Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction

AbstractBackground:The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated.Objective:To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality.Methods:Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models.Results:Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality.Conclusion:One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.

Frequency of Cardiovascular Involvement in Familial Amyloidotic Polyneuropathy in Brazilian Patients

Background:Familial amyloidotic polyneuropathy (FAP) is a rare disease diagnosed in Brazil and worldwide. The frequency of cardiovascular involvement in Brazilian FAP patients is unknown.Objective:Detect the frequency of cardiovascular involvement and correlate the cardiovascular findings with the modified polyneuropathy disability (PND) score.Methods:In a national reference center, 51 patients were evaluated with clinical examination, electrocardiography (ECG), echocardiography (ECHO), and 24-hour Holter. Patients were classified according to the modified PND score and divided into groups: PND 0, PND I, PND II, and PND > II (which included PND IIIa, IIIb, and IV). We chose the classification tree as the statistical method to analyze the association between findings in cardiac tests with the neurological classification (PND).Results:ECG abnormalities were present in almost 2/3 of the FAP patients, whereas ECHO abnormalities occurred in around 1/3 of them. All patients with abnormal ECHO also had abnormal ECG, but the opposite did not apply. The classification tree identified ECG and ECHO as relevant variables (p < 0.001 and p = 0.08, respectively). The probability of a patient to be allocated to the PND 0 group when having a normal ECG was over 80%. When both ECG and ECHO were abnormal, this probability was null.Conclusions:Brazilian patients with FAP have frequent ECG abnormalities. ECG is an appropriate test to discriminate asymptomatic carriers of the mutation from those who develop the disease, whereas ECHO contributes to this discrimination.

Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure

Background: Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. Objectives: Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). Methods: Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. Results: We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). Conclusion: There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals.

Composition and diversity of Trichoptera (Insecta) larvae communities in the middle section of the Jacuí river and some tributaries, State of Rio Grande do Sul, Brazil

The taxonomic composition and diversity of Trichoptera larvae communities were studied in four lotic sites in central region of State of Rio Grande do Sul. Sampling was done monthly from June, 2001 to May, 2002 in four sites located at the middle section of Jacuí River (Point 4) and in three tributaries (Carijinho River - Point 1; Lajeado da Gringa - Point 2 and Lajeado do Gringo - Point 3), with a Surber sampler. The total number of larvae collected was 29,143, belonging to 25 genera distributed in nine families; twenty of these genera are new records for the State. The highest abundance was found at Point 2 (n = 12,547). The highest standardized richness, for a 1,177 specimens sample chosen by chance, was recorded at Point 1, followed by Point 4 (17.7 and 16 genera, respectively). The highest diversity was found at Point 1, and the lowest at Point 3 (H' = 1.31 and H' = 0.77, respectively). Point 1 had the lowest anthropic influence and the best preserved riparian vegetation, while Point 3 presented the highest anthropic impact, and a very reduced riparian vegetation. The diversity of Trichoptera observed in this study is low, compared to the estimated maximum theoretical diversity. Low diversity values are related to the low evenness, since the richness was relatively high. The Trichoptera larvae communities seem to be related to the food availability and physical features (riparian vegetation and anthropic influence) of the study sites.

Distribuição temporal e espacial de anuros em área de Pampa, Santa Maria, RS

Este estudo teve como objetivo determinar a riqueza, a constância de ocorrência, os modos reprodutivos, o padrão de distribuição da abundância, a temporada de vocalização e testar a correlação das variáveis climáticas sobre a atividade de vocalização dos anuros em uma região do Bioma Pampa, Santa Maria, Rio Grande do Sul. Durante o período de novembro de 2001 a outubro de 2002 foram realizadas coletas mensais empregando o método de ‘busca em sítio de reprodução’ e exame de exemplares depositados na Coleção Herpetológica do Setor de Zoologia da Universidade Federal de Santa Maria (ZUFSM). Foi registrada a ocorrência de 25 espécies de anuros. A anurofauna registrada corresponde a 30% das espécies encontradas no Rio Grande do Sul e normalmente está associada a áreas abertas encontradas no estado e em países vizinhos. Foram registrados quatro modos reprodutivos: modo 1 (14 espécies; 58,3%); modos 11 e 30 (nove espécies; 37,5%) e modo 24 (uma espécie; 4,2%). A baixa diversificação de modos reprodutivos provavelmente está relacionada à homogeneidade do hábitat primariamente campestre. A maior parte das espécies mostrou-se constante ou acessória na área estudada e o padrão de distribuição da abundância das espécies apresentou ajuste aos modelos Broken Stick e Log-normal, caracterizados pela homogeneidade na distribuição da abundância das espécies. A maioria das espécies apresentou grande plasticidade na ocupação de hábitats, mas poucas foram plásticas no uso dos sítios de vocalização. Houve correlação positiva, ainda que fraca, da riqueza de espécies com a precipitação mensal acumulada e da abundância com a temperatura média máxima. As correlações obtidas indicaram que na área estudada a temperatura parece atuar mais sobre a abundância de machos em atividade de vocalização e a precipitação sobre a riqueza, apesar da riqueza de espécies ser significativamente maior durante o período mais quente do ano. Estes resultados revelaram que as variáveis climatológicas testadas explicaram muito pouco da ocorrência sazonal das espécies, assim a influência de outras variáveis ambientais merece ser testada em estudos futuros.

