Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia

HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF.

Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis.

Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

P315 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN A PATIENT WITH TAKAYASU’S ARTERITIS: THE CORONARY VASOSPASM AS A MISSING LINK BETWEEN THE IMMUNE SYSTEM AND ACUTE PSYCHOLOGICAL STRESS

Background

Takayasu’s arteritis (TA) is a systemic inflammatory disease that affects aorta and its major branches. There are several cardiac manifestations of TA and, recently, an association with Takotsubo syndrome (TTS) was reported

Case Presentation

A 58–year–old Caucasian female, with history of severe asymptomatic aortic regurgitation (AR) with a recently documented normal LV systolic function and TA in remission under corticosteroids, was admitted in the emergency department with chest pain following an acute intense stressful event. ECG showed sinus tachycardia, T wave inversion in left precordial and lateral leads, and a QTc of 487 ms (Figure 1). Laboratorial evaluation presented high–sensitivity troponin I of 3494 ng/L and B–type natriuretic peptide of 4759 pg/mL. The transthoracic echocardiogram revealed severe dilation of LV with moderate systolic dysfunction, due to apical and midventricular akinesia (“apical ballooning” pattern), and severe AR (Figure 2). The coronary angiography showed normal coronary arteries. An acetylcholine provocative test showed spasm of both the left anterior descending and circumflex arteries, accompanied by chest pain and ST depression in ECG, reverted after intracoronary nitrates administration (Figure 3). The patient was switched to diltiazem and heart failure drug therapy was started. A cardiac magnetic resonance revealed severe dilation of the LV, apical hypokinesia, ejection fraction to 53%, signs of myocardial edema and increased extracellular volume in apical and mid–ventricular anterior and anterolateral walls, and absence of myocardial late gadolinium enhancement, compatible with TTS. Patient was discharged clinically stable, without signs of HF, with progressive reduction of troponin and BNP. A final diagnosis of myocardial infarction with nonobstructive coronary arteries (MINOCA) due to TTS and coronary vasospasm in a patient with TA was done

Discussion

TA is a rare disease and there are reports of its association both with TTS and coronary vasospasm. Besides that, coronary vasospasm may also be involved in the pathophysiology of TTS. Moreover, in this patient we could not exclude the role coronary diastolic hypoperfusion due to AR in the elicitation of coronary vasospasm. Therefore, although the mechanisms behind these pathologies are not yet fully studied, this case supports their relationship

Conclusion

We presented a case of a patient with TA admitted with MINOCA due to TTS and coronary vasospasm

C61 MULTIDISCIPLINARY MANAGEMENT IN A CASE OF EOSINOPHILIC MYOCARDITIS WITH CHURG STRAUSS SYNDROME: FROM ECG TO ENDOMYOCARDIAL BIOPSY

Background

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg–Strauss, is a rare multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia (PE). Cardiac involvement may include eosinophilic myocarditis and it is a serious manifestation of EGPA.

Case Presentation

A 67–year–old woman presented to the emergency department with 2–weeks history of dyspnea, orthopnea and asthenia. She had history of asthma, PE, adjuvant radiotherapy after right mastectomy (July 2021). The patient was diagnosed with new onset atrial fibrillation in the previous month. At admission, the patient was hemodynamically stable and with signs of congestion. Complementary exams showed sinus rhythm and T–wave inversion on lateral leads; PE (2010/uL), elevated troponin and BNP values; and severe biventricular systolic dysfunction with diffuse hypokinesia and apical akinesia. The patient was admitted to the ICU and was treated with intravenous diuretics and levosimendan. Optimal HF therapy was introduced. Serial echocardiography revealed partial recovery of LVEF and blood analysis showed a decrease in troponin levels, with persistent eosinophilia (6330/uL). Computed tomography (CT) excluded significant coronary disease, and showed bilateral basal ground–glass opacities, areas of air–space consolidation and bilateral reticular–nodular pattern. Cardiac magnetic resonance revealed increased T2 values/signs of myocardial edema in anterior wall, interventricular septum and apex and no late gadolinium enhancement, compatible with myocarditis. An endomyocardial biopsy (EMB) was performed and confirmed the diagnosis of eosinophilic myocarditis. Oral corticosteroids were started. Paranasal CT scan showed signs of chronic sinusitis, without polyposis, and antineutrophil cytoplasmic antibodies were positive, making the diagnosis of EGPA, according to ACR criteria.

Discussion

In a patient presenting with new onset heart failure and with history of asthma and eosinophilia, it is important to suspect eosinophilic myocarditis, as this is a rare but reversible life–threatening condition. EMB plays an important role in the diagnosis and should be done promptly.

Conclusion

We described a multidisciplinary management of a case of a patient with eosinophilic myocarditis and EGPA, presenting with severe acute biventricular dysfunction.

BAUN score, a better predictive model of in-hospital and long-term outcomes in acute heart failure?

Introduction

Patients hospitalized due to acute heart failure (AHF) compose a heterogeneous population whose prognosis is difficult to forecast. Previously, BAUN score has proven to be able to accurately predict in-hospital mortality (IHM) in AHF. We aimed to evaluate BAUN score performance in the prediction of long-term outcomes in this population, comparing it to the recently validated Get With The Guidelines (GWTG) score.

Methods

A retrospective analysis of 1052 patients admitted to a Cardiology ward due to AHF was performed. 268 patients were excluded due to data omission or therapy with sacubitril/valsartan. Using the variables systolic blood pressure, urea, brain natriuretic peptide and sodium at admission, BAUN score was calculated, ranging from 0–28 points. GWTG score was also calculated at the index event. ROC curve analysis was used to compare the predictive value of the two scores for IHM. Kaplan-Meyer and Cox-regression analysis were performed to evaluate BAUN score prediction ability for 24-month mortality (24-MM) and for the composite endpoint of 24-month rehospitalization or death (24-MH).

