDVE média da população foi de 22,8 mmHg ± 7,8 mmHg. Os grupos eram homogéneos entre si no que disse respeito ao género, idade, factores de risco cardiovascular, história cardiovascular e medicação prévia à admissão. Quanto maior a PTDVE maior a probabilidade de uma admissão por enfarte agudo do miocárdio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7 %, p

Resumo: Introdução: Permanecem dúvidas sobre o impacto prognóstico a longo prazo da pressão telediastólica do ventrículo esquerdo (PTDVE) no contexto de uma síndrome coronária aguda (SCA). Objectivo: Caracterizar a PTDVE e o seu impacto prognóstico numa população de doentes com SCA e fracção de ejecção ventricular esquerda (FEVE) ≥ a 40%. População e métodos: Estudo prospectivo, longitudinal e contínuo de 1329 doentes admitidos (n = 489) numa unidade de cuidados intensivos coronários entre 2004 e 2006. Foram seleccionados os doentes submetidos a uma estratégia invasiva, no qual foi determinada a PTDVE, com FEVE ≥ 40%. A população foi divida em três grupos: A — PTDVE ≤ 19 mmHg (n = 186); grupo B — PTDVE > 19 ≤ 27 mmHg (n = 172) e; grupo C — PTDVE > 27 mmHg (n = 131). O resultado primário desta análise foi a readmissão por insuficiência cardíaca congestiva (ICC) no ano seguinte à SCA. Resultados: A PTDVE média da população foi de 22,8 mmHg ± 7,8 mmHg. Os grupos eram homogéneos entre si no que disse respeito ao género, idade, factores de risco cardiovascular, história cardiovascular e medicação prévia à admissão. Quanto maior a PTDVE maior a probabilidade de uma admissão por enfarte agudo do miocárdio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7%, p 40% were excluded (n = 489). The population was divided into three groups: A — LVEDP ≤19 mmHg (n = 186); B — LVEDP >19 and ≤27 mmHg (n = 172); and C — LVEDP >27 mmHg (n = 131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results: Mean LVEDP was 22.8 ± 7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p

Introduccion y objetivos. El pronostico y el tratamiento en el hospital de los pacientes con sindrome coronario agudo (SCA) y antecedentes de cirugia de bypass coronario (CABG) es motivo de controversia. El objetivo de este estudio es caracterizar a los pacientes con SCA que tienen antecedentes de CABG y comparar su evolucion intrahospitalaria y extrahospitalaria con la de los pacientes sin antecedentes de CABG. Metodos. Estudio prospectivo observacional continuo de 1.495 ingresos consecutivos por SCA en una misma unidad coronaria, con un seguimiento medio de 19 meses. Se dividio a los pacientes en dos grupos: grupo A (n = 73) con CABG previa y grupo B (n = 1.223) sin CABG previa. Resultados. Los pacientes del grupo A eran con mayor frecuencia varones (el 86,3 frente al 69,1%; p = 0,002), tenian antecedentes mas frecuentes de diabetes mellitus, infarto de miocardio previo e insuficiencia cardiaca. Los pacientes del grupo B tenian mas infartos agudos de miocardio con elevacion del ST, una fraccion de eyeccion mas alta (53% [47%-60%] frente a 50% [42%-55%]; p < 0,01) y valores superiores de concentracion maxima de troponina I. No se observaron diferencias en cuanto al uso de una estrategia invasiva. Por lo que respecta a la medicacion, los pacientes del grupo B tenian una mayor probabilidad de recibir doble tratamiento antiagregante al alta. No se observaron diferencias significativas en cuanto a la mortalidad hospitalaria (el 9,5 frente al 5,9%; p = 0,2) ni en la mortalidad a 1 mes, 6 meses o 1 ano (el 9,8 frente al 9,1%; log-rank test, p = 0,87), y la ausencia acumulativa de eventos adversos cardiovasculares mayores fue tambien similar en ambos grupos. Los antecedentes de CABG se asociaron a una mayor frecuencia de reingresos por angina inestable (el 11,3 frente al 3,1%; p < 0,01). Conclusiones. En nuestra poblacion con SCA, el antecedente de CABG no influyo de manera significativa en la evolucion a corto y medio plazo en cuanto a la mortalidad por cualquier causa o eventos adversos cardiovasculares mayores.