Analysis of phenotypes altered by temperature stress and hipermutability in Drosophila willistoni

Drosophila willistoni (Sturtevant, 1916) is a species of the willistoni group of Drosophila having wide distribution from the South of USA (Florida) and Mexico to the North of Argentina. It has been subject of many evolutionary studies within the group, due to its considerable ability to successfully occupy a wide range of environments and also because of its great genetic variability expressed by different markers. The D. willistoni 17A2 strain was collected in 1991 in the state of Rio Grande do Sul, Brazil (30°05'S, 51°39'W), and has been maintained since then at the Drosophila laboratory of UFRGS. Different to the other D. willistoni strains maintained in the laboratory, the 17A2 strain spontaneously produced mutant males white-like (white eyes) and sepia-like (brown eyes) in stocks held at 17°C. In order to discover if this strain is potentially hypermutable, we submitted it to temperature stress tests. Eighteen isofemale strains were used in our tests and, after the first generation, all the individuals produced in each strain were maintained at 29°C. Different phenotype alterations were observed in subsequent generations, similar to mutations already well characterized in D. melanogaster (white, sepia, blistered and curly). In addition, an uncommon phenotype alteration with an apparent fusion of the antennae was observed, but only in the isofemale line nº 31. This last alteration has not been previously described as a mutation in the D. melanogaster species. Our results indicate that the D. willistoni 17A2 strain is a candidate for hypermutability, which presents considerable cryptic genetic variability. Different factors may be operating for the formation of this effect, such as the mobilization of transposable elements, effect of inbreeding and alteration of the heat-shock proteins functions.

Dieta de juvenis de Trachinotus carolinus (Actinopterygii, Carangidae) em praias arenosas na costa do Rio de Janeiro

Estudamos a dieta dos juvenis de Trachinotus carolinus (Linnaeus, 1766) em praias da Baía de Sepetiba (Rio de Janeiro, Brasil) entre janeiro de 2000 e abril de 2001. Procuramos avaliar a plasticidade trófica de peixes desta espécie ao longo de um gradiente espacial com diferentes níveis de exposição às ondas, sazonalidade, além de avaliar mudanças ontogenéticas na dieta. Os itens alimentares foram analisados através do índice de importância relativa (IIR), determinado pelos valores das frequências de ocorrência, de número e de peso. Os itens de maior importância foram do subfilo Crustacea, ordens Mysidacea, e o representante da ordem Decapoda Emerita brasiliensis (Schmitt, 1935), além de Cefalochordata, representado por Branchiostoma platae (Fitzinger, 1862). Na zona de maior exposição às ondas (praia de Barra de Guaratiba) e com substrato predominantemente arenoso, a dieta foi constituída principalmente por Emerita brasiliensis e Cirripedia, este último presente nos costões rochosos que limitam a praia; na zona de exposição intermediária (praia de Muriqui), houve um predomínio de Mysidacea e Branchiostoma platae; na zona mais protegida (praia de Itacuruçá), os itens de maior abundância foram Polychaeta, Mysidacea e Branchiostoma platae. Sazonalmente não ocorreu variação no uso de Mysidacea, enquanto Branchiostoma platae foi mais consumido durante o inverno, Polychaeta na primavera e Cirripedia e Emerita brasiliensis, no verão. Mysidacea foi o alimento predominante em todas as classes de tamanho, enquanto Polychaeta foi utilizado predominantemente por peixes menores que 20 mm de comprimento padrão e Emerita brasiliensis e Cirripedia foram consumidos principalmente por indivíduos maiores que 40 mm, somente na praia de maior exposição. O sucesso no uso de praias desprotegidas e zonas de arrebentação por esta espécie de peixe pode ser em parte devido à estratégia trófica oportunista, que utiliza uma ampla variedade de recursos disponíveis no ambiente.

