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1.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
2.
Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.
; Marques, Heloisa H.S.
; Gualano, Bruno
; Lindoso, Livia
; Bain, Vera
; Astley, Camilla
; Martins, Fernanda
; Matheus, Denise
; Matsuo, Olivia M.
; Suguita, Priscila
; Trindade, Vitor
; Paula, Camila S.Y.
; Farhat, Sylvia C.L.
; Palmeira, Patricia
; Leal, Gabriela N.
; Suzuki, Lisa
; Odone Filho, Vicente
; Carneiro-Sampaio, Magda
; Duarte, Alberto José S.
; Antonangelo, Leila
; Batisttella, Linamara R.
; Polanczyk, Guilherme V.
; Pereira, Rosa Maria R.
; Carvalho, Carlos Roberto R.
; Buchpiguel, Carlos A.
; Latronico, Ana Claudia
; Seelaender, Marilia
; Silva, Clovis Artur
; Pereira, Maria Fernanda B.
; Sallum, Adriana M. E.
; Brentani, Alexandra V. M.
; Neto, Álvaro José S.
; Ihara, Amanda
; Santos, Andrea R.
; Canton, Ana Pinheiro M.
; Watanabe, Andreia
; Santos, Angélica C. dos
; Pastorino, Antonio C.
; Franco, Bernadette D. G. M.
; Caruzo, Bruna
; Ceneviva, Carina
; Martins, Carolina C. M. F.
; Prado, Danilo
; Abellan, Deipara M.
; Benatti, Fabiana B.
; Smaria, Fabiana
; Gonçalves, Fernanda T.
; Penteado, Fernando D.
; Castro, Gabriela S. F. de
; Gonçalves, Guilherme S.
; Roschel, Hamilton
; Disi, Ilana R.
; Marques, Isabela G.
; Castro, Inar A.
; Buscatti, Izabel M.
; Faiad, Jaline Z.
; Fiamoncini, Jarlei
; Rodrigues, Joaquim C.
; Carneiro, Jorge D. A.
; Paz, Jose A.
; Ferreira, Juliana C.
; Ferreira, Juliana C. O.
; Silva, Katia R.
; Bastos, Karina L. M.
; Kozu, Katia
; Cristofani, Lilian M.
; Souza, Lucas V. B.
; Campos, Lucia M. A.
; Silva Filho, Luiz Vicente R. F.
; Sapienza, Marcelo T.
; Lima, Marcos S.
; Garanito, Marlene P.
; Santos, Márcia F. A.
; Dorna, Mayra B.
; Aikawa, Nadia E.
; Litvinov, Nadia
; Sakita, Neusa K.
; Gaiolla, Paula V. V.
; Pasqualucci, Paula
; Toma, Ricardo K.
; Correa-Silva, Simone
; Sieczkowska, Sofia M.
; Imamura, Marta
; Forsait, Silvana
; Santos, Vera A.
; Zheng, Yingying
.
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
3.
Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.
; Ho, Yeh-Li
; Besen, Bruno A.M.P.
; Malbuisson, Luiz M.S.
; Taniguchi, Leandro U.
; Mendes, Pedro V.
; Costa, Eduardo L.V.
; Park, Marcelo
; Daltro-Oliveira, Renato
; Roepke, Roberta M.L.
; Silva Jr, João M.
; Carmona, Maria José C.