Introduccion y objetivos Evaluar la relacion entre la magnitud de la variacion de la glucemia durante la hospitalizacion y la mortalidad hospitalaria y a largo plazo y otras variables de valoracion posteriores al alta, en dos poblaciones con sindrome coronario agudo: pacientes con o sin diagnostico previo de diabetes. Metodos Estudiamos a 1.210 pacientes ingresados por sindrome coronario agudo entre mayo de 2004 y julio de 2007. Dividimos la poblacion en dos subgrupos: pacientes con un diagnostico previo de diabetes (n = 386) y pacientes no diabeticos (n = 824). Cada una de estas subpoblaciones se dividio en cuatro grupos, segun los cuartiles de variacion de la glucemia: diabeticos (Q1 Resultados En los pacientes diabeticos no hubo relacion alguna entre la magnitud de variacion de la glucemia y las variables de valoracion intrahospitalarias y posteriores al alta. En los no diabeticos, no se observaron diferencias significativas en cuanto a la morbimortalidad hospitalaria, pero si hubo diferencias estadisticamente significativas en el seguimiento clinico. Tras un analisis de regresion multiple, el cuartil Q4 frente al Q1, la edad ≥ 70 anos y los antecedentes previos de tratamiento con antiagregantes plaquetarios o con inhibidores de la enzima de conversion de angiotensina fueron factores predictivos independientes para las variables de valoracion posteriores al alta en el grupo no diabetico. Conclusiones En los pacientes con sindrome coronario agudo no diabeticos, la magnitud de variacion de la glucemia durante la hospitalizacion es un factor predictivo independiente y potente de las variables de valoracion posteriores al alta.

Ventricular dysfunction in acute coronary syndrome (ACS) patients is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, hyperglycemia at admission has been considered as an important marker of poor in-hospital prognosis.To characterize an ACS population and to identify independent predictors of one-year mortality.This study included 1179 consecutive patients admitted to a single coronary care unit for acute coronary syndrome between May 2004 and December 2006. Patients were followed up for 12 months after ACS.In our population, 70.9% of patients were male, with a mean age of 66.6+/-12.5 years; 15.7% were admitted by unstable angina, 44.7% by non-ST elevation myocardial infarction and 38.5% by ST elevation myocardial infarction; 16% of patients had left ventricular systolic dysfunction during the index admission. In-hospital mortality was 3.5% and complications occurred in 5.6% of patients. Mortality rate at 1-year of follow-up was 8.8% and rehospitalization rate for heart failure was 5.5%. After multivariate regression analysis, left ventricular systolic dysfunction [odds ratio (OR): 3.58; confidence interval (CI): 1.57-8.16], glycemia at admission137 mg/dl (OR: 3.58; CI: 1.52-8.47) and age65 years (OR: 2.67; CI: 1.08-6.59) were independent predictors of 1-year mortality.In this population, hyperglycemia at admission was an independent predictor of 1-year mortality, with a predictive value equivalent to that of left ventricular systolic dysfunction. This fact, never before described, emphasizes the importance of metabolic abnormalities and their control in the prognosis of ACS patients.

Salmonellosis is an infection caused by specific or non specific serotypes of theSalmonella genus, responsible for losses in the poultry industry. Fowl typhoid, caused by S. Gallinarum (SG) is important because it causes elevated mortality in adult birds, leading to economic losses in the poultry industry. This study aimed at quantifying the number of viable SG cells in the liver, spleen, lung, cecum, and reproductive tract (ovary and testicles) of experimentally inoculated Japanese quails (Coturnix coturnix), as well as SG shedding in their feces. One hundred and two Japanese quails, with four months of age at the beginning of the experiment, were used. The birds were inoculated with three bacterial cultures containing different concentrations (6x104CFU/0.1mL, 2x105 CFU/0.4mL, or 5x106CFU/0.2mL) of SG resistant to nalidixic acid. On days 1, 4, 7, and 14 after the inoculation (dpi) individual cloacal swabs were collected from six birds per group, which were subsequently sacrificed for organ sampling. The swab samples were streaked directly on plates containing brilliant green agar and nalidixic acid (VBNal). Samples that were negative after 24h, were streaked again. The collected organs were individually macerated and transferred to buffered peptone water at 0.1%. The solutions were immediately diluted serially for CFU counting in VBNal. SG was successfully recovered from one quail, which was inoculated with 2x105 CFU/0.4mL, and from five quails of the group inoculated with 5x106CFU/0.2mL inoculum. All of the analyzed cloacal swab samples were negative. Therefore, this study demonstrated it was difficult to isolate SG from the analyzed organs and that it was not possible to recover thepathogen in the cloacal swabs collected from inoculated quails. These results may be explained by the absence of flagella in SG, inducing weak intestinal immune response in the beginning of the infection and preventing its isolation in cloacal swab samples. The low positivity rate of the analyzed organs may be due to the immune status of the euthanized birds, since the SG dissemination in the animal organism occurs mostly close to death, which was observed in the birds found dead during the experiment.

