Abstract Objective We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. Methods First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. Results A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. Conclusion This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

ABSTRACT Introduction: Near-fatal asthma (NFA) is defined as the most severe form of asthma characterized by a refractory asthma attack with an arterial carbon dioxide tension (PaCO2) greater than 45 mmHg and altered consciousness, requiring mechanical ventilation. Clinical Case: We reported the case of 40-year-old female patient, obese and asthmatic with irregular treatment who presented dyspnea accompanied by severe oppressive chest pain and loss of consciousness, with generalized cyanosis and severe shortness of breath, for which she underwent emergency endotracheal intubation and mechanical ventilation. Laboratory tests show decompensated respiratory acidosis, glycemia of 258 mg / dl and HbA1C of 7.94%; her diagnosing diabetes mellitus (DM). The presentation of NFA is rare and as a clinical manifestation in an obese patient with onset diabetic has never been reported in Peru; therefore, asthmatic patients with obesity and DM should be monitored due to the susceptibility to develop NFA.

RESUMEN Introducción: El asma casi fatal (ACF) se define como la forma más severa de asma que se caracteriza por una crisis asmática refractaria con una presión parcial de dióxido de carbono (PaCO2) mayor a 45 mmHg y alteración de la conciencia que requiere ventilación mecánica. Caso clínico: Presentamos a una paciente de 40 años, obesa y asmática con tratamiento irregular que acude por disnea acompañada de dolor torácico tipo opresivo de intensidad severa y pérdida de la conciencia, con cianosis generalizada y dificultad intensa para respirar por lo que se le realiza intubación endotraqueal de emergencia y ventilación mecánica. En los exámenes de laboratorio se encuentra acidosis respiratoria descompensada, glicemia de 258 mg/dl y HbA1C de 7,94%; diagnosticándole diabetes mellitus (DM). La presentación del ACF es poco frecuente y como manifestación clínica en una paciente obesa con DM debut nunca se ha reportado en el Perú; por tal motivo, se debe vigilar a los pacientes asmátciatis laudantium voluptatem. Vitae, aliquid.

RESUMEN Introducción: El sobrepeso y la obesidad presentan un rápido crecimiento en el mundo, con un mayor riesgo de enfermedades crónicas. Las estrategias nutricionales son de gran interés para el control y pérdida de peso, como la influencia de la frecuencia y el horario de alimentación. Objetivo: Determinar la relación entre la frecuencia y horario de alimentación con el sobrepeso y obesidad en población adulta trujillana de 30 a 70 años. Métodos: Estudio descriptivo, de corte transversal, con enfoque cuantitativo. Se incluyó una muestra de 160 participantes, entre 30 y 70 años; los datos se recolectaron mediante una encuesta virtual. Los participantes se clasificaron en un grupo de peso normal establecido por IMC entre 18.5-24.9 y un grupo de sobrepeso-obesidad establecido por IMC mayor o igual a 25. Se utilizó un cuestionario validado por expertos para evaluar la frecuencia y horario de alimentación. Resultados: De los 160 participantes, el 61.88% fue de sexo femenino, el 40% tuvo una edad entre 30-39 años. El grupo de peso normal se conformó por 60 participantes; y el de sobrepeso-obesidad, por 100 participantes. En el análisis estadístico, se evidenció una diferencia significativa entre el nivel de actividad física bajo-moderado (p=0.019), la frecuencia de alimentación no presentó diferencia significativa (p=0.477) y dentro del horario de alimentación, el consumo de cena posterior a las 8:00 pm presentó diferencia significativa (p=0.021), así como el consumo de intermedios posterior a las 5:00 pm (p=0.016). Conclusión: Consumir alimentos durante la noche en un horario posterior a las 8:00 pm se asocia significativamente a riesgo de sobrepeso y obesidad; mientras que en la frecuencia de alimentación no se presenta.

