SUMMARY: Diacylglycerol kinase (DGK) exerts balancing the intracellular level between two-second messengers, diacylglycerol and phosphatidic acid, by its phosphorylation activity. DGK ζ is often localized in cell nuclei, suggesting its involvement in the regulation of intranuclear activities, including mitosis and apoptosis. The present immunohistochemical study of rat kidneys first revealed no detection levels of DGK ζ -immunoreactivity in nuclei of most proximal tubule epithelia in contrast to its distinct occurrence in cell nuclei of collecting and distal tubules with the former more dominant. This finding suggests that DGK ζ is a key factor regulating vulnerability to acute kidney injury in various renal tubules: its low expression represents the high vulnerability of proximal tubule cells, and its distinct expression does the resistance of collecting and distal tubule cells. In addition, this isozyme was more or less localized in nuclei of cells forming glomeruli as well as in endothelial nuclei of peritubular capillaries and other intrarenal blood vessels, and epithelial nuclei of glomerular capsules (Bowman’s capsules) and renal calyces, including intrarenal interstitial cells.

RESUMEN: La diacilglicerol quinasa (DGK) ejerce el equilibrio del nivel intracelular entre dos segundos mensajeros, diacilglicerol y ácido fosfatídico, por su actividad de fosforilación. La DGK ζ a menudo se localiza en los núcleos celulares, lo que sugiere su participación en la regulación de las actividades intranucleares, incluidas la mitosis y la apoptosis. El presente estudio inmunohistoquímico en riñones de rata no reveló niveles de detección de inmunorreactividad de DGK ζ en los núcleos de la mayoría de los epitelios de los túbulos proximales, en contraste a la detección en los núcleos celulares de los túbulos colectores y distales, siendo el primero más dominante. Este hallazgo sugiere que DGK ζ es un factor clave que regula la vulnerabilidad a la lesión renal aguda en varios túbulos renales: su baja expresión representa la alta vulnerabilidad de las células del túbulo proximal, y su expresión distinta hace a la resistencia de las células del túbulo colector y distal. Además, esta isoenzima estaba más o menos localizada en los núcleos de las células que forman los glomérulos, así como en los núcleos endoteliales de los capilares peritubulares y otros vasos sanguíneos intrarrenales, y en los núcleos epiteliales de las cápsulas glomerulares (cápsulas de Bowman) y los cálices renales, incluidas las células intersticiales intrarrenales.

Resumo Antecedentes A percussão é uma parte importante do exame neurológico e os martelos de reflexo são necessários para obtê-la adequadamente. Objetivo Nós visamos revisar os aspectos históricos dos principais martelos de reflexo neurológico e definir qual é o preferido dos neurologistas brasileiros. Métodos Procuramos artigos originais e artigos de revisão sobre os aspectos históricos dos martelos de reflexo na Scielo e no Pubmed, e conduzimos um questionário online para investigar qual é o preferido dos neurologistas brasileiros. Resultados Na primeira parte, descrevemos os principais marcos na criação dos martelos de reflexo. Na sequência, expomos os resultados do questionário online: Babinski-Rabiner foi o martelo mais votado. Conclusões A origem dos martelos de reflexos vem muito antes de sua criação, a partir de um método de exame clínico básico: a percussão. Desde a descrição dos reflexos tendinosos profundos e da criação de martelos de percussão, muito se aperfeiçoou sobre essa técnica. Dentre todos os martelos pesquisados, o de Babinski-Rabiner foi o escolhido por uma parcela significativa dos neurologistas brasileiros. obtêla obtê la adequadamente brasileiros Pubmed sequência BabinskiRabiner Babinski Rabiner votado básico técnica pesquisados

Abstract Background Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. Objective We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists. Methods We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists. Results In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted. Conclusions The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists. properly neurologists Following BabinskiRabiner Babinski Rabiner voted method technique surveyed