ResumoIntroduçãoA diabetes mellitus tipo 2 (DM2) exige alterações terapêuticas constantes e cuidados de saúde diferenciados ao longo da sua evolução.Objetivocaracterizar uma população de DM2 internados quanto ao tempo de evolução, seguimento médico, tratamento, HbA1c, motivo e tempo de internamento.Materiais e métodosEstudo transversal baseado nos processos clínicos dos doentes com DM2 internados no Serviço de Medicina Interna do Hospital de Braga, entre 3 de junho e 11 de novembro de 2011. Variáveis estudadas: idade, sexo, tempo e motivo de internamento, nível de cuidados de saúde, tempo de evolução, HbA1c, tratamento. Considerou‐se um nível de significância de 5%.ResultadosIdentificaram‐se 286 internamentos de doentes com DM2 (27,1%), obtendo‐se dados em 179 doentes. Idade mediana de 78,0 anos; 53,6% mulheres; tempo de internamento 9,0 dias; tempo de evolução da DM2: 21,8% (20 anos); 71,5% vigiados nos cuidados de saúde primários (CSP), 22,9% nos secundários (CSS); 66,5% medicados com ADO, 12,3% com ADO e insulina e 16,8% apenas com insulina; HbA1c mediana de 6,8%. Os doentes com maior tempo de evolução apresentaram pior controlo metabólico (p=0,006) e maior taxa de insulinização (p=0,001). Relativamente aos CSP, os doentes dos CSS tinham idade inferior (p=0,001), maior tempo de evolução (p20 years); 71.5% were treated in primary care and 22.9% in hospital care; 66.5% were treated with oral drugs, 12.3% with oral drugs and insulin and 16.8% only with insulin. Median HbA1c was 6.8%. Patients with longer duration of disease had worse metabolic control (p=0.006) and were more insulinized (p=0.001). Patients treated in hospital care were younger (p=0.001), more insulinized (p

FUNDAMENTO: Há falta de dados sobre o impacto prognóstico da pressão diastólica final do ventrículo esquerdo (PDFVE) sobre as síndromes coronarianas agudas (SCA). OBJETIVO: Avaliar a PDFVE e suas implicações prognósticas em pacientes com SCA. MÉTODOS: Estudo prospectivo, longitudinal e contínuo de 1.329 pacientes com SCA de um único centro, realizado entre 2004 e 2006. A função diastólica foi determinada através da PDFVE. A população foi dividida em dois grupos: Grupo A - PDFVE < 26,5 mmHg (n = 449); Grupo B - PDFVE > 26,5 mmHg (n = 226). RESULTADOS: Não houve diferenças significantes entre os grupos em relação aos fatores de risco para doença cardiovascular, histórico médico e terapia médica durante a admissão. Nos pacientes do grupo A, a SCA sem elevação do segmento ST foi mais frequente, bem como angiogramas coronários normais. A mortalidade hospitalar foi similar entre os grupos, mas a sobrevida de um ano foi maior entre os pacientes do grupo A (96,9 vs 91,2%, log rank p = 0,002). Em um modelo multivariado de regressão de Cox, uma PDFVE > 26,5 mmHg (RR 2,45, IC95% 1,05 - 5,74) permaneceu um preditor independente para mortalidade de um ano, quando ajustado para idade, fração de ejeção sistólica do VE, SCA com elevação do segmento ST, pico da troponina, glicemia na admissão hospitalar e diuréticos após 24 horas. Além disso, uma PDFVE > 26,5 mmHg foi um preditor independente de uma futura rehospitalização por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSÃO: Em nossa população selecionada, a PDFVE apresentou uma influência prognóstica significante. BACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP > 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence. FUNDAMENTO: Hay falta de datos sobre el impacto pronóstico de la presión diastólica final del ventrículo izquierdo (PDFVI) sobre los síndromes coronarios agudos (SCA). OBJETIVO: Evaluar la PDFVI y sus implicaciones pronósticas en pacientes con SCA. MÉTODOS: Estudio prospectivo, longitudinal y continuo de 1.329 pacientes con SCA de un único centro, realizado entre 2004 y 2006. La función diastólica fue determinada a través de la PDFVI. La población fue dividida en dos grupos: Grupo A - PDFVI < 26,5 mmHg (n = 449); Grupo B - PDFVI > 26,5 mmHg (n = 226). RESULTADOS: No hubo diferencias significativas entre los grupos en relación a los factores de riesgo para enfermedad cardiovascular, historia médica y terapia médica durante la admisión. En los pacientes del grupo A, la SCA sin elevación del segmento ST fue más frecuente, así como angiogramas coronarios normales. La mortalidad hospitalaria fue similar entre los grupos, pero la sobrevida de un año fue mayor entre los pacientes del grupo A (96,9 vs 91,2%, log rank p = 0,002). En un modelo multivariado de regresión de Cox, una PDFVI > 26,5 mmHg (RR 2,45, IC95% 1,05 -5,74) permaneció un predictor independiente para mortalidad de un año, cuando fue ajustado para edad, fracción de eyección sistólica del VI, SCA con elevación del segmento ST, pico de la troponina, glicemia en la admisión hospitalaria y diuréticos después de 24 horas. Además de eso, una PDFVI > 26,5 mmHg fue un predictor independiente de una futura rehospitalización por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSIÓN: En nuestra población seleccionada, la PDFVI presentó una influencia pronóstica significativa.