Results

Mean patient age was 77 (±10) years; 51% were men. Mean left ventricle ejection fraction (EF) was 49% (±16.4). An EF<40% was present in 31% of patients. IHM, 24-MM and 24-HM were 6.5%, 17.1% and 57.8%, respectively. Mean BAUN score was 7 (±5.64). Mean GWTG score was 49.7 (±9.8). ROC curve analysis for IHM prediction revealed a better performance of the BAUN score (AUC: 0.738p, <0.001) in comparison with GWTG score (AUC: 0.687, p<0.001). Patients were stratified into subgroups according to BAUN risk score – very-high risk (≥22), high risk (16–21), intermediate risk (5–15) and low risk (<5). Kaplan-Meyer analysis revealed a significant difference in 24-MM according to risk subgroup (very high: 35%, high: 26.7%, intermediate: 19.5%, low risk: 12.7%, χ2=16.304, p=0.001). When stratified by non-reduced or reduced EF (≥40% or <40%), there was still a significant mortality difference in subgroups with reduced (p=0.007) and borderline significant in patients with nonreduced EF (p=0.05). Kaplan-Meyer analysis also revealed a significant difference between subgroup risk for 24-MH (51%; 63.8%; 63.3% and 75%, respectively, for low, intermediate, high and very-high risk, χ2=21.237, p<0.001). Cox regression analysis demonstrated that BAUN score independently predicts 24-MM (HR: 1.056, p=0.043) and 24-MH (HR: 1.033, p=0.048), even after adjustment for other prognostic markers, such as atrial fibrillation, coronary artery disease, previous myocardial infarction, age, EF and GWTG score.

Conclusion

BAUN outperforms GWTG score for IHM prediction in AHF. It also independently predicts 24-MM and 24-MH. Its use may identify patients with high risk of mortality/readmission, in need of specialized care, and those patients with low risk of death, who might be candidates for lenient surveillance.

Funding Acknowledgement

Type of funding sources: None.

Modified FAST score as a predictor of fibrinolysis in normotensive patients with acute pulmonary embolism

Introduction

Intermediate risk pulmonary embolism (PE) encompass a heterogeneous group of patients with very distinct prognosis. While some patients will only need anticoagulation, in others fibrinolytic therapy (FT) should be considered in order to prevent further hemodynamic decompensation. It is very important to identify the subgroup of intermediate risk PE patients at highest risk of an adverse outcome in whom FT may be needed. Modified FAST score was developed to identify non-high risk PE patients at highest risk of early PE-related complications. This study aims to evaluate if modified FAST score is a predictor of necessity of FT.

Methods

A retrospective analysis of 178 patients admitted for acute PE was performed. Modified FAST score evaluates the presence of syncope (1.5 points), troponin I elevation (1.5 points) and heart rate ≥100bpm (2 points), ranging from 0–5 points (<3 points low risk and ≥3 points intermediate-high risk for adverse in-hospital outcome). PESI score was also calculated for each patient. The Mann-Whitney U was used for comparisons between groups. Binary logistic regressions were used to obtain the odds ratio (OR) for FT of the various variables. ROC curves allowed the comparison of modified FAST and PESI scores.

Results

Mean age was 63±18 years; 61% were female; 8.5% had previous history of venous thromboembolism; 48% of patients had a precipitating factor identified; 58% had signs of right ventricle dilation on echocardiography (echo) and/or chest computed tomography (CCT). 47% had low risk (LR) and 53% had intermediate-high risk (IHR), according to modified FAST score. Mean FAST score was 2.22±1.4.

There were no differences between patients with LR or IHR regarding age, sex and precipitating factor. IHR was associated with dyspnea (p=0.002), lower arterial systolic pressure at admission (p=0.007), higher levels of D-dimer (p=0.013), S1Q3T3 pattern (p=0.001) and right bundle branch block pattern (p=0.005) in electrocardiography and higher right ventricle diameter in echo and CCT (p=0.006).

During hospitalization patients with IHR had more worsening of renal function (p=0.015).

Patients with IRH were submitted more frequently to FT than patients with LR (65% vs 39%; p=0.001). Modified FAST score was a predictor of FT (OR 2.9; 95% CI 1.5–5.5; p<0.001) and was independent of PESI score (OR 2.9; 95% CI 1.5–5.6; p=z0.001). ROC curve analysis revealed a higher area under the curve for modified FAST score comparing to PESI score (0.659 vs 0.497).

Conclusion

IHR modified FAST score was associated with characteristics of poor prognosis in PE. Furthermore, modified FAST score was a predictor of FT in normotensive patients with PE, and was independent of PESI score. Therefore, this score may be useful to select patients with PE that will benefit from FT.

Funding Acknowledgement

Type of funding sources: None.

Comparison of the GRACE score, TIMI score and a New Laboratorial Score to predict adverse outcomes in acute coronary syndrome

Introduction

Acute coronary syndrome (ACS) is a clinical entity which includes a heterogeneous group of patients with different outcomes. Risk scores are in this setting a resourceful tool to identify the subset of patients with a worse prognosis, in order to plan therapeutic and surveillance strategies.

Aim

To create a risk score – Laboratory Risk Score (LRS) – which exclusively includes analytical and echocardiographic parameters, as a predictor of adverse outcomes (in-hospital mortality and 1-year mortality), and compare it with other well-known scores: GRACE Score (GS) and TIMI-score (TS).

Methods

A retrospective cohort study was conducted, which included patients admitted in the Cardiology Department with the diagnosis of ACS. In order to calculate the new LRS, the authors attributed the value of 1 to each of the satisfied condition from the following: leucocytes >11,7g/L, hemoglobin <13.3g/dL, red cell distribution width >14%, prothrombinemia <90%, glycaemia at admission >143mg/dL, urea >53.5mg/dL, creatinine >1.16mg/dL, reactive C-protein >1.0mg/dL, maximum troponin >35.0ng/dL, natriuretic brain peptide >416 pg/dL and left ventricular ejection fraction <40%. LRS resulted from the sum of the satisfied conditions.

ROC curves for LRS, GS and TS to predict in-hospital mortality and to predict 1-year mortality were constructed. The statistical analysis was performed in SPSS and Medcalc. p value <0.05 was considered statistically significant.