; Carvalho, Carlos Roberto Ribeiro
; Hirota, Adriana
; Kanasiro, Alberto Kendy
; Crescenzi, Alessandra
; Fernandes, Amanda Coelho
; Miethke-Morais, Anna
; Bellintani, Arthur Petrillo
; Canasiro, Artur Ribeiro
; Carneiro, Bárbara Vieira
; Zanbon, Beatriz Keiko
; Batista, Bernardo Pinheiro De Senna Nogueira
; Nicolao, Bianca Ruiz
; Besen, Bruno Adler Maccagnan Pinheiro
; Biselli, Bruno
; Macedo, Bruno Rocha De
; Toledo, Caio Machado Gomes De
; Pompilio, Carlos Eduardo
; Carvalho, Carlos Roberto Ribeiro De
; Mol, Caroline Gomes
; Stipanich, Cassio
; Bueno, Caue Gasparotto
; Garzillo, Cibele
; Tanaka, Clarice
; Forte, Daniel Neves
; Joelsons, Daniel
; Robira, Daniele
; Costa, Eduardo Leite Vieira
; Silva Júnior, Elson Mendes Da
; Regalio, Fabiane Aliotti
; Segura, Gabriela Cardoso
; Marcelino, Gustavo Brasil
; Louro, Giulia Sefrin
; Ho, Yeh-Li
; Ferreira, Isabela Argollo
; Gois, Jeison de Oliveira
; Silva Junior, Joao Manoel Da
; Reusing Junior, Jose Otto
; Ribeiro, Julia Fray
; Ferreira, Juliana Carvalho
; Galleti, Karine Vusberg
; Silva, Katia Regina
; Isensee, Larissa Padrao
; Oliveira, Larissa dos Santos
; Taniguchi, Leandro Utino
; Letaif, Leila Suemi
; Lima, Lígia Trombetta
; Park, Lucas Yongsoo
; Chaves Netto, Lucas
; Nobrega, Luciana Cassimiro
; Haddad, Luciana
; Hajjar, Ludhmila
; Malbouisson, Luiz Marcelo
; Pandolfi, Manuela Cristina Adsuara
; Park, Marcelo
; Carmona, Maria José Carvalho
; Andrade, Maria Castilho Prandini H De
; Santos, Mariana Moreira
; Bateloche, Matheus Pereira
; Suiama, Mayra Akimi
; Oliveira, Mayron Faria de
; Sousa, Mayson Laercio
; Louvaes, Michelle
; Huemer, Natassja
; Mendes, Pedro
; Lins, Paulo Ricardo Gessolo
; Santos, Pedro Gaspar Dos
; Moreira, Pedro Ferreira Paiva
; Guazzelli, Renata Mello
; Reis, Renato Batista Dos
; Oliveira, Renato Daltro De
; Roepke, Roberta Muriel Longo
; Pedro, Rodolpho Augusto De Moura
; Kondo, Rodrigo
; Rached, Samia Zahi
; Fonseca, Sergio Roberto Silveira Da
; Borges, Thais Sousa
; Ferreira, Thalissa
; Cobello Junior, Vilson
; Sales, Vivian Vieira Tenório
; Ferreira, Willaby Serafim Cassa
.
OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
https://doi.org/10.6061/clinics/2020/e2294
1957 downloads
4.
Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry
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Soeiro, Alexandre de Matos
; Silva, Pedro Gabriel Melo de Barros e
; Roque, Eduardo Alberto de Castro
; Bossa, Aline Siqueira
; Biselli, Bruno
; Leal, Tatiana de Carvalho Andreucci Torres
; Soeiro, Maria Carolina Feres de Almeida
; Pitta, Fábio Grunspun
; Serrano Jr., Carlos V.
; Oliveira Jr., Múcio Tavares
.
Resumo Fundamento: Existem diferenças relatadas entre pacientes com síndrome coronariana aguda, de acordo com o sexo. A descrição deste achado comparativo em registro brasileiro ainda não foi documentada. Objetivo: Comparar pacientes do sexo masculino vs. feminino quanto a características basais, achados coronarianos, tratamento e prognóstico intra-hospitalar e em longo prazo. Métodos: Trata-se de estudo retrospectivo, multicêntrico e observacional, no qual foram incluídos 3.745 pacientes (2.437 do sexo masculino e 1.308 do sexo feminino) entre maio de 2010 e maio de 2015. O desfecho primário intra-hospitalar foi mortalidade por todas as causas. O desfecho secundário foi eventos combinados (choque cardiogênico, reinfarto, morte, acidente vascular cerebral e sangramento). A comparação entre grupos foi realizada por meio de qui-quadrado e teste t, sendo considerado significativo p < 0,05. Em longo prazo, foram avaliados a mortalidade e os eventos combinados pelo método Kaplan-Meier, com seguimento médio de 8,79 meses. Resultados: A média de idade foi de 60,3 anos no sexo masculino e 64,6 no feminino (p < 0,0001). O fator de risco mais prevalente foi hipertensão arterial sistêmica em 72,9% das mulheres e 67,8% nos homens (p = 0,001). Intervenção coronária percutânea foi realizada em 44,9% no sexo masculino e 35,4% no feminino (p < 0,0001), e revascularização miocárdica cirúrgica em 17% no sexo masculino e 11,8% no feminino (p < 0,0001), com maior prevalência de padrão coronariano triarterial no sexo masculino (27,3% vs. 16,2%; p < 0,0001). Cerca de 79,9% dos pacientes do sexo feminino enquadraram-se no diagnóstico de síndrome coronariana aguda sem supradesnivelamento do segmento ST, enquanto no sexo masculino este número foi de 71,5% (p < 0,0001). Em curto e longo prazos não se observaram diferenças significativas entre os grupos, tanto em mortalidade quanto em eventos combinados. Conclusão: Observaram-se múltiplas diferenças relacionadas ao sexo em pacientes com síndrome coronariana aguda no que se refere a características demográficas, padrão coronariano e tratamento adotado. No entanto, a evolução prognóstica foi semelhante entre os grupos.
