Resumen Objetivo: La enfermedad vascular periférica (EVP) afecta generalmente múltiples segmentos de los miembros. Existe información contradictoria con respecto al pronóstico de pacientes con enfermedad aortoilíaca, sin embargo, la diabetes y la enfermedad critica de miembros inferiores habitualmente afecta el territorio infrapatelar. Nuestro objetivo es determinar el impacto de la afectación infrapatelar en eventos cardiovasculares. Métodos: Estudio retrospectivo, observacional en un hospital universitario de Argentina. Se revisó la historia clínica electrónica de pacientes con EVP con requerimiento de revascularización. Se generó un modelo de regresión multivariado incluyendo variables clínicamente relevantes. El punto final primario fue un combinado de hospitalización por isquemia crítica y amputaciones mayores entre pacientes con afectación infrapatelar y suprapatelar. Amputaciones menores, muerte por todas las causas, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV) y un combinado de eventos cardiovasculares (MACE) fueron los puntos secundarios. Resultados: Se reclutó un total de 309 pacientes desde enero de 2014 hasta julio de 2020. 151 pacientes presentaron enfermedad suprapatelar y 158 infrapatelar. El punto final primario ocurrió en 35 pacientes (22.2%) en el grupo infrapatelar y en 18 pacientes (11.9%) en suprapatelares (HR 2.16; intervalo de confianza 95% [1.22-3.82]; p = 0.008). Ambos componentes ocurrieron con mayor frecuencia en pacientes con afectación infrapatelar. Los eventos de amputación menor fueron mas prevalentes en pacientes con afectación infrapatelar (HR 5.09; IC95% [1.47-17.6]; p = 0.010) La mortalidad por todas las causas, IAM, ACV y MACE no fueron diferentes entre los grupos (p > 0.05). Conclusión: La enfermedad infrapatelar fue un factor independiente para mayor riesgo de hospitalización por isquemia critica, amputación mayor y menor comparado con pacientes con afectación suprapatelar en EVP sintomática revascularizada.

Abstract Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapatellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI] = [1.22-3.82]; p = 0.008). Both components of the primary outcomes occurred more frequently in infrapatellar patients. Minor amputation events were more prevalent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death, MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was an independent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellar disease in symptomatic revascularized PAD patients.

OBJECTIVES: To evaluate if Proton Pump Inhibitor (PPI) prescription is based in Clinical Practice Guidelines (CPG) in hospitalized patients at two academic hospitals of Lima. MATERIALS AND METHODS: The services of Intern Medicine, Tropical Medicine and General Surgery were visited. Therapeutic sheets and nursing transcript were checked. The prescription motifs were determined in patients who received PPI. These motifs were obtained according to a check list, which was made from different CPG. RESULTS: 54.57% of the PPI prescriptions in the two academic hospitals were not based in CPG. No statistic significant difference was found between the two academic hospitals in the PPI prescription based in CPG (p=0,208). Most of the prescriptions not base on CPG belong to the service of General Surgery (83.6%; p<0.0001). The main indication for the prescription of PPI based on CPG was prevention of NSAIDS induced gastric ulcers if advanced age (65.72%). CONCLUSIONS: There is a high rate of PPI overuse in two academic hospitals.

OBJETIVOS: Evaluar si la prescripción de inhibidores de bomba de protones (IBP) está basada en Guías de Práctica Clínica en pacientes hospitalizados en dos hospitales docentes de Lima. MATERIALES Y MÉTODOS: Se acudió a los servicios de Medicina Interna, Medicina Tropical y Cirugía General de dos hospitales docentes, y se procedió a revisar las hojas de terapéutica y kárdex de enfermería. En los pacientes que recibían IBP se procedió a determinar el motivo de su prescripción según una lista de chequeo obtenida de diferentes guías de práctica clínica (GPC). RESULTADOS: El 54,57% de las prescripciones de IBP en los dos hospitales docentes no estuvieron basadas en GPC. No se encontró diferencias estadísticamente significativas entre ambos hospitales en cuanto a la prescripción de IBP basada en GPC (p=0,208). En el servicio de Cirugía General fue mayor la prescripción de IBP no basada en GPC con respecto al servicio de Medicina (83,6% versus 16.4%; p<0.0001). El principal motivo de prescripción de IBP basado en GPC fue la prevención de úlceras gástricas producidas por antiinflamatorio no esteroideo en pacientes con edad avanzada (65,72%). CONCLUSIONES: Existe una elevada frecuencia de sobreuso de IBP en los dos hospitales docentes.

