Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

BACKGROUND Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques(CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events(AE) in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria, 226(34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them(33.6%) had CP. During a mean follow-up time of 8.2(2.1) years, 27 AE were found(11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1%(0.6), 95.1%(1.4) and 86.5%(2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio(HR) 2.52, 95% confidence interval(CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE(HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate(HR 0.98, 95%CI 0.96-0.99; P= 0.023), peak metabolic equivalents(HR 0.83, 95%CI 0.70–0.99, P = 0.034) and moderate mitral regurgitation(HR 5.02, 95%CI 1.42–17.75, P = 0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.     

Piranhas (Serrasalmus spp.) as markers of mercury bioaccumulation in Amazonian ecosystems

Mercury (Hg) concentration in fish depends on feeding strategies and age/size within the species as well as on water parameters related to acidity and Hg speciation. We chose two species of piranhas (Serrasalmus aff. eigenmanni and Serrasalmus rhombeus) to test their suitability as markers of Hg bioaccumulation. The results of Hg concentrations in piranhas of the Rio Negro, with no history of gold-mining activity, are similar to other Amazonian rivers with intensive gold mining. An increase in water Hg associated with low pH favored higher mean Hg concentrations in the two species. S. rhombeus in this habitat showed a consistently higher Hg concentration than S. eigenmanni. This result was attributed to fish size because of differences in correlation coefficient between S. rhombeus (r = 0.4443; P < 0.0001) and S. eigenmanni (r = 0.1520; P = 0.0135). Matching for fish weight resulted in comparable ranges of Hg concentrations between the two species.     

Zinc and vitamin A in liver of foetuses and infants

The association of zinc and vitamin A levels was studied in liver of foetuses and infants which were stillborn or died of various causes between the age of 26 weeks of gestation up to 16 weeks post-partum. No correlation between zinc and vitamin A was observed (r = 0.07). Although smaller infants had more hepatic vitamin A than larger infants no significant difference was observed between these groups for liver zinc values.     

The nociceptive flexion reflex as a tool for exploring pain control systems in headache and other pain syndromes

The authors review the neural pathways mediating nociceptive flexion reflexes, the method for analyzing these reflexes in human beings, and available data on their modulation by supraspinal, opioid as well as serotonergic systems. They present results of studies of the biceps femoris flexion reflex (RIII) in pain syndromes and various types of headache. Nociceptive flexor reflexes appear to be interesting for studying the pathophysiology of head pain mechanisms and possibly for evaluating analgesic treatment.     

Contact dermatitis to quinoline, corticosteroids and antibiotics after short time treatment of delayed wound healing following malignant melanoma excision in a young woman

BACKGROUND: We describe a 20-year old woman with retarded healing after a melanoma excision. After short time application of several creams containing antiseptic, antibiotic and anti-inflammatory ingredients she developed a severe contact dermatitis. Patch testing revealed sensitizations against corticosteroids, an antibiotic and quinoline. CONCLUSION: In our case multiple relevant contact sensitizations appeared within a short period of two months after excision of a malignant tumour.