Abstract Background: Gender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented. Objective: To compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis. Methods: This is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months. Results: The mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events. Conclusion: Several gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.
https://doi.org/10.5935/abc.20180166
1757 downloads
5.
Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome
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de Matos Soeiro, Alexandre
; de Barros e Silva, Pedro Gabriel Melo
; Roque, Eduardo Alberto de Castro
; Bossa, Aline Siqueira
; Zullino, Cindel Nogueira
; Simões, Sheila Aparecida
; Okada, Mariana Yumi
; Leal, Tatiana de Carvalho Andreucci Torres
; Soeiro, Maria Carolina Feres de Almeida
; Serrano Jr., Carlos V.
; Oliveira Jr, Múcio Tavares
.
OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05. RESULTS: Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02). CONCLUSIONS: Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.
https://doi.org/10.6061/clinics/2016(11)03
1153 downloads
6.
Spatio-temporal distribution and target species in a longline fishery off the southeastern coast of Brazil
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Mourato, Bruno L.
; Arfelli, Carlos A.
; Amorim, Alberto F.
; Hazin, Humberto G.
; Carvalho, Felipe C.
; Hazin, Fábio H. V.
.
No presente estudo, uma análise de agrupamento foi utilizada para classificar 6.486 lances feitos pela frota espinheleira sediada no Estado de São Paulo, Brasil, de 1998 até 2006, em relação à composição das espécies presentes nas capturas. Baseado nas proporções de doze espécies e três grupos de espécies, três agrupamentos foram identificados: C1: outros peixes; C2: tubarão-azul; C3: espadarte. Os resultados indicaram que ao longo do período estudado, a frota direcionou suas capturas principalmente para o tubarão-azul e para o espadarte, além de terem evidenciado que a importância do tubarão-azul nessa pescaria tem crescido progressivamente ao longo dos anos. Áreas mais afastadas da costa foram exploradas principalmente no primeiro e quarto trimestres (em especial a partir de 2001), enquanto que um esforço de pesca mais concentrado perto da quebra da plataforma continental foi observado durante o segundo e terceiro trimestres (para todo o período estudado). A frota espinheleira sediada em São Paulo mudou a estratégia de pesca para diferentes espécies-alvo, o que produziu importantes mudanças nas principais espécies capturadas por esforço de pesca (CPUE). A análise de agrupamento parece ter identificado apropriadamente essas alterações ao longo do tempo, em relação às quais não há, em geral, qualquer informação nos mapas de bordo.
In the present study, a cluster analysis, in relation to the species composition of the catches, was used to classify 6,486 fishing sets by a longline fleet based in São Paulo State, Brazil, from 1998 to 2006. Based on the proportions of 12 species and three broader species groups, three clusters were identified: C1: other fishes; C2: blue shark; C3: swordfish. Results indicated that the fleet targeted mainly blue shark and swordfish and also showed that the blue shark importance in this fishery has been growing progressively trough the years. Offshore areas were exploited mainly in the first and fourth quarters (from 2001 mainly), while the fishing effort was more concentrated near the continental shelf break, during the second and third quarters (for the whole period). The longline fishery based in Sao Paulo State changed fishing strategy to target different species which produced important changes in catch-per-unit-effort (CPUE) of the main species caught. Cluster analysis seems to have appropriately identified these changes over time, which is an important information, often missing in logbooks.
2417 downloads
7.