Results

1714 patients (70.4% male, average age 69±13 years-old) were included in this study. Intra-hospital mortality rate was 6.8% and 1-year mortality rate after de discharge was 4.8%.

The areas under the ROC curves for predicting in-hospital mortality were the following: 0,790 (LRS, p<0,001), 0,793 (GS, p<0.01), 0.817 (TS, p<0.001). For predicting 1-year mortality, the areas under the ROC curves were: 0,715 (LRS, p<0,001), 0,761 (GS, p<0,001), 0.742 (TS, p<0.001). Pairwise comparison of ROC curves showed no significant differences between the scores.

Conclusion

The above-mentioned risk scores, including the new LRS, are obtained with non-invasive and widely available parameters and displayed a good performance in predicting in-hospital and 1-year mortality. Pairwise comparison of ROC curves demonstrated that the new laboratorial score was not inferior predicting adverse outcomes. The SRL is an easily obtained score, that shows a statistical significance in predicting mortality, especially the prediction of in-hospital mortality.

Funding Acknowledgement

Type of funding sources: None.

Global longitudinal strain as a predictor of cardiovascular events and mortality in patients with ischemic heart disease and heart failure with preserved/mid-range ejection fraction

Introduction

Global longitudinal strain (GLS) is considered a more sensitive marker of systolic dysfunction than other measures commonly used in clinical practice, such as left ventricle ejection fraction (EF). Our objective was to evaluate the impact of reduced GLS in death and cardiovascular events in patients hospitalized due to heart failure with mid-range or preserved ejection fraction, with previous history of acute myocardial infarction.

Methods

A retrospective analysis of 170 patients admitted to a Cardiology ward due to acute heart failure (AHF) was performed. Patients with reduced EF (Simpson biplane method - EF<40%) were excluded based on echocardiographic evaluation after AHF stabilization. GLS measured by “speckle tracking” technique was calculated for each patient. Measurements were made by the same operator to minimize interoperator variability. Mann-Whitney U test was used for univariate analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 12-month mortality (12MM) and in the composite endpoint of cardiovascular event or death (12CVM) at 12 months.

Results

A total of 127 patients were included. Mean patient age was 64 (±14) years; 72% were men. 48% of patients had history of ST elevation AMI. Mean EF was 54% (±8) and mean GLS was −14.3 (±3.8). Rates of 12MM and 12CV M were 14.2% and 19.3%, respectively. A statistically significant association between 12MM and 12MCV was found in univariate analysis for GLS (p<0.001). Kaplan-Meyer survival plots revealed that a compromised GLS (<−16) was associated with significantly increased 12MM (23% vs 2.5%, X2: 7.999, p=0.005) and 12CVM (26.6% vs 10%, X2: 4.139, p=0.042). When stratified by mid-range vs preserved EF, GLS <−16 was associated with worse outcomes, although the results did not reach statistical significance (p>0.05). However, when considering a severely compromised GLS (<−13), GLS was significantly associated with increased 12MM (52% vs 8.3%, X2: 5.533, p=0.019) and 12CVM (50% vs 8.3%, X2: 4.970, p=0.026), in the subgroup of patients with heart failure with mid-range EF. Cox-regression analysis demonstrated that GLS was independently associated with 12MM (HR: 0.668p, <0.001) and the 12CVM composite endpoint (HR: 0.819, p=0.008), even after adjustment for other important prognostic markers such as chronic kidney disease, pulmonary disease and diabetes, with significant hazard ratio reduction for each positive point increase in GLS.

Conclusion

GLS is an independent predictor of 12MM and 12CVM in patients hospitalized due to AHF, with an EF ≥40% and previous history of acute myocardial infarction. In the subgroup of patients with heart failure with mid-range EF, a severely compromised GLS (<−13) is a strong predictor of 12MM and 12CVM.

Funding Acknowledgement

Type of funding sources: None.

AHFM score, a predictive model of in-hospital and long-term mortality in heart failure

Introduction

Patients hospitalized due to heart failure (HF) constitute a heterogeneous population whose prognosis is difficult to forecast. The purpose of this study was to create a model based on simple bedside recordable echocardiographic, analytical and objective clinical parameters that could accurately predict mortality and/or rehospitalization risk in different stages of HF course.

Methods

A retrospective analysis of 347 patients admitted to a Cardiology ward due to decompensated HF was performed. The echocardiographic variables pulmonary artery systolic pressure (PSAP) and E/e' ratio, and the analytical/clinical variables systolic blood pressure (SBP), urea and brain natriuretic peptide (BNP) were selected for inclusion. Subgroups were created for each variable and an odds ratio (OR) for the risk of in-hospital mortality (IHM) was calculated. A numerical value proportional to the OR was attributed to each subgroup. A score was created, ranging from 0–47 points, corresponding to the sum of the classification attributed to each variable. ROC curve analysis was used to assess predictive value of the score for IHM. Kaplan-Meyer and Cox-regression plots were used to assess mortality (24MM) and the composite endpoint of HF rehospitalization or death at 24 months (24HM).

Results

Mean patient age was 78 (±9) years; 51% were men. Score variable means were - PSAP: 47 (±15) mmHg; E/e': 16.8 (±7.8); SPB: 138 (±31) mmHg; Urea: 71 (±35) mg/dl; BNP: 911 (±995) pg/ml. Mean ejection fraction (EF) was 48% (±16). 35% of patients had EF<40%. IHM, 24MM and 24HM were 3.5%, 17.1% and 63.6%, respectively. A statistically significant association between IHM and PSAP, E/e', BNP, urea and SBP (p<0.05) was found on univariate analysis. ROC curve analysis of AHFM revealed an AUC of 0.785 (p=0.001) for IHM risk prediction. The cut-off point with most sensitivity (S) and specificity (E) obtained using the Youden index (0.4246) was 18 (S≈75%; E≈67%), associated with significant difference in IHM (1.3% vs 7.6%). IHM by score interval was 1.3%, 3.1% and 25%, respectively, for the intervals 0–18, 19–29 and ≥30. ECHO-AHF score <13 predicted in-hospital survival in all patients. Kaplan Meyer survival analysis by subgroup revealed significant differences in 24MM according to AHFM risk category (13.8% vs 21.9% vs 30.8%, respectively, χ 2= 17.217 p<0.001), but not for 24 MH. Cox-regression analysis demonstrated that AHFM score remained a significant independent predictor of 24MM (HR: 1.067, p=0.05), even after adjustment for other variables, such as coronary disease, chronic kidney disease, atrial fibrillation, EF and diabetes.