In biliary atresia (BA), efforts to prevent premature liver transplantation (LT) are aimed at early diagnosis, timing of Kasai-portoenterostomy (KPE), and centralization of care. This report presents the clinical picture, treatment strategies, and outcomes of BA patients with no previous treatment. A retrospective cohort study (Jan/2001 to Jan/2021) was conducted to evaluate the outcome of patients with BA referred to a single team. Study groups were: 1) Kasai-only group (K-only) n=9), 2) LT-only group (n=7), and 3) Kasai+LT group (K+LT) (n=23). Survival with native liver and overall survival were 22.9 and 94.8%, respectively, at 120 months of follow-up. There was no difference in age at KPE in the K-only group (46.8±21.8 days) vs K+LT (52.1±22 days), P=0.4. Ten (25.6%) patients were babies conceived through in vitro fertilization (IVF). Four IVF patients (40%) presented associated congenital heart disease vs 5 patients (17%) in the remaining group (P=0.14). Two of the IVF patients were premature (<37 weeks). Median maternal age at birth was 35 years (33 to 41 years). Excellent patient survival is expected for patients with BA with the available treatment strategies. IVF+BA was an unexpected prevalent association in this cohort, and further studies are required to better understand these findings.

Abstract Objectives Hospitalization during pregnancy and childbirth increases the risk of Venous Thromboembolism Risk (VTE). This study applied a VTE risk score to all hospitalized pregnant women to ascertain its effectiveness in preventing maternal death from VTE until 3 months after discharge. Methods In this interventional study, patients were classified as low- or high-risk according to the VTE risk score (Clinics Hospital risk score). High-risk patients (score ≥ 3) were scheduled for pharmacological Thromboprophylaxis (TPX). Interaction analysis of the main risk factors was performed using Odds Ratio (OR) and Poisson regression with robust variance. Results The data of 10694 cases (7212 patients) were analyzed; 1626 (15.2%, 1000 patients) and 9068 (84.8%, 6212 patients) cases were classified as high-risk (score ≥ 3) and low-risk (score < 3), respectively. The main risk factors (Odds Ratio, 95% Confidence Interval) for VTE were age ≥ 35 and < 40 years (1.6, 1.4-1.8), parity ≥ 3 (3.5, 3.0-4.0), age ≥ 40 years (4.8, 4.1-5.6), multiple pregnancies (2.1, 1.7-2.5), BMI ≥ 40 kg/m2 (5.1, 4.3-6.0), severe infection (4.1, 3.3-5.1), and cancer (12.3, 8.8-17.2). There were 10 cases of VTE: 7/1636 (0.4%) and 3/9068 (0.03%) in the high- and low-risk groups, respectively. No patient died of VTE. The intervention reduced the VTE risk by 87%; the number needed to treat was 3. Conclusions This VTE risk score was effective in preventing maternal deaths from VTE, with a low indication for TPX. Maternal age, multiparity, obesity, severe infections, multiple pregnancies, and cancer were the main risk factors for VTE.

ABSTRACT Purpose COVID-19 posed numerous challenges to educational programs that had to quickly adapt to remote online learning (ROL) to ensure the continuity of health professional training over the pandemic. We aimed to assess the students' and professors' perceptions of the teaching-learning process in the Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs at a Brazilian public university. Methods We used an electronic self-reported questionnaire with multiple-choice questions on a Likert scale ranged 1-5; higher the score, higher the level of agreement/importance/satisfaction. Results Most of undergraduate students and teachers had previous experience using information and communication technologies, and 85% stated their preference for in-person learning. Students expressed their appreciation for more active learning methodologies with clear objectives, accessible content, and visualization of abstract concepts. Regarding benefits and barriers, some similar perceptions were observed between students and teachers with ROL favoring time management, benefits in the teaching-learning process, satisfaction and motivation with the course content, and low attendance rates to general academic activities due to absent or poor access to technological resources. Conclusion ROL is an alternative learning mode when the in-person classes cannot be carried out, as in the case of the COVID-19 pandemic. ROL is believed to be unfit to replace in-person learning, although it can complement the traditional classroom-based education in a hybrid model, respecting the nature of each program in the field of health that requires in-person practical training.