Development of a Low Cost Bioprocess for Endotoxin Production by Bacillus thuringiensis var israelensis Intended for Biological Control of Aedes aegypti
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Soccol, Carlos Ricardo
; Pollom, Teresinha E. V.
; Fendrich, Ricardo Cancio
; Prochmann, Fernando Alberto
; Mohan, Radijiskumar
; Blaskowski, Marita Maciel Moreira
; Melo, André Luiz de Almeida
; Carvalho, Cláudio Jose Barros de
; Soccol, Vanete Thomaz
.
Brazilian Archives of Biology and Technology
- Journal Metrics
A dengue é transmitida pelo Aedes aegypti, doença responsável por 20.000 mortes/ano no mundo. Bacillus thuringiensis var israelensis libera toxinas seletivas e eficazes (proteínas cristal) contra larvas de A. aegypti. Propõe-se um bioprocesso de baixo custo para a produção da toxina, pelo emprego de uma cepa brasileira selecionada de Bti (BR-LPB01) e de substratos de baixo custo. Farelo de soja e melaço de cana levaram a eficácia tóxica alta após fermentação em biorreator 2L (DL50=26ng/mL), valor próximo a estirpe de referência IPS82 (DL50=17,3 ng/mL). O pH variou entre 5,8 e 7,0 durante o período de crescimento exponencial e entre 7,0 e 8,4 durante a fase estacionária, com baixa atividade larvicida. Assim, controles de espuma e de pH 7,0 foram iniciados e demonstraram serem cruciais para alta atividade. Verificou-se que a fermentação deve ser interrompida após vinte horas, quando se obtém a maior atividade.
Aedes aegypti is the vector of Dengue disease, responsible for 20,000 deaths/year worldwide. Bacillus thuringiensis var israelensis - Bti releases selective and effective toxins (crystal proteins) against A. aegypti larvae. We present a low cost bioprocess for toxin production, accomplished by a selected Brazilian strain Bti (BR-LPB01) and employment of low cost substrates. Soybean meal and sugarcane molasses lead to high toxic effectiveness after 2L bioreactor fermentation (LD50=26ng/mL), near to the reference strain IPS82 (LD50=17.3 ng/mL). The pH ranged between 5.8 and 7.0 during the exponential growth period and between 7.0 and 8.4 during the stationary phase, with low activity. Thus, control of foam and pH 7.0 were started and proved to be crucial for high activity. It was verified that the fermentation could be discontinued after 20 hours, when the highest activity was present.
4549 downloads
8.
Brazilian coffee genome project: an EST-based genomic resource
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Vieira, Luiz Gonzaga Esteves
; Andrade, Alan Carvalho
; Colombo, Carlos Augusto
; Moraes, Ana Heloneida de Araújo
; Metha, Ângela
; Oliveira, Angélica Carvalho de
; Labate, Carlos Alberto
; Marino, Celso Luis
; Monteiro-Vitorello, Claúdia de Barros
; Monte, Damares de Castro
; Giglioti, Éder
; Kimura, Edna Teruko
; Romano, Eduardo
; Kuramae, Eiko Eurya
; Lemos, Eliana Gertrudes Macedo
; Almeida, Elionor Rita Pereira de
; Jorge, Érika C.
; Albuquerque, Érika V. S.
; Silva, Felipe Rodrigues da
; Vinecky, Felipe
; Sawazaki, Haiko Enok
; Dorry, Hamza Fahmi A.
; Carrer, Helaine
; Abreu, Ilka Nacif
; Batista, João A. N.
; Teixeira, João Batista
; Kitajima, João Paulo
; Xavier, Karem Guimarães
; Lima, Liziane Maria de
; Camargo, Luis Eduardo Aranha de
; Pereira, Luiz Filipe Protasio
; Coutinho, Luiz Lehmann
; Lemos, Manoel Victor Franco
; Romano, Marcelo Ribeiro
; Machado, Marcos Antonio
; Costa, Marcos Mota do Carmo
; Sá, Maria Fátima Grossi de
; Goldman, Maria Helena S.
; Ferro, Maria Inês T.
; Tinoco, Maria Laine Penha
; Oliveira, Mariana C.