Conclusion

AHFM score is an accurate model for predicting IHM and long-term risk of HF death. Its use may help to identify patients with high risk of mortality, in need of specialized care, and those with lower risk of death, who might be candidates for early discharge or lenient follow-up.

Funding Acknowledgement

Type of funding sources: None.

Left ventricular noncompaction and EcoScore: prognostic value of a new echographic risk score

Introduction

Left Ventricular Non-Compaction (LVNC) is a rare and underdiagnosed cardiomyopathy, characterized by hypertrabeculation of the left ventricle. This disease is associated with high rates of morbidity and mortality; however, its main adverse prognostic factors are not well established.

Aim

To create a risk score for LVNC based on echocardiographic criteria (EcoScore) to predict the occurrence of adverse events.

Methods

The authors included patients with the diagnosis of LVNC, according to the Jenni Criteria. Clinical and echocardiographic data were evaluated and the occurrence of the following adverse events was reported: hospitalizations due to supraventricular or ventricular tachyarrythmias and heart failure, acute myocardial infarction, stroke, heart transplant and death. The follow-up time was 24 months. ROC curves to predict the occurrence of at least one adverse event were constructed for each echocardiographic parameter. The optimal cut-off obtained from each ROC curve was then used to attribute points (1 point per parameter). The EcoScore resulted from the sum of the obtained points. The authors finally created a ROC curve to predict the occurrence of any adverse event for the EcoScore. The statistical analysis was performed in SPSS. p value <0.05 was considered statistically significant.

Results

33 patients (48.5% male, age at diagnosis 45.9±21 years) were included in this study. The optimal cut-offs for each parameter obtained from the ROC curves were the following: left ventricle dyastolic diameter >55mm, left atrial diameter >40mm, pulmonary artery systolic pressure >22mmHg and left ventricle ejection fraction <40%. The area under the curve for the EcoScore to predict any adverse event was 0.850 (p=0.017) and an EcoScore >1 had a sensibility of 85.7% and a specificity of 70%.

Conclusion

The EcoScore accurately predicted the occurrence of at least one adverse event in this population. Thus, it could be a good tool in the daily practice to select patients who may benefit from a more aggressive surveillance and treatment.

Funding Acknowledgement

Type of funding sources: None.

NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

Funding Acknowledgements

Type of funding sources: None.

Introduction

Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking

Aims

To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months.

Methods

A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction < 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS.

Results

102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up.  After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)].

Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

The impact of lipid profile in acute coronary syndrome: young patient vs old patient

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have suggested a relationship between dyslipidemia and atherogenesis, which displays a main role in the pathophysiology of Acute Coronary Syndrome (ACS).

Aim

To compare the lipid profile between younger (<55 years) and older (≥55 years) patients admitted due to ACS.

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Several analytical parameters were evaluated, including total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL) and triglycerides (TG) and CT/HDL, LDL/HDL and TG/HDL ratios were calculated. All parameters are presented in mg/dL. Afterwards, comparison of these data between younger (age < 55 years, Group-A) and older (age≥55 years, Group-B) patients was done. Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1168 patients (70.1% male, mean age 69 ±12 years) were included in this study. 15.8% of patients were from Group-A. Mean levels of the analysed parameters were the following: CT 176 ± 55, LDL 111 ± 45, HDL 40 ± 12 and TG 137 ± 102. The following mean ratios were obtained: CT/HDL 4.6 ± 1.9, LDL/HDL 2.9 ± 1.4 and TG/HDL 3.8 ± 3.5. Comparison of the analysed parameters and calculated ratios is exhibited in table 1.

Conclusion

Overall, a worse lipid profile was observed in younger patients. This data reveals the role of dyslipidemia in coronary heart disease, which displays a main role in atherosclerosis at a younger age. This fact highlights the importance of adopting a healthy lifestyle and the adherence to primary and secondary prevention measures of cardiovascular events.

Lipid profile: young vs old patient Group A Group B Total Cholesterol 199 ± 44 170 ± 56 p < 0.001 LDL Cholesterol 128 ± 37 107 ± 46 p < 0.001 HDL Cholesterol 39 ± 10 40 ± 12 p = 0.307 Triglycerides 195 ± 189 125 ± 66 p < 0.001 CT/HDL 5.3 ± 1.5 6.8 ± 2.0 p < 0.001 LDL/HDL 3.4 ± 1.1 2.8 ± 1.4 p < 0.001 TG/HDL 5.6 ± 6.3 3.5 ± 2.5 p < 0.001

The effects of smoking and alcoholism in acute coronary syndrome

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have concluded that smoking increases mortality in patients with coronary disease. On the other hand, a J-shaped dose-effect curve has been used to describe the relationship between alcohol and cardiovascular mortality. According to the majority of studies, a moderate intake of alcohol is associated with a decrease in mortality, while an excessive alcohol intake appears to increase mortality.

Aim

To evaluate the effect of smoking and excessive alcohol intake in hospital mortality and 1-year mortality in patients hospitalized due to acute coronary syndrome (ACS).

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Follow-up started after hospital admission and ended upon hospital death, death within the following 12 months or 12 months after study entry. Patients were divided in two groups: smokers (Group-A) and non-smokers (Group-B), to analyse the effect of smoking in hospital mortality and 1-year mortality. To analyse the effect of excessive alcohol intake, patients were also divided in other two groups: Group-C (excessive drinkers) and Group-D (non-excessive drinkers). Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1120 patients (68.9% male, mean age 69.12 ± 12.67 years) were included in this study. 20.5% were smokers and 3.2% had a previous excessive alcohol intake.

