Background The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Objetivo: Obter evidências sobre a atuação do profissional farmacêutico no processo de gerenciamento de órteses, próteses e materiais especiais em âmbito hospitalar. Métodos: Trata-se de uma revisão integrativa de artigos publicados no período de 2012 a 2022, cujos descritores utilizados nas bases de dados Google Scholar, Medline, Pubmed e Scielo, foram: Órteses, Próteses e Materiais Especiais; Gestão Hospitalar; Farmácia Hospitalar; Análise e Desempenho de Tarefas; Garantia da Qualidade; Indicadores de Gestão. Resultados: Foram recuperados 48 artigos, dentre os quais, 34 foram excluídos e 14 selecionados. Resultados: Os artigos incluídos evidenciam os fatores que dificultam a gestão de OPME’s, abordando principalmente o controle, os custos e a necessidade de profissionais especializados para o gerenciamento desses materiais, em especial ao farmacêutico, com suas atribuições, sendo o profissional capacitado para alcançar esses objetivos nas redes de saúde. Considerações finais: Os estudos evidenciam benefícios da atuação do profissional farmacêutico na administração de Órteses, Próteses e Materiais Especiais e da sua importância na promoção do uso com qualidade desses materiais.

BackgroundThe incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation.ObjectiveTo test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS.MethodsA total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina.ResultsThe incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15).ConclusionAlthough CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score.

Atherogenic events promote changes in vessel walls, with alteration of the redox state, and increased activity of matrix metalloproteinases (MMPs). Thus, this study aims to evaluate aortic remodeling, MMP activity, and reactive oxygen species (ROS) levels after treatment with doxycycline in ApoE-⁄- and ovariectomized mice (OVX). Female ApoE-⁄--knockout mice (5 weeks) were submitted to ovariectomy surgery to induce experimental menopause. They then received chow enriched with 1% cholesterol to induce hypercholesterolemia. The animals were divided into two experimental groups: ApoE-⁄-/OVX vehicle and ApoE-⁄-/OVX doxycycline (30 mg/kg) administered by gavage once a day for 28 days (15th to the 18th week of life). Blood samples were collected to measure total cholesterol and fractions. The aorta was used for morphometry and to measure the activity and expression of MMP-2 and ROS levels. The ApoE-⁄-/OVX doxycycline group showed no change in total and fraction cholesterol levels. However, there was a reduction in ROS levels, MMP-2 expression, and activity that correlated with a decrease in atherosclerotic lesions relative to the ApoE-⁄-/OVX vehicle (p > 0.05). Therefore, we conclude that doxycycline in ApoE-⁄-/OVX animals promotes a reduction in atherosclerotic lesions by reducing ROS and MMP-2 activity and expression.

Rational: The GRACE Score assessed at admission predicts mortality in patients with non-ST elevation acute coronary syndromes (ACS). However, once coronary anatomy is assessed, it is not known whether this score increments prognostic assessment.  Objective: To test the hypothesis that the GRACE Score adds prognostic value to coronary anatomy in patients with ACS. Methods: Prospective cohort, including patients with ACS who underwent coronary angiography while admitted to the hospital. Anatomical extension of coronary disease was characterized by the Duke Jeopardy score (DJS) and the number diseased artery (NDA). The primary end-point was the composite of death, non-fatal MI or refractory unstable angina.  Results: 112 patients enrolled, aged 70 ± 12, 14% incidence of cardiovascular events. C-statistics for GRACE was 0.68 (95%CI=0.53-0.84), for DJS was 0.78 (95%CI=0.67-0.9) and for NAD was 0.74 (95%CI=0.61-0.88). Logistic regression analysis demonstrated independent predictive value of GRACE in relation to anatomical information. However, when this Score was added to DJS or NDA, no improving in c-statistic was observed: DJS-GRACE had a c-statistics of 0.78 (95%CI=0.64–0.92) and NAD-GRACE of 0.76 (95%CI=0.60–0.92).  Conclusion: The GRACE score does not add prognostic value to angiographic data in patients with ACS.