; Van Sluys, Marie-Anne
; Shimizu, Milton Massao
; Maluf, Mirian Perez
; Eira, Mirian Therezinha Souza da
; Guerreiro Filho, Oliveiro
; Arruda, Paulo
; Mazzafera, Paulo
; Mariani, Pilar Drummond Sampaio Correa
; Oliveira, Regina L.B.C. de
; Harakava, Ricardo
; Balbao, Silvia Filippi
; Tsai, Siu Mui
; Mauro, Sonia Marli Zingaretti di
; Santos, Suzana Neiva
; Siqueira, Walter José
; Costa, Gustavo Gilson Lacerda
; Formighieri, Eduardo Fernandes
; Carazzolle, Marcelo Falsarella
; Pereira, Gonçalo Amarante Guimarães
.
O café é um dos principais produtos agrícolas, sendo considerado o segundo item em importância do comércio internacional de "commodities". O gênero Coffea pertence à família Rubiaceae que também inclui outras plantas importantes. Este gênero contém aproximadamente 100 espécies, mas a produção comercial é baseada somente em duas espécies, Coffea arabica e Coffea canephora, que representam aproximadamente 70 % e 30 % do mercado total de café, respectivamente. O Projeto Genoma Café Brasileiro foi desenvolvido com o objetivo de disponibilizar os modernos recursos da genômica à comunidade científica e aos diferentes segmentos da cadeia produtiva do café. Para isso, foram seqüenciados 214.964 clones escolhidos aleatoriamente de 37 bibliotecas de cDNA de C. arabica, C. canephora e C. racemosa representando estádios específicos do desenvolvimento de células e de tecidos do cafeeiro, resultando em 130.792, 12.381 e 10.566 seqüências de cada espécie, respectivamente, após processo de trimagem. Os ESTs foram agrupados em 17.982 contigs e em 32.155 singletons. A comparação destas seqüências pelo programa BLAST revelou que 22 % não tiveram nenhuma similaridade significativa às seqüências no banco de dados do National Center for Biotechnology Information (de função conhecida ou desconhecida). A base de dados de ESTs do cafeeiro resultou na identificação de cerca de 33.000 unigenes diferentes. Os resultados de anotação das seqüências foram armazenados em base de dados "online" em <A HREF="http://www.lge.ibi.unicamp.br/cafe">http://www.lge.ibi.unicamp.br/cafe</A>. Os recursos desenvolvidos por este projeto disponibilizam ferramentas genéticas e genômicas que podem ser decisivas para a sustentabilidade, a competitividade e a futura viabilidade da agroindústria cafeeira nos mercados interno e externo.
Coffee is one of the most valuable agricultural commodities and ranks second on international trade exchanges. The genus Coffea belongs to the Rubiaceae family which includes other important plants. The genus contains about 100 species but commercial production is based only on two species, Coffea arabica and Coffea canephora that represent about 70 % and 30 % of the total coffee market, respectively. The Brazilian Coffee Genome Project was designed with the objective of making modern genomics resources available to the coffee scientific community, working on different aspects of the coffee production chain. We have single-pass sequenced a total of 214,964 randomly picked clones from 37 cDNA libraries of C. arabica, C. canephora and C. racemosa, representing specific stages of cells and plant development that after trimming resulted in 130,792, 12,381 and 10,566 sequences for each species, respectively. The ESTs clustered into 17,982 clusters and 32,155 singletons. Blast analysis of these sequences revealed that 22 % had no significant matches to sequences in the National Center for Biotechnology Information database (of known or unknown function). The generated coffee EST database resulted in the identification of close to 33,000 different unigenes. Annotated sequencing results have been stored in an online database at <A HREF="http://www.lge.ibi.unicamp.br/cafe">http://www.lge.ibi.unicamp.br/cafe</A>. Resources developed in this project provide genetic and genomic tools that may hold the key to the sustainability, competitiveness and future viability of the coffee industry in local and international markets.
11944 downloads
9.