Between Group-A and Group-B, a statistically significant difference was observed in gender (93.1% male in Group-A vs 62.9% male in Group-B, p = 0.002), but not in age (p = 0.116). Hospital mortality rates in Group-A and Group-B were respectively 6.0% and 8.7% (p = 0.191) and 1-year mortality rates were 3.1% vs 5.1% (p = 0.239).

Between Group-C and Group-D, a statistically significant difference was observed in gender (94.4% male in Group-C vs 69.8% male in Group-B, p < 0.001), but not in age (p = 0.730). Hospital mortality rates in Group-C and Group-D were respectively 25% and 9.6% (p = 0.003) and 1-year mortality were 3.8% vs 6.6% (p = 0.577).

Conclusions

Smoking did not have a positive or negative effect in hospital mortality and 1-year mortality. However, excessive alcohol intake was associated with increased hospital mortality in this population.

Impact of postmenopausal vaginal discomfort on sex and relationships in Brazil: the CLOSER survey

OBJECTIVE

The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) survey investigated how postmenopausal vaginal atrophy (VA) affects relationships between Brazilian women and male partners.

METHODS

Postmenopausal women (age 55-65 years) with VA, and male partners of women with the condition, completed an online survey on the impact of VA and local estrogen treatment on intimacy and relationships.

RESULTS

A total of 360 women and 352 men from Brazil were included. Women (83%) and men (91%) reported that they were comfortable discussing VA with their partners. Women's key source of information on VA was health-care providers (HCPs), but 44% felt that not enough information is available. VA caused 70% of women to avoid sexual intimacy and resulted in less satisfying sex. VA had a negative impact on women's feelings and self-esteem. Women (76%) and men (70%) both reported that treatment with vaginal estrogen improved their sexual relationship, primarily by alleviating women's pain during sex. Women (56%) and men (59%) felt closer to each other after treatment.

CONCLUSIONS

VA had a negative impact on sexual relationships for both women and men in Brazil, and reduced women's self-confidence. Vaginal hormone therapy improved couples' sexual relationships. A proactive attitude of HCPs is essential to educate women on VA and the potential benefits of treatment.

High COX-2 expression in canine mast cell tumours is associated with proliferation, angiogenesis and decreased overall survival

COX-2 overexpression is associated with several hallmarks of carcinogenesis such as proliferation, angiogenesis, invasion and metastasis. Fifty cases of canine mast cell tumours (MCT) were retrospectively evaluated and submitted to immunohistochemistry for COX-2, CD31, Ki-67, MAC-387 and CD3. Furthermore its relationship with clinicopathological variables and overall survival (OS) was analysed. COX-2 intensity (P = 0.016), but not COX-2 extension nor score was associated with decreased OS and higher grades of malignancy according to Patnaik (P = 0.002) and Kiupel (P < 0.001) grading systems. Cox-2 intensity was also associated with higher Ki-67 scores (P = 0.009), higher mitotic index (P = 0.022) and higher microvascularization density (P = 0.045). No association was observed for COX-2 intensity and CD3-T lymphocyte (P = 0.377) and macrophage infiltration (P = 0.261) by MAC-387 immunollabelling, suggesting an active role of COX-2 in MCT oncogenesis mainly through proliferation and angiogenesis stimulation making it a potentially clinical relevant prognosis marker and therapeutic target.

Ki-67 and PCNA Expression in Canine Mammary Tumors and Adjacent Nonneoplastic Mammary Glands: Prognostic Impact by a Multivariate Survival Analysis

The assessment of tumor proliferation has been considered a determining prognostic factor in canine mammary tumors (CMTs). However, no studies have assessed the prognostic importance of proliferation in adjacent nonneoplastic mammary glands. We included 64 CMTs (21 benign and 43 malignant) and studied the proliferation index (PI) of Ki-67 and proliferating cell nuclear antigen (PCNA) together with several clinicopathological characteristics. A positive and statistically significant correlation between the PI of Ki-67 and PCNA in tumors and adjacent nonneoplastic mammary glands was observed in benign and malignant tumors. Tumor size, skin ulceration, histological type, mitotic index, nuclear grade, differentiation grade, histological grade of malignancy, lymph node metastasis, Ki-67, and PCNA expression in tumors and adjacent nonneoplastic mammary glands were statistically associated with overall survival by univariate analysis in malignant cases (n = 43). Histological grade of malignancy and high intratumoral PCNA retained their significance by multivariate analysis arising as independent predictors of overall survival. Interestingly, the PI of Ki-67 and PCNA of adjacent nontumoral mammary glands were associated with clinicopathological features of tumor aggressiveness and shorter overall survival, demonstrating the need to better explore this adjacent non-neoplastic tissue.

Immunohistochemical Labelling for Cyclo-oxygenase-2: Does the Positive Control Guarantee Standardized Results?

Since the identification of cyclo-oxygenase-2 as a potentially important therapeutic target in veterinary oncology, numerous studies on its expression have been conducted. Unfortunately, results have been heterogeneous and conclusions are difficult to draw. We tested the ability of a defined positive control to guarantee reproducibility of results among different laboratories. Valid positive controls were defined by positivity of the renal macula densa without background labelling. Fifteen colorectal tumours and 15 oral squamous cell carcinomas were labelled immunohistochemically by six European laboratories. Slides were evaluated in blinded fashion for percentage of positive cells and labelling intensity by three pathologists, and results were analyzed statistically for reproducibility and inter-reader variability. Macula densa positivity was an insufficiently sensitive control to guarantee reproducible results for percentage of positive cells and labelling intensity. Inter-reader variability was proven statistically, making the case for image analysis or other automated quantitative evaluation techniques.