RESUMO Objetivo O COVID-19 impôs inúmeros desafios aos programas educacionais que tiveram que se adaptar rapidamente ao aprendizado remoto on-line (ARO) para garantir a continuidade da formação dos profissionais de saúde durante a pandemia. O objetivo do estudo foi avaliar a percepção de alunos e professores sobre o processo ensino-aprendizagem dos cursos de graduação em Fisioterapia, Fonoaudiologia e Terapia Ocupacional de uma universidade pública brasileira. Métodos Foi utilizado um questionário eletrônico autoaplicável com questões de múltipla escolha em escala Likert de 1 a 5; quanto maior a pontuação, maior o nível de concordância/importância/satisfação. Resultados A maioria dos alunos de graduação e professores tinha experiência anterior no uso de tecnologias de informação e comunicação, e 85% afirmaram preferir o ensino presencial. Os alunos expressaram preferência por metodologias de aprendizagem mais ativas, com objetivos claros, conteúdo acessível e visualização de conceitos abstratos. Em relação aos benefícios e barreiras, algumas percepções semelhantes foram observadas entre alunos e professores com ARO favorecendo a gestão do tempo, benefícios no processo ensino-aprendizagem, satisfação e motivação com o conteúdo do curso e baixa frequência às atividades acadêmicas gerais por ausência ou dificuldade de acesso aos recursos tecnológicos. Conclusão O ARO pode ser uma modalidade alternativa de aprendizado quando as aulas presenciais não podem ser realizadas, como no caso da pandemia do COVID-19. Porém, o ARO é inadequado para substituir a aprendizagem presencial, embora possa complementar a educação presencial tradicional em um modelo híbrido, respeitando a natureza de cada programa na área da saúde que exige formação prática presencial.

SUMMARY OBJECTIVE: The objective of this study was to compare the nutritional status and dietary intake of pregnant women with sickle cell disease (SS hemoglobinopathy and SC hemoglobinopathy) to healthy controls and report the maternal and perinatal outcomes. METHODS: This is a prospective, longitudinal cohort study. Pregnant women with a diagnosis of sickle cell disease and control group were recruited in an outpatient clinic of a tertiary care hospital in São Paulo, Brazil. Maternal anthropometric data and dietary intake data were collected at the second and third trimesters. RESULTS: A total of 49 pregnancies complicated by sickle cell disease were included. Prepregnancy body mass index was significantly lower in the SS hemoglobinopathy group (n=26, median 20.3 kg/m2) than the SC hemoglobinopathy group (n=23, 22.7 kg/m2) or control group (n=33, 23.2 kg/m2, p<0.05). The prepregnancy nutritional status revealed significantly more women classified as underweight in the SS hemoglobinopathy group (15.4%) than in the SC hemoglobinopathy group (4.4%) and control group (1.6%, p=0.009). In the second trimester, maternal protein intake was significantly lower in SS hemoglobinopathy (73.2 g/day) and SC hemoglobinopathy (68.8 g/day) than in the control group (95.7 g/day, p=0.004). In the third trimester, only SS hemoglobinopathy mothers showed dietary intake of protein significantly lower than that of the controls (67.5 g/day vs. 92.8 g/day, p=0.02). Vitamin A and E consumption was also reduced in the third trimester in the SS hemoglobinopathy group (p<0.05). CONCLUSION: The nutritional status of pregnant women with SS hemoglobinopathy is characterized by a state of undernutrition. The lower protein intake in the second and third trimesters of pregnant women with SS hemoglobinopathy may contribute to this condition. Undernourishment is a serious complication of sickle cell disease, primarily during pregnancy, and it should be addressed during the prenatal period.