IV Diretrizes Brasileiras de Hipertensão Arterial Grupos de trabalho
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Gomes, Marco Antonio Mota
; Pierin, Angela Maria Geraldo
; Sbissa, Antonio Silveira
; Nogueira, Armando da Rocha
; Brandão, Ayrton Pires
; Rodrigues, Cibeli I. Saad
; Mello, Edgar Pessoa de
; Mello Filho, José Xavier de
; Bodanese, Luiz Carlos
; Toscano, Paulo
; Ferreira Filho, Sebastião
; Nobre, Fernando
; Tavares, Agostinho
; Lopes, Antonio Carlos
; Ribeiro, Jorge Pinto
; Ayoub, José Carlos Aydar
; Ribeiro, José Márcio
; Introcaso, Luiz
; Corrêa, Marcelo
; Maranhão, Mario
; Jabur, Pedro
; Nascimento, Raimundo Marques
; Cunha, Roberto de Sá
; Mulinari, Rogério Andrade
; Machado, Carlos Alberto
; Avila, Adriana
; Andrade, Clóvis Oliveira
; Rocha, João Carlos
; Lopes, Margarida Maria Veríssimo
; Arruda, Maria Cecília G. Marinho
; Azevedo, Maria Fátima
; Carvalho, Maria Helena C.
; Lipp, Marilda Novaes
; Kohlmann, Nárcia Elisa B.
; Jesus, Neide de
; Jardim, Paulo César da Veiga
; Amodeo, Celso
; Negrão, Carlos Eduardo
; Ferreira, Celso
; Cunha, Cláudio Pereira da
; Toscano, Eli
; Lima, Eliuden Galvão de
; Monego, Estelamaris Tronco
; Braga, Fátima Lúcia Machado
; Chaves Jr., Hilton de Castro
; Heiman, Joel
; Carvalho, Tales de
; Kohlmann Jr., Osvaldo
; Avezum, Alvaro
; Ribeiro, Artur Beltrame
; Gomes, Carlos Alberto
; Giorgi, Dante Marcelo Artigas
; Feitosa, Gilson
; Ohashi, Harue
; Ramirez, José Antonio Franchini
; Machado, Marcelo Marcondes
; Salgado Filho, Natalino
; Luna, Rafael Leite
; Franco, Roberto Jorge da Silva
; Santos, Robson Augusto dos
; Oigman, Wille
; Pascoal, Istênio Fernandes
; Massaro, Airton
; Atallah, Álvaro Nagib
; Brandão, Andréa
; Freitas, Elizabete Viana de
; Cordovil, Ivan
; Oliveira, José Egídio Paulo de
; Ramos, José Geraldo L.
; Zanella, Maria Teresa
; Wajngarten, Maurício
; Miranda, Roberto Dischinger
; Kahhale, Soubihe
; Koch, Vera
; Mion Jr., Décio
; Guimarães, Armênio C.
; Palmeira, Catia Sueli
; Forjaz, Claudia Lucia de Moraes
; Coelho, Eduardo B.
; Almeida, Fernando Antonio
; Pellizari, Isabel Cristina Estefano
; Ribeiro, Marcos Ausenka
; Batlouni, Michel
; Lotufo, Paulo
; Capelari, Regina Teresa
; Magalhães, Lucélia C.
; Afiune Neto, Abrahão
; Cury, Abrão
; Moreira, Alci
; Souza, Ana Luisa de
; Fuchs, Flavio Danni
; Lessa, Ines
; Malachias, Marcus V. Bolívar
; Bezerra, Romero
; Fuchs, Sandra
; Praxedes, José Nery
; Cambara, Antonio
; Lucon, Antonio Marmo
; Mendonça, Berenice
; Borelli, Flavio
; Silva, Helio B.
; Romão Jr., João Egidio
; Carvalho, José Gastão Rocha
; Santello, José Luiz
; Bortolotto, Luiz
; Matavelli, Luis Celso
; Pinheiro, Maria Eliete
; Guimarães, Valéria
.
9380 downloads
10.
Lectins from Pisum arvense seeds behave differently from storage proteins during germination in the darkness
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SILVA, LUIZA IZABEL M. MOREIRA DA
; RAMOS, MÁRCIO VIANA
; CAJAZEIRAS, JOÃO BATISTA
; FERREIRA, PATRÍCIA RODRIGUES
; CARVALHO, CARLOS ALBERTO V.
; GRANGEIRO, THALLES BARBOSA
; NUNES, EDSON PAULA
; SAMPAIO, ALEXANDRE HOLANDA
; FREITAS, BEATRIZ TUPINAMBÁ
; SILVEIRA, JOAQUIM ALBENÍSIO G. DA
; CAVADA, BENILDO SOUSA
.