People with diabetes are at increased risk for heart failure (HF), major adverse cardiovascular events (MACE) and death following acute coronary syndromes (ACS). It is important to recognize the most powerful predictors of these events after an ACS as early as possible, in order to address them more aggressively. This is particularly important considering that various studies have shown that this population is undertreated in the setting of ACS.To characterize a diabetic population presenting with ACS and to determine independent predictors of HF, MACE and mortality on follow-up.This was a longitudinal, observational, retrospective study including 471 consecutive diabetic patients, both previously known and newly diagnosed, hospitalized for ACS in a single center between May 2004 and December 2006. A mean 12-month follow-up was conducted. Cox regression analysis was used to determine the independent predictors of HF, MACE and mortality on follow-up, divided into different periods--1 month, 6 months and 1 year.Of the overall diabetic population, 67.3% were male and mean age was 69 +/- 11 years. Mean glomerular filtration rate (GFR) was 62 +/- 22 ml/min and mean left ventricular ejection traction (LVEF) was 50%. diagnosis on admission was ST-elevation myocardial infarction (STEMI) in 31.3%, non-ST elevation myocardial infarction (NSTEMI) in 50.1%, unstable angina (UA) in 14.3% and ACS with left bundle branch block or pacemaker in 4.2%. Cardiac catheterization was performed in 55.6% of the patients during the index hospitalization. Mortality during hospitalization and at 1 year was 6.4% and 10.4%, respectively. The one-year MACE rate was 20.4% and hospitalization for HF occurred in 10.1% of the patients. The independent predictors of HF at 1 year were blood glucose on admission184.5 mg/dl, GFR63.8 ml/min, LVEF46.5% and NSTEMI, while predictors of mortality were LVEF40.5% and Killip class on admissionI. Blood glucose on admission130.5 mg/dl and LVEF49.5% were independent predictors of MACE, whereas cardiac catheterization was a protective factor.Following ACS diabetic patients have high rates of mortality, HF and MACE. The low rate of invasive strategy may contribute to this situation. HF during hospitalization, whether by low LVEF or Killip classI, and higher blood glucose on admission were powerful predictors of poorer outcome. Moreover, the use of recommended cardiovascular agents and procedures were protective factors. These findings suggest that diabetic patients should not be excluded from recommended cardiovascular interventions. Efforts should be made to identify these high-risk patients as early as possible in order to manage them carefully and aggressively to improve their poor prognosis.