Three soybean experiments, one for each maturation group (early, semi-early, and medium), were installed in the field in Assis, State of São Paulo, during the 2003/2004 growing season to evaluate damage caused by Anticarsia gemmatalis (Hubn.) and by the soybean stink bug complex, Euschistus heros (F.), Piezodorus guildinii (West.), and Nezara viridula (L.). The experiments were installed again in 2004/2005, with the exception of the early cycle group. Defoliation caused by A. gemmatalis was evaluated by the percentage estimate of leaf area cut in the first year only, due to low caterpillar infestations in 2004/2005. All three stink bug species were present in both growing seasons. In 2003/2004, E. heros was predominant over the other two; in the following year, all three species occurred in similar numbers. The productivity criterion was adopted to evaluate stink bug damage. Based on both growing seasons and mainly considering productivity, a few lines could be selected within each maturation group for new field studies or for hybridizations in breeding programs. Among the early germplasm varieties, lines IAC 98-4540, IAC 98-4576, and IAC 98-3123 can be highlighted as promising; the latter also showed little defoliation by A. gemmatalis; in the semi-early group, IAC 98-4017, IAC 98-2663, and IAC 98-4250 were prominent, with steady productivity in both years; in the medium group, IAC 98-4136, the most productive, as well as IAC 98-4140 and IAC 98-4133, all with little defoliation, can be pointed out as promising.

A utilização de cultivares de soja resistentes a pragas e doenças reduz a aplicação de pesticidas, diminuindo custos de produção e favorecendo uma agricultura sustentável. Assim, avaliaram-se os danos causados por percevejos e coleópteros crisomelídeos e a severidade de oídio (Microsphaera diffusa) em cultivares e linhagens de soja de ciclos precoce, semiprecoce e médio, em experimentos de campo instalados em Tarumã e Ribeirão Preto (SP), em 1999/2000 e 2000/2001. Em 1999/2000, essa doença atingiu a área experimental de Tarumã; ainda nesse ano, houve infestação de coleópteros crisomelídeos (Cerotoma sp. e Colaspis sp.) em Ribeirão Preto. Percevejos ocorreram nas duas localidades em baixas infestações, ultrapassando o nível de dano econômico em Tarumã, nos dois anos, apenas na fase de maturação. A severidade da doença foi avaliada mediante escala de notas, variando de 1 a 5. As injúrias de coleópteros foram avaliadas estimando-se a porcentagem de área foliar cortada (PAFC) e os danos de percevejos através da porcentagem de retenção foliar (PRF) e da produtividade. Baseando-se em todos os experimentos, infere-se que, entre o germoplasma de ciclo precoce, a linhagem IAC 94-2675 apresenta níveis de produtividade comparáveis aos de material comercial, baixos índices de PRF, além de resistência a oídio. No grupo semiprecoce, as linhagens IAC 94-5, IAC 94-1172, IAC 94-1017, IAC 94-133 e IAC 94-745 exibem boa produtividade, sendo as duas últimas resistentes a oídio. Entre os genótipos de ciclo médio, destacam-se as linhagens IAC 93-1564 e IAC 94-2939, resistentes a oídio, com baixos índices de PRF e boa produtividade.

The use of soybean cultivars resistant to insects and diseases reduces the application of pesticides, decreasing production costs and promoting a sustainable agriculture. The damage of stink bugs and defoliators and the severity of powdery mildew (Microsphaera diffusa) in soybean of three maturity groups were evaluated under field conditions, at Tarumã and Ribeirão Preto, State of São Paulo, Brazil. Three experiments, one for each group, were carried out in the 1999/2000 and 2000/2001 growing seasons. In 1999/2000, the disease occurred in Tarumã; in that year, infestation of chrysomelids (Cerotoma sp. and Colaspis sp.) was observed in Ribeirão Preto. Low infestations of stink bugs occurred in both years and locations, but in Tarumã, at the stage of plant maturation, the insect population exceeded the economic injury level. The severity of powdery mildew was evaluated using a scale varying from 1 (no symptom) to 5 (more than 50% of leaves with symptoms). Chrysomelid injuries were estimated by the percentage of leaf area removed, and stink bug damage was evaluated by the percentage of leaf retention (LRP) and yield. Within the early maturity group (110 days), IAC 94-2675 showed good yield levels, low LRP, and resistance to powdery mildew. In the genotypes of the 120-day maturity group, IAC 94-5, IAC 94-1172, IAC 94-1017, IAC 94-133, and IAC 94-745 presented good yield; the last two behaved as resistant to the disease. With regard to the genotypes of the 135-day maturity group, IAC 93-1564 and IAC 94-2939 showed good yield, low LRP, and resistance to powdery mildew.