A mobilização das proteínas de sementes de Pisum arvense L. durante a germinação na ausência de luz foi estudada. As sementes foram completamente exauridas de suas reservas após 22 dias de germinação e as plântulas cresceram até o 18° dia de germinação. Experimentos de eletroforese em gel de poliacrilamida em presença de SDS indicaram que as principais bandas protéicas, correspondendo às proteínas de reserva de alta massa molecular, foram detectadas apenas até o 7° dia após a germinação. Entretanto, as bandas protéicas correspondentes às lectinas da semente puderam ser detectadas ao longo de todo o processo germinativo, sugerindo que essas proteínas são fortemente resistentes à ação das proteases da semente e devem, de alguma forma, ser importantes para o estabelecimento das plântulas. A atividade hemaglutinante nos cotilédones foi detectada até o 22° dia de germinação, indicando que as lectinas também permaneceram ativas quando os cotilédones estavam bastante exauridos de suas reservas.
ABSTRACT - The mobilization of seed proteins from Pisum arvense L. during germination in the absence of light was studied. The seeds were found to be completely consumed 22 days after germination and seedlings ceased growth after the 18th day. SDS-PAGE indicated that the main protein bands correspond to high molecular mass storage proteins which undergo proteolysis in the initial stages of germination and are not detected after the 7th day of germination. However, the corresponding lectin profiles were detected during the entire germination process, suggesting that these proteins are strongly resistant to seed proteolytic enzymes and should be important for seedling establishment. Furthermore, haemagglutinating activity in cotyledons was detected until 22 days after germination, indicating that the lectins remain active even in senescent cotyledons.
2616 downloads
11.
Mefloquina no tratamento da leishmaniose cutânea em uma área endêmica de Leishmania (Viannia) braziliensis
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Laguna-Torres, Victor Alberto
; Silva, Carlos A.C.
; Correia, Dalmo
; Carvalho, Edgard M.
; Magalhães, Albino V.
; Macêdo, Vanize de Oliveira
.
Revista da Sociedade Brasileira de Medicina Tropical
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O objetivo deste trabalho foi avaliar a eficácia da mefloquina numa região endêmica de leishmaniose cutânea por Leishmania (Viannia) braziliensis, considerando que esta droga de administração oral, eficaz no tratamento da malária, com meia vida prolongada e efeitos colaterais pouco freqüentes poderia ser menos tóxica e de mais fácil administração, quando comparada com os antimoniais pentavalentes. Em Corte de Pedra, no litoral sul do Estado da Bahia, foram tratados, aleatoriamente, dez pacientes portadores de lesões leishmanióticas, subdivididos em dois grupos. O primeiro grupo recebeu mefloquina pela via oral, dose de 250mg/dia, durante seis dias, repetindo-se o mesmo esquema após intervalo de três semanas. O segundo grupo recebeu antimoniato de meglumina (Glucantime®) diariamente, pela via endovenosa, na dose de 20mg/kg por 20 dias. Do grupo da mefloquina só um paciente apresentou cicatrização depois do segundo ciclo. Um desses, com quatro lesões apresentou nova lesão durante o primeiro ciclo de tratamento. A evolução dos outros três foi lenta sendo que em nove semanas nenhum deles tinha cicatrizado as úlceras que permaneciam com grande infiltração e sinais evidentes de atividade. O grupo tratado com Glucantime® apresentou evidente melhora.
The aim of this study was to evaluate the efficacy of mefloquine in the treatment of skin leishmaniasis in patients infected with Leishmania (Viannia) braziliensis at an endemic region. Mefloquine is an oral drug effective against malaria with a prolonged half-life, less toxicity and easier administration than pentavalent antimonials. At Corte de Pedra in the Southern litoral of Bahia State, two randomized groups of ten patients with leishmaniasis were treated. The first group was treated with oral mefloquine, 250mg per day in a single dose for six days and repeated three weeks later. The second group received meglumine antimoniate (Glucantime®), 20mg/kg daily administered intravenously for 20 days. Only one patient in the group treated with mefloquine showed evidence of clinical success. During treatment, one patient with four lesions developed a new lesion. The other three patients with clinical leismaniasis did not show evidence of clinical success after nine weeks of treatment. The group treated with Glucantime® showed evident clinical improvement of the skin lesions.
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