ABSTRACT Introduction: Overweight and obesity present rapid growth in the world, with an increased risk of chronic diseases. Nutritional strategies are of great interest for weight control and loss, as is the influence of feeding frequency and schedule. Objective: To determine the relationship between feeding frequency and schedule with overweight and obesity in the Trujilloan adult population aged 30 to 70. Methods: Descriptive, cross-sectional study with a quantitative approach. A sample of 160 participants aged between 30 and 70 years was included; the data were collected through a virtual survey. Participants were classified into a normal weight group established by BMI between 18.5-24.9 and an overweight-obesity group established by BMI greater than or equal to 25. An expert-validated questionnaire was used to assess feeding frequency and schedule. Results: Of the 160 participants, 61.88% were of the female sex, and 40% had aged between 30-39 years. The normal weight group was conformed of 60 participants, and the overweight obesity consisted of overweight-obesity per 100 participants. In the statistical analysis, a significant difference was evidenced between the low-moderate physical activity level (p=0.019), the feeding frequency presented no significant difference (p=0.477), and within the feeding schedule, the post-dinner consumption at 8:00 pm presented a significant difference (p=0.021), as well as the consumption of intermediates after 5:00 pm (p=0.016). Conclusion: Consume food during the evening at a time after 8:00 pm is significantly associated with risk of overweight and obesity; while at the feed frequency it is not presented.

ABSTRACT Nutrient-diluted diets, with lower protein and higher fiber contents, can reduce the cost of food. The present study evaluated the effect of diets with protein and fiber contents below the recommended standard on the growth of male Muscovy ducks (Cairina moschata Linnaeus, 1758) from 28 to 77 days of age. The proximal chemical analysis determined protein and fiber contents of 8.4 and 3.0% for diet 1 and 14.8 and 6.3% for diet 2, respectively. Diet 1 resulted in decreased weight gain, trends for lower carcass yield and liver weight, and increased gut size compared to diet 2. Abdominal fat deposition was not influenced by the diets. The excessive decrease in protein would lead to the appearance of nutrients that limit the synthesis of body proteins, resulting in lower weight gain and yield of the carcass. The trend of lower liver weight and shorter intestinal length in ducks that consumed high-fiber diets suggest less fat deposition in the liver and decreased intestinal absorption area due to the effect of fiber, respectively.

RESUMEN Dietas diluidas en nutrientes, con un menor contenido de proteína y mayor contenido en fibra, pueden ser elaboradas con la finalidad de disminuir el costo del alimento. El presente estudio evaluó el efecto de dietas con contenido de proteína y fibra por debajo del estándar recomendado sobre el crecimiento de patos machos Muscovy (Cairina moschata Linnaeus, 1758) desde los 28 hasta los 77 días de edad. El análisis químico proximal determinó el contenido de proteína y fibra en 8,4 y 3,0% para la dieta 1 y 14,8 y 6,3% para la dieta 2, respectivamente. El consumo de la dieta 1 disminuyó la ganancia de peso, mostró tendencias de menor rendimiento de la canal y peso del hígado, y aumentó el tamaño del intestino comparado con el consumo de la dieta 2. La deposición de grasa abdominal no fue influenciada por las dietas. La excesiva disminución de proteína en la dieta conllevaría a la aparición de nutrientes que limitan la síntesis de proteínas corporales, lo que se reflejarían en la menor ganancia de peso y rendimiento de la canal. La tendencia de menor peso hepático y menor longitud intestinal, en patos que consumieron dietas altas en fibra, sugieren menor depósito de grasa en el hígado y disminución del área de absorción intestinal por efecto de la fibra, respectivamente.

Abstract: This manuscript is an addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies, already published. It is the first part of a wider reflection aimed on refute several of the theses and arguments of a group of clinicians and researchers who question the validity of the “cholesterol hypothesis”, the usefulness and safety of statins and the most modern inhibitors of proprotein convertase of subtilisin/kexin type 9 (iPCSK9,) and the role of saturated fatty acids consumed in the usual diet in the atherosclerotic risk. This iconoclastic point of view is dangerous insofar as it undermines the scaffolding that supports the primary and secondary prevention of atherosclerosis. In this section of the manuscript, only the cholesterol hypothesis is discussed. The data of comparative zoology are reviewed, and several experimental animal models are analyzed, both supporting the link between cholesterol and the appearance and evolution of atherosclerotic lesions. The methodology and the results of the Study of the 7 Countries are defended and are exposed the numerous epidemiological, pathological, clinical and interventional evidences, which in our opinion give a solid sustenance to the cholesterol hypothesis. Based on this knowledge it is criticized the LDL cholesterol values currently considered adequate. Furthermore, the so-called residual risk is considered, as well as the conflicting evidence about the usefulness of statins in elderly patients.