High COX-2 expression is associated with increased angiogenesis, proliferation and tumoural inflammatory infiltrate in canine malignant mammary tumours: a multivariate survival study

COX-2 expression affects mammary tumourigenesis by promoting angiogenesis and cell proliferation, encouraging metastatic spread and tumour-associated inflammation. Samples of canine mammary tumours (n = 109) were submitted to immunohistochemistry to detect COX-2, CD31, VEGF, Ki-67, CD3 and MAC387 expression. Concurrent high expression of COX-2/CD31, COX-2/VEGF, COX-2/Ki-67, COX-2/CD3 and COX-2/MAC was associated with elevated grade of malignancy, presence of intravascular emboli and presence of lymph node metastasis. Tumours with high COX-2 (P < 0.001) and tumours with concurrent expression of high COX-2 and high CD31 (P = 0.008); high VEGF (P < 0.001); high Ki-67 (P < 0.001); high CD3+ T-lymphocytes (P = 0.002) and elevated MAC387 macrophages (P = 0.024) were associated with shorter overall survival (OS) time. Interestingly the groups with high COX-2/CD31 and high COX-2/VEGF retained their significance after multivariate analysis arising as independent predictors of OS. Present data highlight the importance of COX-2 in canine mammary tumourigenesis.

Exploring new biomarkers in the tumour microenvironment of canine inflammatory mammary tumours

Human inflammatory breast cancer (IBC) and canine inflammatory mammary cancer (CIMC) are the most aggressive forms of mammary cancer. Current research aims to identify new therapeutic targets. Here, we investigated gene expression levels of biomarkers associated with the inflammatory microenvironment. A total of 32 formalin-fixed paraffin-embedded samples of canine mammary carcinoma (CIMC = 26; non-CIMC = 6) were used and their cDNA subjected to quantitative polymerase chain reaction (qPCR) to establish gene expression levels for mediators commonly implicated in linking carcinogenesis with inflammation. Gene expression differences between CIMC and non-CIMC types were obtained for cyclooxygenase 2 (COX-2) (P = 0.004), synuclein gamma (SNCG) (P = 0.006), tribbles 1 (P = 0.025), vascular endothelial growth factor (VEGF) (P = 0.017) and CSF1R (P = 0.045). Among these biomarkers correlations were found, particularly between SNCG and tribbles 1 (r = 0.512, P = 0.001). The efficient metastasis of CIMC is intimately linked to components in the tumour microenvironment. This study suggests that upregulation and correlation of SNCG and tribbles 1 deserves to be further explored.

Pre-emptive pediatric kidney transplantation or not?

BACKGROUND

Kidney transplantation prior to dialysis (pre-emptive kidney transplantation, PKT) has been controversial because of the paucity of clinical evidence to clarify the risks and benefits of PKT. Several authors have confirmed a significant advantage of PKT in the treatment of patients with end-stage renal disease (ESRD). The aim of this study was to examine the characteristics of patients who received PKT or non-pre-emptive kidney transplant (NPKT).

METHODS

We used a cohort of 323 consecutive kidney-transplanted children (53% boys) from Hospital da Criança Santo Antonio, Porto Alegre, Brazil, who underwent transplantation between January 2000 and December 2010.

RESULTS

The main causes of ESRD were congenital anomalies of the kidney and urinary tract (CAKUT) (39%) and glomerulopathies (27.5%). The 12-, 36-, 60-, and 90-months death-censored graft survival rates were 97%, 92%, 86%, and 76%, respectively, in the PKT group, and 87%, 79%, 72%, and 65% in the NPKT group (P < .05).

CONCLUSIONS

The results of this study suggest that pre-emptive transplantation is beneficial (hazard ratio = 0.37; 95% confidence interval: 0.18-0.82). The main causes of graft loss (n = 67) were recurrence of primary disease (21%), chronic allograft injury (17%), and death with a functioning graft (16%). We recommend PKT as a better choice for transplantation whenever possible to minimize ESRD morbidity and provide better long-term patient and graft survival.

Coexistence of tuberculosis and mammary carcinoma in a goat

Synchronic occurrence of tuberculosis mastitis and mammary cancer is rare in humans and, to the best of our knowledge, not reported in domestic animals. Here, we present a case of a female adult goat of Serrana breed with simultaneous occurrence of a granulomatous mastitis, due to Mycobacterium caprae, and a mammary carcinoma. Both pathological conditions are rare in goats and should be included in differential diagnosis of mammary lesions.

Tumour-associated macrophages are associated with vascular endothelial growth factor expression in canine mammary tumours

Tumour-associated macrophages (TAMs) have been implicated in carcinogenesis including an important role in angiogenesis. In this study, we describe the relationship between TAMs and angiogenesis in canine mammary tumours (CMT). Formalin-fixed paraffin-embedded CMT samples [(n = 128: malignant (n = 97) and benign (n = 31)] were submitted to immunohistochemical staining to detect MAC387, vascular endothelial growth factor VEGF and CD31 expression. A statistical analysis was carried out to assess possible associations with clinicopathological variables and biological markers of tumour angiogenesis. TAMs, detected by MAC387 expression, were significantly associated with malignant CMT (P < 0.001) and VEGF positive tumours (P = 0.002) and also associated with VEGF expression within malignant CMT (P = 0.043). Associations with clinicopathological variables were found between TAMs and the presence of infiltrative growth (P = 0.031), low tubule formation (P = 0.040) and lymph node metastasis (P = 0.016). The results support the hypothesis that TAMs influence angiogenesis in CMT suggesting TAMs may represent a therapeutic target in this disease.

Lesões melanocíticas em suínos abatidos para consumo

O presente estudo teve como principais objetivos conhecer a taxa de ocorrência de lesões melanocíticas (melanose, melanocitomas e melanomas) em suínos abatidos para consumo e identificar possíveis padrões de distinção e de classificação macroscópica dessas lesões. Para tal, procedeu-se à recolha de lesões melanocíticas em matadouro, durante oito meses, e à sua avaliação macroscópica e microscópica. Os resultados deste estudo demonstraram que as melanoses foram as lesões melanocíticas mais frequentemente encontradas (74,04%) e que, relativamente às lesões tumorais, os melanomas (malignos) foram os mais frequentes (21,15%) comparativamente com os melanocitomas (benignos) (4,81%). Pela análise comparativa das características macroscópicas e microscópicas, verificou-se que, nem sempre, por uma avaliação macroscópica, é possível a distinção entre essas lesões (melanoses, melanocitomas e melanomas). No entanto, identificaram-se, neste estudo, algumas características sugestivas da malignidade, como: o tamanho superior a 2,5cm, a presença de ulceração, a libertação de pigmento negro e a presença de coloração negra do gânglio linfático regional. É, portanto, de extrema importância a observação criteriosa e sistemática dessas lesões, para a avaliação das suas características, uma vez que a decisão sanitária é diferente consoante se trate de uma melanose, de um tumor maligno ou de um tumor benigno.