O girino de Scinax nebulosus (Amphibia, Anura, Hylidae)

É descrito e ilustrado o girino de Scinax nebulosus (Spix, 1824), proveniente do estado de Pernambuco, nordeste do Brasil. O girino apresenta braço labial no disco oral. A presença dessa estrutura associa claramente essa espécie ao grupo de Scinax rostratus. A identificação do girino anteriormente atribuído a Scinax nebulosus é considerada errônea e com base na literatura é feita a comparação com os demais girinos conhecidos do grupo.

Acanthocefalan eggs in animal coprolites from archaeological sites from Brazil

An important point in paleoparasitology is the correct diagnosis of the origin of coprolites found in archaelogical sites. The identification of human and animal coprolites, through the study of the shape, size, charactheristics after rehydration, alimentary contents, and the presence of parasites, has proved to be accurate for human coprolites. For non-human ones we compared coprolites with recent faeces of animals collected near the archaeological sites, following the methodology above mentioned. In this paper anteaters coprolites (Tamandua tetradactyla; Mymecophaga tridactyla) with eggs of Gigantorhynchus echinodiscus (Archiancanthocephala; Gigantorynchidae) were identified.

Isolamento de amostras do Trypanosoma cruzi por xenodiagnóstico e hemocultura de pacientes na fase crônica da doença de Chagas

Cinquenta e nove pacientes chagásicos crônicos foram submetidos a xenodiagnósticos e hemocultura concomitantes para isolamento de amostras de Trypanosoma cruzi. O xenodiagnóstico foi composto de 40 ninfas de Panstrongylus megistrus, Triatoma infestans e Dipetalogylus megistus, Triatoma infestans e Dipetalogaster maximus num total de 120 triatomíneos. Os insetos foram dissecados em grupo de 10 por espécie e o conteúdo intestinal, agrupado, examinado após prévia trituração e homogeneização. O material negativo ao microscópio foi semeado em meio LIT e examinado após 20 dias. Vinte e nove pacientes foram parasitologicamente comprovados, sendo 15 apenas no xenodiagnóstico, quatro apenas com a hemocultura e 10 por ambos os métodos. Discutem-se as dificuldades para a comprovação parasitológica dos pacientes chagásicos crônicos, o valor da utilização simultânea de diferentes espécies de triatomíneos no xenodiagnóstico e a hemocultura, numa associação positiva favorável ao aumento da sensibilidade para o diagnóstico da doença de Chagas. A positividade de 49,2% obtida neste grupo de pacientes visualiza abordagens do tipo ensaio clínico-terapêutico e/ou epidemiológico (tipo caso-controle) com a finalidade de investigar uma possível associação entre amostras do T. cruzi e diferentes formas clínicas da doença de Chagas.

Strongyloides ferreirai Rodrigues, Vicente & Gomes, 1985 (Nematoda, Rhabdiasoidea) in rodent coprolites (8.000-2.000 years BP), from archaeological sites from Piauí, Brazil

Eggs and larvae of Strongyloides ferreirai Rodrigues, Vicente & Gomes, 1985 are identified in Kerodon rupestris (Wied.) coprolites dated from 8.000-2.000 years BP (Before Present), collected from archaeological sites from the northeast of Brazil.

Biological control of Biomphalaria tenagophila (Mollusca, Planorbidae), a schistosomiasis vector, using the fish Geophagus brasiliensis (Pisces, Cichlidae) in the laboratory or in a seminatural environment

In order to investigate a possible method of biological control of schistosomiasis, we used the fish Geophagus brasiliensis (Quoy & Gaimard, 1824) which is widely distributed throughout Brazil, to interrupt the life cycle of the snail Biomphalaria tenagophila (Orbigny, 1835), an intermediate host of Schistosoma mansoni. In the laboratory, predation eliminated 97.6% of the smaller snails (3-8 mm shell diameter) and 9.2% of the larger ones (12-14 mm shell diameter). Very promising results were also obtained in a seminatural environment. Studies of this fish in natural snail habitats should be further encouraged.

On the immature stages of two mosquitoes (Diptera: Culicidae) originally described from Rio de Janeiro, Brazil

The fourth-instar larva and pupa of Psorophora pseudomelanota Barata & Cotrim, 1971 and Phoniomyia deanei Lourenço-de-Oliveira, 1983 are described and compared with those of related species.