Resumen El género de insectos escama Crypticerya Cockerell, 1895 (Hemiptera: Coccomorpha: Monophlebidae: Iceryini), se distribuye principalmente en el Nuevo Mundo e incluye numerosas especies de plagas a pesar de ser un grupo relativamente pequeño. Los ovisacos, en las especies que los producen, tienen canales o surcos longitudinales, de ahí su nombre común “cochinillas acanaladas”. En el presente estudio, Crypticerya multicicatrices Kondo & Unruh y Crypticerya genistae (Hempel) (Hemiptera: Coccomorpha: Monophlebidae) se reportan por primera vez en Ecuador. Las dos especies se encontraron causando brotes poblacionales en áreas verdes urbanas de la provincia de Guayas en la costa ecuatoriana, donde atacan plantas nativas y exóticas. Se identificaron 85 y 11 nuevos registros de plantas hospedantes para C. multicicatrices y C. genistae, respectivamente. Las especies de plantas hospedadoras preferidas para ambas escamas acanaladas invasoras pertenecen a la familia Fabaceae. No se encontraron diferencias significativas en el nivel de infestación por C. multicicatrices y C. genistae entre especies de plantas hospedantes nativas y exóticas. En general, C. multicicatrices prefiere los árboles como hospedantes, mientras que C. genistae prefiere las plantas arvenses y los arbustos. Ambas especies se consideran plagas importantes en las áreas verdes urbanas, asociadas con fumagina, el amarillamiento de las hojas e incluso la muerte regresiva de los árboles. Por último, se discuten brevemente las estrategias de manejo para controlar las escamas acanaladas.

Abstract The scale insect genus Crypticerya Cockerell, 1895 (Hemiptera: Coccomorpha: Monophlebidae: Iceryini) is mainly distributed in the New World and includes numerous pest species despite being a relatively small group. Ovisacs have longitudinal flutes or grooves in those species that produce them, hence their common name “fluted scales”. In the present study, Crypticerya multicicatrices Kondo & Unruh and Crypticerya genistae (Hempel) are reported for the first time from Ecuador. The two species of fluted scales were found to cause outbreaks in urban green areas in Guayas province on the Ecuadorian coast, attacking native and alien plants. Eighty-five and eleven new host plant species were recorded for C. multicicatrices and C. genistae, respectively. Both invasive fluted scales prefer hosts in the family Fabaceae. No significant differences in the infestation levels of C. multicicatrices and C. genistae were found between native and alien host-plant species. In general, C. multicicatrices prefers trees as hosts, whereas C. genistae prefers herbaceous plants and shrubs. Both species are considered serious pests in urban green areas, associated with sooty molds, yellowing of leaves, and, in some cases, tree dieback. Management strategies to control the fluted scales are discussed briefly.

ABSTRACT Objective: We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods: We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results: A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 ± 12.7 years, HbA1c: 8.3 ± 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion: The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia.

RESUMO Variações climáticas tendem a aumentar a ocorrência de condições extremas de seca em ambientes semiáridos e isso pode comprometer o rendimento mesmo de culturas tolerantes como palma forrageira. A irrigação da palma com água salina têm possibilitado bons resultados, e sua combinação com modificações nas densidades de plantio pode refletir em mudanças na resposta produtiva da cultura. Um experimento de campo em dois ciclos de cultivo foi realizado para avaliar as concentrações de nutrientes em palma forrageira ‘Gigante’ (Opuntia ficus-indica Mill) irrigada sob diferentes laminas de água salina e densidades de plantio. O delineamento experimental foi em blocos casualizados em esquema de parcelas subsubdivididas, sendo alocados nas parcelas dois turnos de rega (7 e 14 dias), nas subparcelas quatro densidades de plantio (20.000; 40.000; 60.000 e 80.000 plantas ha-1) e nas subsubparcelas quatro lâminas de irrigação com água salina de condutividade elétrica de 2,91 dS m-1 (0, 11, 22 e 33% da evapotranspiração de referência - ETo). As lâminas de irrigação foram aplicadas somente no período do ano sem chuva. Densidades de plantio intermediárias (43.002 e 54.687 plantas ha-1) promovem menores concentrações de P, Ca e Fe nos tecidos dos cladódios de palma forrageira ‘Gigante’. Irrigação de palma forrageira ‘Gigante’ com água salina até a lâmina 33% da ETo, possibilita aumento das concentrações de N, P, Ca, Mg, B, Cu, Mn e Zn nos tecidos dos cladódios. Lâminas de irrigação entre 16 e 25% da ETo com água salina, promove máximas concentrações de K, S e Na.