Avaliaram-se os danos causados por percevejos e por desfolhadores em genótipos de soja de ciclos precoce, semiprecoce e médio, em experimentos de campo instalados em Tarumã e Ribeirão Preto, SP, em 1997/98 e 1998/99. Em Tarumã, ocorreram os crisomelídeos Diabrotica speciosa (Germar) e Cerotoma sp. nos dois anos e Anticarsia gemmatalis Hubn. no segundo; em Ribeirão Preto, apenas no segundo ano ocorreu a lagarta. Com relação a percevejos, somente no primeiro ano em Tarumã as infestações [predominância de Piezodorus guildinii (West.)] flutuaram acima do nível de dano econômico; em Ribeirão Preto, essas infestações foram baixas. Os danos de desfolhadores foram avaliados pela estimativa da porcentagem de área foliar cortada e os de percevejos pela estimativa da porcentagem de retenção foliar e pela produtividade. Considerando-se os dois anos e as duas localidades, no grupo precoce, 'IAC-22' exibiu suscetibilidade a desfolhadores enquanto 'IAC-17' confirmou sua resistência a esse grupo de pragas e também a percevejos. Dentre o germoplasma de ciclo semiprecoce, a linhagem IAC 93-3379 destacou-se pela maior produtividade, demonstrando estabilidade para esse critério. As linhagens IAC 93-3275 e IAC 93-3237 apresentaram baixa produtividade e altos índices de desfolha e de retenção foliar, principalmente em Tarumã. Nos genótipos de ciclo médio, verificou-se suscetibilidade aos percevejos em 'IAC Holambra-Stwart', 'IAC PL-1' e IAC 87-2048, embora esta linhagem seja produtiva em condições de baixa infestação. Ainda neste grupo, as linhagens IAC 78-2318, IAC 93-1789 e IAC 93-1796 apresentaram os menores índices de retenção foliar, indicando serem pouco suscetíveis a essa anomalia.

The damage of stinkbugs and defoliators in soybean genotypes was evaluated, under field conditions, at Tarumã and Ribeirão Preto, State of São Paulo, Brazil. Three experiments, one for each of three maturity group, were carried out, in the 1997/98 and 1998/99 seasons. In Tarumã, infestations of Diabrotica speciosa (Germar) and Cerotoma sp. occurred in both seasons and Anticarsia gemmatalis Hubn. in the second; in Ribeirão Preto, this caterpillar occurred only in the second year. Only in the first year in Tarumã, stinkbug infestations [predominantly Piezodorus guildinii (West.)], fluctuated above the economic injury level (EIL); in Ribeirão Preto, the stinkbug infestations did not exceed the EIL. Defoliaton damage was estimated by the percentage of eaten leaf area (PAFC). Percentage of foliar retention (PRF) and yield were used to evaluate the stinkbug damage. Considering both years and both locations, among the early maturing genotypes (110 days), 'IAC-22' showed susceptibility to defoliators while 'IAC-17' confirmed its resistance to this group of pests as well as to stinkbugs. Among the genotypes of 120-day maturity group, IAC 93-3379 could be distinguished for the high yield, showing stability by this criteria. IAC 93-3275 and IAC 93-3237 presented low yield and high PAFC and PRF, mainly in Tarumã. Regarding the genotypes of 135-day maturity group, susceptibility to stinkbugs was observed in 'IAC Holambra-Stwart', 'IAC PL-1' and IAC 87-2048; however, this line showed high yield under low infestation. Also, IAC 78-2318, IAC 93-1789 and IAC 93-1796 presented the lowest PRF, indicating to be less susceptible to this disorder.