Diagnosis of Mycobacterium avium complex in granulomatous lymphadenitis in slaughtered domestic pigs

The aim of this study was to compare two diagnostic methods for the detection of Mycobacterium avium complex (MAC) infection in lymph nodes with granulomatous lymphadenitis from slaughtered domestic pigs. Fifty affected lymph nodes were collected from 50 pigs and examined microscopically and by polymerase chain reaction (PCR). Microscopically, granulomatous lesions were observed in 92% of the samples, consisting mostly of central necrosis (78%) with dystrophic calcification (46%) and associated with inflammatory infiltration by epithelioid giant cells, lymphocytes, neutrophils (92%), eosinophils (60%) and Langhans-type cells (70%). In 64% of the lesions, a capsule of connective tissue was found. Acid-fast bacilli were observed in all cases. PCR detected DNA from Mycobacterium spp. in 82% (41/50) of the lymph nodes. MAC was confirmed in 58% (24/41) and M. avium avium/silvaticum subspecies in 39% (16/41). The results of this study suggest that combined histopathology and PCR of lymph nodes are useful in the diagnosis of granulomatous lymphadenitis in slaughtered pigs.

Prognostic value of tumour-associated macrophages in canine mammary tumours

Tumour-associated macrophages (TAMs) have already been associated in human breast cancer to a poor prognosis. As a part of a tumoural microenvironment, TAMs have an important contribution influencing neoplastic progression. Hitherto, in canine mammary tumours (CMT) the prognostic value of TAMs has not been reported. In this study, MAC387 immunohistochemical expression was evaluated in 59 CMTs (20 benign and 39 malignant). The TAM value was significantly higher in malignant than benign CMT (P = 0.011). In malignant CMT, TAMs were associated with skin ulceration (P = 0.022), histological type (P = 0.044), nuclear grade (P = 0.031) and tubular differentiation (P = 0.042). The survival analysis revealed a significant association between tumours with higher levels of TAMs and the decrease in overall survival (P = 0.030). TAMs have proven to have a prognostic value. These findings suggest the future possibility of using TAMs as a novel therapeutic target in CMT.

Ceftriaxone-induced acute reversible encephalopathy in a patient treated for a urinary tract infection

Encephalopathy is a rare side effect of third- and fourth-generation cephalosporins. Renal failure and previous disease of the central nervous system predispose to this neurotoxicity. We describe a case of encephalopathy with generalised triphasic waves in a patient with pre-existent cerebrovascular disease who was treated with ceftriaxone for a urinary tract infection. Early recognition of this complication is relevant given that ceftriaxone discontinuation reverted the neurological syndrome.

“Full Moon Fits”: Focal Temporal Epilepsy Presenting as First Episode Psychosis

Introduction:

Epilepsy rarely presents as psychosis; this is reportedly more common in temporal lobe epilepsy, particularly mesial temporal lobe sclerosis (MTLS). in first psychotic episodes, epilepsy is often a neglected diagnosis. Also, distinguishing ictal behavioral manifestations from postictal psychosis may be troublesome, hindering adequate management.

Case report:

26-year-old female without known psychiatric or neurological disorder, brought to the emergency department due to rapidly progressive behavioral disturbance, with Capgras and persecutory delusions, marked aggressiveness and disorientation. Hallucinations were absent. According to her mother, she experienced several “fits” during the previous 2 days, and she also invariably sustains these every month, around “the full moon days”. Blood and urine tests and a brain CT scan were normal. She was treated with risperidone and lorazepam, with symptom remission in two days. Further exploration revealed a two year history of undiagnosed partial complex and generalized seizures; MRI disclosed right MTLS. Interictal EEG and video-EEG were normal (with a negative psychogenic induction trial). the symptoms are successfully controlled with oxcarbazepine.

Discussion:

Although the EEG was not carried out acutely, this seems to be a case of postictal psychosis; this diagnosis is also supported by the clinical progression. the differential diagnoses include toxic psychosis and non-convulsive status epilepticus; a brief review of epilepsy-related psychosis will be conducted. A low suspicion threshold must be kept in these situations, and a meticulous multidisciplinary approach seems advisable.

Expression of Cox-1 and Cox-2 in Canine Mammary Tumours

The aim of this study was to investigate immunohistochemically the expression of cyclooxygenase-1 (Cox-1) and cyclooxygenase-2 (Cox-2) in canine mammary tumours of different histological types. Cox-1 and Cox-2 enzyme expression was evaluated in 70 mammary samples (four normal, six hyperplastic, 60 neoplastic [21 benign and 39 malignant]). Cox-1 expression was identified in all the samples, and Cox-2 in all the mammary lesions except ductal hyperplasia. Two of the four normal mammary gland samples showed focal immunoreactivity for Cox-2. Cox-1 immunoexpression did not differ significantly between benign and malignant lesions (P=0.272). Cox-2 immunoexpression was higher in malignant tumours than in benign counterparts (P<0.001). Of the malignant tumours, carcinosarcomas and tubulopapillary and squamous cell carcinomas had the highest Cox-2 scores. The study showed that malignant tumours had the highest values of Cox-2 expression, and Cox-2 immunolabelling was particularly intense in histological types classically associated with high malignancy. This suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), particularly Cox-2 inhibitors, may have a useful role to play in the treatment of canine malignant mammary tumours.