Age is an important prognostic factor in acute coronary syndromes (ACS). An invasive strategy has been shown to benefit many non-ST elevation ACS populations; however, there is some controversy regarding patients who are more susceptible to procedure-related complications, such as the elderly, an under-represented population in the studies on this subject.We aimed to compare the in-hospital and long-term prognosis of elderly patients with non-ST elevation ACS treated with either invasive procedures or a conservative strategy, and to characterize the patients selected for an early invasive approach.This observational, longitudinal, prospective and continuous study included 307 patients aged over 75 years consecutively admitted for non-ST elevation ACS. They were divided into two groups, according to the approach adopted: Group A (n=91)--patients treated with an early invasive strategy; and Group B (n=216)--patients treated conservatively. The median clinical follow-up was 18 months.The subjects who were treated invasively were younger (79.8 +/- 3.2 vs. 81.4 +/- 3.9 years, p0.001) and more often male (63.7 vs. 50.9%, p = 0.04), had a higher incidence of previous coronary artery disease, were more often treated with clopidogrel, and had a longer hospital stay (5.8 +/- 3.1 vs. 4.9 +/- 2.6 days, p = 0.01). Patients managed conservatively presented higher Killip class, and were more often treated with diuretics during hospitalization. The group treated by an invasive approach presented a higher incidence of in-hospital complications (13.6 vs. 4.9%, p = 0.009), but there were no significant differences in mortality rates. Multivariate analysis showed that an invasive strategy was an independent predictor of in-hospital morbidity (OR = 3.55). In follow-up, rates of MACE (56.3 vs. 33.3%, p = 0.002) and death (32.5 vs. 13.8%, p = 0.007) were higher in the group that received conservative treatment, and an invasive strategy was a protective factor against MACE; the strongest predictor of mortality was left ventricular ejection fraction50%.Although an invasive strategy was associated with increased in-hospital complications, it was shown to confer a better long-term prognosis. These data show that age should not be the only criterion in selecting patients for an invasive strategy and favor early adoption of this approach in the elderly.

Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events.We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFRor = 60 ml/min (group A) and eGFR60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population.Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p0.001, and 76.2 vs. 86.2%, p0.001, respectively). Multivariate analysis showed that eGFR of30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71).We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.

Resting heart rate (RHR) is inversely correlated with the average life span of living beings. In coronary patients, increased RHR has been associated with rapid progression of atherosclerosis. The aim of this study was to compare in-hospital and long-term outcome of acute coronary syndromes according to patients' RHR.We prospectively studied 1720 consecutive patients, divided into two groups according to RHR at admission: group A--RHRor =82 bpm (n=543), and group B--RHR82 bpm (n=1177). Epidemiological, clinical, laboratory and therapeutic data were analyzed for both groups. Appropriate statistical tests and multivariate analysis were used to identify independent predictors of in-hospital and one-year mortality.Group A included more women (35.9% vs. 27.0%, p0.001), older (68.36 +/- 12.74 vs. 66.39 +/- 12.43 years, p = 0.002), and diabetic patients (30.9% vs. 25.1%, p = 0.014) and non-smokers (85.8% vs. 81.4%, p = 0.024). They were admitted more often with ST-segment elevation myocardial infarction (31.5% vs. 21.5%, p0.001), presented higher Killip class at admission and had worse left ventricular ejection fraction (47.99 +/- 11.87% vs. 52.45 +/- 10.32%, p0.001). Peak myocardial markers, creatinine and blood glucose at admission were significantly higher in this group. Discharge medication was not statistically different. In-hospital mortality (7.7% vs. 3.3%, p0.001) and morbidity (10.4% vs. 4.9%, p0.001) and one-year mortality (21.3% vs. 9.6%, p0.001) and morbidity (43.9% vs. 36.4%, p = 0.009) were higher in the group with RHRor =82 bpm. The independent predictors of in-hospital mortality were ageor =70.5 years (p = 0.001), RHRor =82 bpm at admission (p = 0.035) and previous type 2 diabetes (p = 0.004). Ageor =69.5 years (p0.001) and RHRor =82 bpm (p = 0.008) were also independent predictors of one-year mortality, together with Killip classI (p0.001) and ejection fractionor =49.5% (p0.001).In our population of acute coronary syndrome patients, RHRor =82 bpm was associated with worse short- and long-term outcome.

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease. OBJECTIVO: Avaliar se a insulinoterapia prévia influencia de forma independente o prognóstico de diabéticos após uma síndrome coronária aguda (SCA). SUJEITOS E MÉTODOS: 375 doentes diabéticos com SCA, divididos em 2 grupos: Grupo A (n = 69) - sob insulinoterapia prévia e Grupo B (n = 306) - sem insulinoterapia prévia. Os preditores de mortalidade a um ano e de eventos cardíacos adversos maiores (MACE) foram determinados pela regressão de Cox. RESULTADOS: Verificou-se maior proporção de acidente vascular cerebral prévio (17,4% vs. 9,2%, p = 0,047) e doença arterial periférica (13,0% vs. 3,6%, p = 0,005) no Grupo A. Esses doentes apresentaram glicemia na admissão significativamente mais elevada e LDL inferior. Não houve diferenças estatisticamente significativas no tipo de SCA, na mortalidade (18,2% vs. 10,4%, p = 0,103) e MACE (32,1% vs. 23,0%, p = 0,146) em um ano entre os 2 grupos. Na análise multivariada, a insulinoterapia prévia não foi preditor independente nem de mortalidade, nem de MACE em 1 ano. CONCLUSÃO: Apesar da doença aterosclerótica mais avançada, os diabéticos previamente insulino-tratados têm um prognóstico semelhante aos não insulino-tratados. A insulinoterapia crônica poderá proteger os diabéticos da evolução desfavorável própria da doença aterosclerótica avançada.

Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS).To assess LVEDP and its prognostic implications in ACS patients.Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP26.5 mmHg (n = 449); group B - LVEDP ≥ 26.5 mmHg (n = 226).There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP ≥ 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP ≥ 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5).In our selected population, LVEDP had a significant prognostic influence.

Nesse trabalho pretende-se analisar as concepções prévias de professores sobre a escola na perspectiva EDS, comparando suas idéias com as propostas no Guia de critérios de qualidade para escolas EDS. É fundamental conhecer os conceitos construídos pelos professores sobre a escola EDS para que se possa redimensionar e aprimorar a continuidade do processo educativo voltado à sustentabilidade. O resultado indica que 20% abordaram os três critérios, 40% apontaram dois critérios e 40% mencionaram um critério, demonstrando que os critérios são conhecidos, porém ainda necessitam ser mais difundidos e estudados pelos professores, escola e sociedade, preocupados com o desenvolvimento sustentável.

To evaluate the impact of admission glycaemia on short-term and long-term prognosis in diabetic and non-diabetic patients admitted for acute coronary syndromes (ACS), and to identify the independent predictors of post-ACS mortality in this population.This study included 1149 consecutive patients admitted to a single coronary care unit for ACS between May 2004 and December 2006. Our population was divided into four groups according to the quartiles of glycaemia at admission [Q15.77 mmol/l, Q2 (5.77-7.0) mmol/l, Q3 (7.0-9.22) mmol/l and Q4or =9.22 mmol/l]. Diabetic (n = 396) and non-diabetic (n = 753) subgroups were then separately analysed.Hyperglycaemia at admission was associated with worse cardiovascular risk profile, high levels of necrosis and inflammation biomarkers and low left ventricle ejection fraction. Considering overall population, in-hospital, 30-day and 3-year mortalities were higher in more elevated glycaemia quartiles. In diabetic patients, there were no significant differences in mortality among glycaemia quartiles; however, in non-diabetic group higher admission glucose levels were associated with successively higher in-hospital and 3-year mortalities. After multivariate regression analysis, glycaemia at admissionor =5.77 mmol/l, ageor =72 years, Killip class1 and troponin Ior =6.0 ng/ml were independent predictors of in-hospital mortality.This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.

FUNDAMENTO: O eletrocardiograma (ECG) de admissão tem um grande impacto no diagnóstico e tratamento de síndromes coronarianas agudas (SCA) sem supradesnivelamento do segmento ST. OBJETIVO: Avaliar o impacto do ECG de admissão no prognóstico da SCA sem supradesnivelamento de ST. População: estudo prospectivo, contínuo, observacional, de 802 pacientes com SCA sem supradesnivelamento de ST de um único centro. MÉTODOS: Os pacientes foram divididos em 2 grupos: A (n=538) - ECG Anormal e B (n=264) - ECG Normal. ECG Normal era sinônimo de ritmo sinusal sem alterações isquêmicas agudas. Um seguimento clínico de um ano foi realizado tendo como alvo todas as causas de mortalidade e a taxa de eventos cardíacos adversos maiores (MACE). RESULTADOS: Os pacientes do Grupo A eram mais velhos (68,7±11,7 vs. 63,4±12,7 anos, p

Nowadays, there is a wide range of commercial LBMS (Location-Based Mobile Services) available in the market, and a trend towards the display of 3D maps can be clearly observed. Given the complete disparity of ideas and a visible commercial orientation in the industry, the study of the visualization aspects that influence user performance and experience in the exploration of urban environments, using 3D maps, becomes an important issue. Based on a proposed conceptual framework, an online questionnaire was developed and administered in order to measure the real impact of each element. Combining the experimental results with the current state-of-the-art, a new visualization paradigm is defined in a dual specification: “layers” providing relevant visual content to the map, and “functions” providing the necessary functionality.