Resumen: Este manuscrito es un apéndice del posicionamiento en torno al diagnóstico y tratamiento de las dislipidemias de la ANCAM y el grupo de las sociedades médicas asociadas, previamente publicado. Es la primera parte de un trabajo más amplio enfocado a refutar varias de las tesis y argumentos de un grupo de clínicos e investigadores que ponen en duda la validez de la “hipótesis del colesterol”, la utilidad y seguridad de las estatinas y los más modernos inhibidores de la proproteína convertasa de la subtilisina/kexina tipo 9 (iPCSK9) y el papel de los ácidos grasos saturados consumidos en la dieta habitual en el riesgo ateroscleroso. Este punto de vista iconoclástico es peligroso porque socava el andamiaje que soporta la prevención primaria y secundaria de la aterosclerosis. En esta primera sección del manuscrito, se discute sólo la hipótesis del colesterol. Se revisan los datos de zoología comparada y se analizan varios modelos animales de experimentación, que apoyan la liga entre el colesterol y la aparición y evolución de las lesiones aterosclerosa. Se defienden la metodología y los resultados del estudio de los 7 países y se exponen las numerosas evidencias epidemiológicas, patológicas, clínicas e intervencionistas, que a nuestro juicio dan un sustento sólido a la hipótesis del colesterol. Se critican también, en base a ese conocimiento, los valores de colesterol LDL actualmente considerados adecuados, a la vez que se discute el llamado riesgo residual y las evidencias conflictivas acerca de la utilidad de las estatinas en pacientes ancianos.

A proteína de superfície eritrocitária, Antígeno 1 do Merozoíta de Theileria equi (EMA-1), é um potencial candidato para o desenvolvimento de antígenos de valor diagnóstico para a piroplasmose equina. Com o objetivo de estabelecer um método de diagnóstico efetivo e prático, o gene EMA-1 da amostra Jaboticabal - SP de T. equi foi clonado e expresso em Escherichia coli contendo uma cauda de poli-histidina (His6-EMA1). O EMA-1 expresso reagiu com anticorpos específicos no Western blot e apresentou peso molecular aparente de 34 kDa, sendo altamente consistente com seu valor teórico. A sequência nucleotídica do gene EMA-1 da amostra Jaboticabal foi analisado comparativamente com outras sequências públicas, e os resultados indicam elevado grau de homologia com amostras de diversos países. A proteína recombinante purificada His6-EMA1 foi testada no ensaio imunoenzimático (ELISA) para a detecção de anticorpos anti-T. equi em equinos. O teste de ELISA diferenciou-se claramente entre soros de equinos infectados por T. equi, soros de animais infectados por Babesia caballi e soro normal de equino. Amostras de soros coletadas de equinos do Estado de São Paulo, sudeste do Brasil, foram examinadas para o diagnóstico da infecção por T. equi pelo ELISA. Das 170 amostras analisadas, 95,88% (163/170) foram positivas para T. equi. Os resultados sugerem que a proteína His6-EMA1 expressa em E. coli pode ser um antígeno confiável para diagnóstico imunológico pelo teste de ELISA, e que T. equi merece grande atenção no Estado de São Paulo.

The erythrocytic-stage surface protein, Equi Merozoite Antigen 1 (EMA-1), is a major candidate for the development of a diagnostic antigen for equine piroplasmosis. In order to establish an effective diagnostic method for practical use, the gene encoding the entire EMA-1 of Theileria equi Jaboticabal strain was cloned and expressed in Escherichia coli as a histidine-tagged protein (His6-EMA1). The expressed EMA-1 reacted with specific antibodies in Western blot and had an apparent molecular mass of 34 kDa which was largely consistent with its theoretical value. The nucleotide sequence of the EMA-1 gene of Jaboticabal strain was comparatively analyzed with other published sequences. The results indicated a high degree of homology with EMA-1 genes of all other strains isolated from various countries. The recombinant purified His6-EMA1 protein was tested in an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies anti-T. equi in horses. The ELISA clearly differentiated T. equi-infected from Babesia caballi-infected horse sera or normal horse sera. Field serum samples collected from horses in the State of São Paulo, Southeastern Brazil, were examined for the diagnosis of T. equi infection by ELISA. Of 170 samples analyzed, 95.88% (163/170) were positive for T. equi infection. These results suggest that the His6-EMA1 protein expressed in E. coli could be a reliable immunodiagnostic antigen for ELISA test and that T. equi infection is a serious concern in the State of São Paulo, Brazil.