Primary and secondary tumours occurring simultaneously in the brain of a dog

Primary brain tumours of a single histological type and metastatic brain tumours are well described in dogs in the current veterinary literature. However, the concurrent presence of a primary and secondary tumour in the brain of a dog has never, to the authors' knowledge, been previously reported. The clinical and pathological features of a nine-year-old, female boxer with an oligodendroglioma and metastases from a mammary gland adenocarcinoma occurring simultaneously in the brain are described in this case report. Information in the veterinary literature on multiple malignancies affecting the central nervous system is very limited; therefore, a discussion about comparative situations in human medicine has been included.

Effects of acetylcholine and spermineNONOate on erythrocyte hemorheologic and oxygen carrying properties

PURPOSE OF THE STUDY

To determine the effects of acetylcholine and spermineNONOate--a NO donor--on RBC membrane and oxygen carrying properties.

MATERIAL AND METHODS

Aliquots of venous blood from eleven healthy subjects were incubated with ACh 10(-3) M, ACh 10(-5) M, spermineNONOate 10(-5) M and spermineNONOate 10(-4) M. The following parameters were determined: erythrocyte aggregation and deformability, hematocrit, plasma pH, osmolality, K(+), Na(+), Ca(2+) concentrations, hemoglobin, oxyhemoglobin, carboxyhemoglobin and methemoglobin concentrations, oxygen saturation of hemoglobin, oxygen and carbon dioxide partial pressures and p50.

RESULTS

In presence of ACh there is an increase of erythrocyte deformability, decrease of erythrocyte aggregation, plasma pH, K(+) and Na(+) concentration, increase of Ca(2+) concentration and p50. In presence of spermineNONOate there is an increase of erythrocyte deformability, plasma pH, decrease of Na(+) and Ca(2+) concentration, increase of metHb concentration and decrease of p50.

CONCLUSION

Acetylcholine and spermineNONOate are able to induce changes on RBC membrane and oxygen carrying properties.

Antimicrobial activity of Terminalia macroptera root

Terminalia macroptera Guill et Perr. (Combretaceae) is a medicinal plant used in Guinea-Bissau and other West African countries to treat infectious diseases. The ethanol extract from T. macroptera decorticated root and their liquid-liquid partition fractions, were screened for antimicrobial activity, by the twofold serial microdilution assay against seven reference bacterial strains and against Candida albicans. The extract and fractions showed some activity against at least one of the test microorganisms. The best results were obtained against Shigella dysenteriae and Vibrio cholerae. The minimum inhibitory concentrations (MIC) of T. macroptera ethanol extract were also determined for about 100 clinical strains of Campylobacter sp., Escherichia coli, Salmonella sp., Shigella sp. and Vibrio cholerae. The ethanol extract activity against Campylobacter strains is similar to co-trimoxazole, higher than sulfamethoxazole but lower than tetracycline, erythromycin, ampicillin and streptomycin. Ellagitannins are the major compounds in the extract and active fractions. The obtained results suggest a potential importance of this medicinal plant in the treatment of enteric diseases, particularly in Campylobacter infections.

Cryptolepis sanguinolenta activity against diarrhoeal bacteria

Cryptolepine is the main alkaloid of Cryptolepis sanguinolenta (Lindl.) Schlechter, a plant used in traditional medicine in West Africa. The minimal inhibitory concentrations (MICs) of cryptolepine, ethanol and aqueous extracts of Cryptolepis sanguinolenta root were determined for 65 strains of Campylobacter jejuni, 41 strains of Campylobacter coli isolated from sporadic cases of gastroenteritis in Portugal and 86 strains of Vibrio cholerae isolated from patients with enteric infections in Angola, Brazil and Portugal. The ethanol extract activity against Campylobacter strains (MIC90% = 25 micrograms/ml) is higher than that of co-trimoxazole and sulfamethoxazole and Campylobacter strains susceptibility for cryptolepine (MIC90% = 12.5 micrograms/ml) is equal for ampicillin. The ethanol extract and cryptolepine show some activity against the Vibrio cholerae strains, although their activities are lower than that of tetracycline. The results suggest that these roots could be a therapeutic alternative for bacterial etiologic diarrhoea in West Africa.

Prevalence, biotypes, plasmid profile and antimicrobial resistance of Campylobacter isolated from wild and domestic animals from northeast Portugal

The incidence of Campylobacter jejuni and Campylobacter coli in wild and producing animals has been studied to evaluate their importance as potential reservoirs of campylobacter infection. These organisms were isolated from: 59 chicken (60.2%), 65 swine (59.1%), 31 black rats (57.4%), 61 sparrows (45.5%), 21 ducks (40.5%), 32 cows (19.5%) and 27 sheep (15.3%). Biotypes, plasmid and resistance profiles were studied in order to characterize the isolates. Biotypes I and II of C. jejuni were predominant in all reservoirs except swine, where C. coli I was more frequent. Plasmid prevalence was higher in strains isolated from swine (53.8%) and rats (45.5%). The size of the plasmids ranged from 1.3 to 82 MDa. A 2.3 MDa plasmid was the most frequent, detected in all the reservoirs except ducks. Antimicrobial susceptibility testing revealed that 5.5% of the strains were resistant to ampicillin, 5.5% to tetracycline, 12.6% to erythromycin and 23.5% to streptomycin. Resistance to erythromycin (26.2%) and to streptomycin (58.4%) was particularly high in isolates from swine. Tetracycline resistance was encoded by a 33 or a 41 MDa plasmid and transferred by conjugation.

Campylobacter enteritis in Portugal: epidemiological features and biological markers

From 1984 to 1989, stool samples from 2811 gastroenteritis cases were examined for the presence of Campylobacter jejuni and C. Coli, Salmonella, Shigella and Yersinia species. Isolation rates were: Campylobacter jejuni and C. Coli, 5.3%, Salmonella spp., 14.8%, Shigella spp., 4.6% and Yersinia enterocolitica, 1.1%. Age group distribution analysis shows a higher Campylobacter isolation rate in children under one year of age. Seasonal distribution revealed a peak incidence in winter as in other Mediterranean countries. Predominant biotypes were C. jejuni I (51%), C. jejuni II (21.5%) and C. coli I (18.8%). Antimicrobial susceptibility testing did not reveal resistance to erythromycin. Thirty of the strains harboured plasmids with 7 different profiles.