ABSTRACT Climate variability tends to increase the occurrence of extreme drought conditions in semi-arid regions, thereby compromising crop yield, including that of drought-tolerant plants such as forage cactus pear. Irrigation of cactus with saline water has enabled good results, and its combination with changes in planting densities may promote changes in the production response of this crop. A field experiment spanning two crop cycles was carried out to evaluate nutrient concentrations in ‘Gigante’ forage cactus pear (Opuntia ficus-indica Mill) under different saline water irrigation depths and planting densities. A randomized block design was used with treatments arranged in split-split plots. Two irrigation intervals (7 and 14 days) were assigned to plots, four planting densities (20,000; 40,000; 60,000 and 80,000 plants ha-1) to subplots, and four irrigation depths of saline water of electrical conductivity 2.91 dS m-1 (0, 11, 22 and 33% of reference evapotranspiration) to sub-subplots. The irrigation depths were applied only in the period of the year without rain. Intermediate planting densities (43,002 and 54,687 plants ha-1) promote lower P, Ca and Fe concentrations in cladode tissues of forage cactus pear. Irrigating ‘Gigante’ cactus forage with saline water up to 33% ETo increases the concentrations of N, P, Ca, Mg, B, Cu, Mn and Zn in cladode tissues. Irrigation levels between 16 and 25% of ETo with saline water resulted in the highest concentrations of K, S and Na.

ABSTRACT A major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN. Materials and Methods: Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3). Results: Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography. Conclusions: We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

RESUMEN Durante un estudio realizado para determinar la prevalencia de cochinillas harinosas en huertos de piña (Ananas comosus) realizado en el departamento del Valle del Cauca, Colombia, la avispa parasitoide, Hambletonia pseudococcina Compere, 1936 (Hymenoptera: Encyrtidae) y la mosca depredadora Pseudiastata sp. (Diptera: Drosophilidae) se encontraron en asociación con la cochinilla harinosa de la piña, Dysmicoccus brevipes (Cockerell, 1893) (Hemiptera: Pseudococcidae). Los dos enemigos naturales se diagnostican e ilustran brevemente. Este es el primer registro del género Pseudiastata en Colombia.

ABSTRACT During a study carried out to determine the prevalence of mealybugs in pineapple (Ananas comosus) orchards conducted in the department of Valle del Cauca, Colombia, the parasitoid wasp Hambletonia pseudococcina Compere, 1936 (Hymenoptera: Encyrtidae) and the predatory fly Pseudiastata sp. (Diptera: Drosophilidae) were found in association with the pineapple mealybug Dysmicoccus brevipes (Cockerell, 1893) (Hemiptera: Pseudococcidae). These two natural enemies are briefly diagnosed and illustrated. This is the first record of the genus Pseudiastata in Colombia.