O comportamento de 20 genótipos de soja foi avaliado em relação à preferência para oviposição, atratividade para adultos e colonização das plantas pela mosca branca Bemisia tabaci (Genn.) biótipo B, em teste de livre escolha, em casa de vegetação. O experimento foi conduzido com plantas de soja nas fases vegetativa e reprodutiva, infestadas artificialmente com esse inseto. As cultivares IAC 17, IAC 19 e a linhagem D 75-10169 apresentaram resistência do tipo não preferência para oviposição, baixos níveis de colonização e atratividade para adultos em relação a B. tabaci biótipo B. Também em casa de vegetação, foi avaliada a densidade de tricomas na superfície abaxial de folíolos dos 20 genótipos de soja, nos estratos superior, médio e inferior das plantas, nas fases de desenvolvimento em que as plantas foram avaliadas no teste de livre escolha. A linhagem D 75-10169 apresentou baixa densidade de tricomas, enquanto a cultivar IAC Holambra Stwart mostrou-se altamente pubescente. Foram verificadas correlações entre atratividade para adultos e preferência para oviposição e entre atratividade para adultos e colonização das plantas. Para confirmação dos resultados de preferência para oviposição, foi realizado teste sem chance de escolha, em casa de vegetação, no qual foi avaliado o comportamento de cinco genótipos (um altamente suscetível e os quatro menos preferidos para oviposição no teste com chance de escolha). A linhagem PI 227687, embora apresente resistência múltipla a insetos, foi altamente ovipositada por B. tabaci biótipo B, enquanto que 'IAC 19', 'IAC 17', 'Coodetec 201' e a linhagem D 75-10169 mantiveram a resistência do tipo não-preferência para oviposição.

Twenty soybean genotypes were evaluated in relation to silverleaf whitefly [Bemisia tabaci (Genn.) biotype B] resistance, in a free-choice test, under greenhouse conditions. The experiment was carried out with artificially infested soybean plants and evaluated during vegetative and reproductive stages. Line D 75-10169 and cultivars IAC 17 and IAC 19 presented nonpreference for oviposition, weak colonization and low adult attractiveness. Trichome density at abaxial trifoliolate surface was also measured in twenty soybean genotypes, at three plant positions (upper, middle and lower canopies), at the same development stages of the free-choice test. The line D 75-10169 presented the lowest trichome density while the cultivar 'IAC Holambra Stwart' showed the highest one. Significant correlations were detected between adult attractiveness and oviposition preference and between adult attractiveness and colonization level. To confirm the oviposition preference results, a no-choice test was carried out, also in greenhouse conditions, and the performance of five soybean genotypes (one highly susceptible and four with the smallest levels of oviposition) was checked. The line PI 227687, though showing multiple resistance to insects, was highly oviposited by silverleaf whitefly, while 'IAC 19', 'IAC 17', 'Coodetec 201' and line D 75-10169 showed oviposition nonpreference as the mecanism of resistance. The results strongly suggest that the resistance observed in those genotypes is stable.

Moscas brancas são pragas de diversas culturas, causam redução na produção e na qualidade do produto. Inseticidas, com diferentes modos de ação vêm sendo utilizados, sem muito sucesso. Neste trabalho avaliou-se a eficiência de inseticidas sobre ovos de diferentes idades (1, 3 e 5 dias) e de ninfas de 1° ínstar da mosca branca Bemisia tabaci biótipo B. Os experimentos foram realizados em condições de laboratório, sob temperatura de 25 ± 2°C e fotofase de 12 horas. Piriproxifem (75 mg L-1) atuou como excelente ovicida, sendo altamente eficiente, 3 dias de idade. Cartape (500 mg L-1) não teve efeito satisfatório, mas a 1000 mg L-1 foi eficiente em ovos com até 5 dias de idade. Quanto à ação sobre ninfas de 1° ínstar, para pulverizações na face superior das folhas, piriproxifem, a 75 mg L-1, apresentou eficiência na supressão da emergência de adultos, caracterizando presença de ação translaminar; buprofezim, cartape, acefato e fempiroximate não apresentaram eficiência no controle de ninfas. Quando aplicado na face inferior das folhas, buprofezim (375 mg L-1) apresentou eficiência comparável à de piriproxifem, impedindo a emergência de adultos.

Whiteflies are pests of many crops, cause severe yield losses and reduce crop quality. Insecticides of different modes of action have been used without success. In this work, the efficiency of five insecticides on Bemisia tabaci B biotype (= B. argentifolii) eggs and nymphs was evaluated under laboratory conditions (T = 25 ± 2°C; 12 h photophase). In relation to the ovicidal effect, pyriproxyfen (75 mg L-1) caused egg hatching inhibition up to three day old eggs. Cartap showed efficiency only at the concentration of 1000 mg L-1, supressing the viability of eggs up to five days. Soybean leaves with first instar nymphs were treated in the upper surface with pyriproxyfen (75 mg L-1), buprofezin (375 mg L-1), cartap (1000 mg L-1), acephate (750 mg L-1) and fenpyroximate (100 mg L-1); in this condition, only pyriproxyfen suppressed adult emergence, indicating the presence of a translaminar effect. When leaves with nymphs were treated on both surfaces, buprofezin showed an efficiency similar to that of pyriproxyfen, also preventing adult emergence of the B. tabaci B biotype.