Em cultivos tradicionais de mandioca de mesa (Manihot esculenta Crantz), bons rendimentos quanto à produção e qualidade das raízes, são obtidos a partir de oito a dez meses após o plantio. Plantas submetidas à menor competição resultam em maior produção de raízes. O objetivo deste trabalho foi avaliar a densidade populacional como instrumento para a produção precoce de raízes comerciais. O experimento foi desenvolvido no ano agrícola de 2001/2002, utilizando-se a cultivar IAC 576-70, em sete densidades populacionais variáveis de 5.000 e 20.000 plantas ha-1, com colheitas aos seis, oito, dez, doze, quatorze e dezesseis meses após o plantio. Obteve-se a produtividade máxima de 26,8 t ha-1 de raízes aos 16 meses, estimada por regressão na densidade de 20.000 plantas ha-1. No entanto, as maiores produções de raízes comerciais ocorrem nas menores densidades populacionais, para todas as épocas de colheita estudadas, devido à menor taxa de descarte de raízes que se observa nas baixas populações. Nas colheitas precoces, aos seis e oito meses, observaram-se as produções comerciais estimadas de, respectivamente, 5,9 e 11,1 t ha-1 com 5.000 plantas ha-1, e 5,0 e 7,2 t ha-1 com 20.000 plantas ha-1. Esses resultados demonstram que, baixas densidades populacionais em mandioca de mesa possibilitam colheitas precoces, aos 6, 8 e 10 meses após o plantio, com bons rendimentos comerciais de raízes.

In sweet cassava production, economic yields of high quality roots are obtained only after a growing season of eight to ten months. In addition, cassava plants under little competition present higher yields per plant. The objective of this work was to study the handling of population densities in the sweet cassava crop, as a tool to obtain high yield of high quality roots in earlier harvests. Seven plant densities, from 5,000 to 20,000 plants ha-1, were tested with growing cycles of six, eight, ten, twelve, fourteen and sixteen months, in a field trial using the cv. IAC 576-70. Total root yields increased with time, being the highest values obtained with the highest plant densities. It was estimated, with a regression model, a maximum yield of 26.8 t ha-1, when using 20,000 plants ha-1 and a growing cycle of sixteen months. On the other hand, the highest yields of marketable roots were obtained with smaller plant densities in all harvests, which was caused by lower root discard rate at low populations. The maximum yield was 19.1 t ha-1 in the latest harvest by using 5,000 plants. In earlier harvests, after six and eight months, the marketable yields estimated were 5.9 t ha-1 and 11.1 t ha-1, when using 5,000 plants; and 5.0 t ha-1 and 7.2 t ha-1 with 20,000 plants. In this way, low population densities for the sweet cassava crop enable earlier harvests, at six, eight and ten months after planting with good yields of commercial roots.

O presente estudo teve como objetivo avaliar as possíveis alterações eletrocardiográficas e as alterações histopatológicas no pulmão de cães submetidos à pneumonectomia esquerda em abordagem comparativa entre dois tipos de sutura de coto brônquico (manual e mecânica). Foram utilizados doze cães, machos e fêmeas, adultos, sem raça definida, pesando entre quinze e vinte quilos sendo avaliados as alterações microscópicas apresentadas pelo pulmão direito e as alterações do eletrocardiograma. Todos os animais apresentaram-se em condições clínicas satisfatórias no período pós-operatório. As principais alterações eletrocardiográficas observadas no período pós-operatório foram desvio de eixo cardíaco, bloqueio sinoatrial e isquemia de miocárdio. No exame histopatológico, constatou-se atelectasia pulmonar, proliferação de epitélio de bronquíolo tendendo à obliteração, bronquiolite obliterante e enfisema pulmonar. O estudo sugere ainda que o pulmão direito foi submetido à hipertensão pulmonar.

The study had purpose to evaluate the possible electrocardiographical alterations and the histopathological alterations in the lung of dogs submited by left pneumonectomy with comparative approach between two types of suture of bronchial stamp (manual and mechanical). We used twelve dogs, males and females, adults, mongrel dogs, weighting between 15 and 20 kilograms and evaluated the macroscopic alterations of right lung and the alterations of electrocardiogram. All animals showed clinical condition satisfactory in the post operated time. The electrocardiographical alterations were deviation of cardiac axis, sinoatrial block and miocardial isquemia. The histopathological alterations were pulmonary atelectasis, proliferations of bronchiole epithelium tended to obliterations and pulmonary emphysema. The study suggested that right lung was submited to pulmonary hipertension.