RESUMO Objetivou-se com esse trabalho avaliar o desempenho agronômico e a eficiência do uso da água de sistemas de sucessão de culturas em preparo convencional (PC) e plantio direto (PD), em dois experimentos instalados na região norte de Minas Gerais. O experimento 1 foi constituído pelo plantio em sucessão de milho- grão / feijão-comum, e o experimento 2 constituído pelo plantio em sucessão de sorgo / milho-verde. Em ambos os experimentos, os tratamentos foram constituídos por dois sistemas de manejo (PC e PD), dispostos no esquema de faixas, em dois anos de cultivo, com dez repetições. Foram avaliadas a produtividade e os componentes de produção de cada cultura, além da eficiência no uso de água (EUA) pelas culturas instaladas nas safras de outono-inverno, dentro de cada sistema de sucessão. Os dados obtidos foram submetidos à análise de variância, e, no caso de significância, as médias foram estudadas pelo próprio teste F a 5% de significância. Os resultados obtidos permitiram concluir que na sucessão milho-grão / feijão-comum, o PD aumenta a produtividade do milho em 21.45%, contudo, não há diferença entre os manejos para a produtividade feijão- comum. Na sucessão sorgo / milho-verde, o PD proporciona aumento da produtividade da matéria verde e matéria seca de sorgo em 39.65 e 84.26%, respectivamente, enquanto que no cultivo do milho-verde, o PD aumenta em 11.99 e 21.80%, respectivamente, a produtividade de espigas totais e comerciais. Nos dois sistemas de sucessão, o PD proporciona aumento na EUA pelas culturas, nas safras de outono-inverno.

ABSTRACT The objective of this work was to evaluate the agronomic performance and water use efficiency of crop rotations under conventional system (CTS) and no-tillage system (NTS) through two experiments conducted in the Semiarid region of the northern state of Minas Gerais, Brazil. Experiment 1 consisted of a grain corn-common bean rotation, and experiment 2 consisted of a sorghum-sweet corn rotation. The treatments, in both experiments, consisted of two tillage systems (CTS and NTS) arranged in strip-plots, in two crop years, with ten replications. Yield and production components of all crops and water use efficiency (WUE) of crops grown in the autumn-winter seasons were evaluated within each crop rotation. The data obtained were subjected to analysis of variance and, when significant, the means were subjected to the F test at 5% significance level. The results obtained showed that the NTS increases corn yield in 21.45% in the grain corn-common bean rotation; however, the common bean yield present no difference between tillage systems. NTS increases the sorghum fresh and dry matter yields in 39.65% and 84.26%, respectively, in the sorghum- sweet corn rotation, and the sweet corn total and commercial ear yield in 11.99% and 21.80%, respectively. The NTS increases the WUE of crops grown in the autumn-winter season, in both crop rotations.

ABSTRACT BACKGROUND: Although autonomic dysfunction has been shown to be associated with liver cirrhosis, the prevalence and prognostic implications are unclear. Abnormal heart rate variability (HRV), a measure of autonomic function, has not been well investigated in cirrhosis. OBJECTIVE: To evaluate the prevalence of high-risk HRV parameters in a cohort of cirrhotic patients and their association with cardiac dysfunction and mortality. DESIGN AND SETTING: Prospective observational study conducted in the Federal University of São Paulo. METHOD: A cohort of 120 patients, comprising 17 healthy controls and 103 cirrhotic outpatients, was evaluated and followed for 10 months. HRV analysis was based on 24-hour Holter monitoring and defined using time-domain and frequency-domain parameters. RESULTS: The HRV parameters were statistically lower in cirrhotic patients than in healthy subjects. High-risk HRV parameters were prevalent, such that 64% had at least one high-risk parameter. Time-domain parameters correlated with Child scores (P < 0.0001). In regression models, HRV parameters were independent predictors of diastolic dysfunction and mortality. During 10 months of follow-up, there were 11 deaths, all of patients with at least one high-risk HRV parameter. Kaplan-Meier analysis estimated low survival rates among patients with standard deviation of normal-to-normal RR intervals (SDNN) < 100. CONCLUSION: Reduced HRV is prevalent in liver cirrhosis and is related to cardiac dysfunction, severity of liver disease and mortality. Abnormal high-risk HRV parameters are prevalent among cirrhotic patients and are also predictors of mortality. Our findings highlight the need for a more careful cardiac evaluation of cirrhotic patients.