Mortality and Embolic Potential of Cardiac Tumors

Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results: Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion: Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

Spectral Analysis Related to Bare-Metal and Drug-Eluting Coronary Stent Implantation

Background: The autonomic nervous system plays a central role in cardiovascular regulation; sympathetic activation occurs during myocardial ischemia. Objective: To assess the spectral analysis of heart rate variability during stent implantation, comparing the types of stent. Methods: This study assessed 61 patients (mean age, 64.0 years; 35 men) with ischemic heart disease and indication for stenting. Stent implantation was performed under Holter monitoring to record the spectral analysis of heart rate variability (Fourier transform), measuring the low-frequency (LF) and high-frequency (HF) components, and the LF/HF ratio before and during the procedure. Results: Bare-metal stent was implanted in 34 patients, while the others received drug-eluting stents. The right coronary artery was approached in 21 patients, the left anterior descending, in 28, and the circumflex, in 9. As compared with the pre-stenting period, all patients showed an increase in LF and HF during stent implantation (658 versus 185 ms2, p = 0.00; 322 versus 121, p = 0.00, respectively), with no change in LF/HF. During stent implantation, LF was 864 ms2 in patients with bare-metal stents, and 398 ms2 in those with drug-eluting stents (p = 0.00). The spectral analysis of heart rate variability showed no association with diabetes mellitus, family history, clinical presentation, beta-blockers, age, and vessel or its segment. Conclusions: Stent implantation resulted in concomitant sympathetic and vagal activations. Diabetes mellitus, use of beta-blockers, and the vessel approached showed no influence on the spectral analysis of heart rate variability. Sympathetic activation was lower during the implantation of drug-eluting stents.

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

Análise de poliembrionia em Citrus, máxime em toranjas

1 - This paper is a joined publication of the Dept. of Genetics, Escola Superior de Agricultura "Luiz de Queiroz", University of São Paulo, and Secção de Citricultura e Frutas Tropicais, Instituto Agronômico, de Campinas, and deal with the number of seed per fruit and the polyembryony in Citrus, with special reference to the pummelos (C. grandis). 2 - For C. pectinifera, hibrid limon x acid lime, C. histrix and Citrus sp. the mean of seeds per fruit is 5,8 - 17,3 - 30,2 -94,6; for 14 pummelos the average was 100 and the range of variation 11 to 185 seeds per fruit. For the four above mentioned Citrus the cotyledons were classified into 3 types: big (near 8 mm.), medium (near 6 mm) and small (near 4 mm) and for the pummelos there was only one size of cotyledons, about 10 mm (table 1). 3 - The polyembryony was determined by two processes: a) counting of the embryos in the mature seed; b) counting after germination in flats or seed-beds. The rasults obtained are in table 2; the process a gave larger results than process b.The following pummelos are monoembryonics: melancia, inerme, Kaune Paune, sunshine, vermelha, Singapura, periforme, Zamboa, doce, Indochina, Lau-Tau, Shantenyau and Siamesa. Sometime it was found a branching of the main stem that gave a impression of polyembryonic seeds. 4 - It was shown by the x2 test that the distribution of embryo numbers fits the Poisson's series (table 2) in both processes. 5 - It is discussed in table 2 the variability of polyembryony for the following cases: a) between plants, within years. The teste for the differences of mean of polyembryony between 3 plants of C. pectinifera is statistically significant in 1948 and 1949; b) between yields of the same plant, within year. The same case of C. pectinifera may be used for this purpose; c) between process, within year. It is shown in table 3, for C. pectinifera and the hibrid "limon x acid lime" that there is a statistically signicicant between both process above mentioned.

Uso de áreas agrícolas por Mazama gouazoubira (Mammalia, Cervidae) no Estado de São Paulo

O veado-catingueiro, Mazama gouazoubira (Fischer, 1814) é a espécie mais abundante de cervídeo do Brasil e suas populações têm resistido a alterações antrópicas consideráveis e ocupam regularmente áreas modificadas. Pouco se sabe sobre o uso de ambientes agrícolas pela espécie, portanto, este trabalho teve por objetivo analisar a preferência de uso do hábitat por M. gouazoubira em um agrossistema dedicado à produção de cana-de-açúcar. O trabalho foi desenvolvido na Fazenda Santa Cecília, município de Jaboticabal, região nordeste do estado de São Paulo, entre fevereiro de 2011 e janeiro de 2012. A área de estudo abrange cerca de 185 ha, cujas formações podem ser classificadas em plantios de cana-de-açúcar nos estágios (i) adulto (1 a 3 m altura), (ii) jovem (até 1 m) e sem cana (pós-safra), além de (iii) eucalipto e (iv) remanescentes de mata ciliar. Os registros foram obtidos percorrendo-se a pé os aceiros entre os talhões cultivados e o perímetro da área, totalizando 204 km percorridos em busca de pegadas e visualizações. A amostragem foi realizada mensalmente, com duração de dois dias consecutivos, entre 6h e 9h, e para cada registro obteve-se a coordenada geográfica e o tipo de vegetação do entorno. Considerando a rotatividade das culturas anuais, foi estimada a disponibilidade total, em hectares, de cada formação vegetacional ao longo do período de amostragem. Foram obtidos 44 registros, sendo que M. gouazoubira evitou o uso das áreas com cana jovem e sem cana e preferiu ambientes próximos à mata ciliar e aos plantios de eucalipto. Estes resultados sugerem que, embora M. gouazoubira apresente grande plasticidade ecológica, existe preferência por ambientes florestais, sugerindo que um mosaico como o encontrado no presente projeto pode sustentar populações da espécie.

Produção irregular e inconstante de oocistos pela ministração de cistos de Toxoplasma gondii Nicole & Manceaux, 1909, em gatos

Como a produção de oocistos pelo T. gondii no gato parece vinculada à forma cística, uma vez que ela não ocorre pela ministração de formas vegetativas (17), cérebros de camundongos e ratos, com infecção crônica de T. gondii, forma ministrados "per os" a um total de 32 gatos. Com uma amostra (TC1) nenhum dos 8 gatos experimentados eliminou oocistos atribuiíveis a T. gondii; e com as outras 3 amostras a produção de oocistos foi de 25% ("pombo") e 37,5% ("sonia" e "AS-28"). Esses resultados forma atribuídos, em parte, à pobreza de cistos nos cérebros ministrados aos gatos; e, em parte, à existência em condições naturais de amostras de "T. gondii" oocistogênicas, paucloocistogênicas e noocistogênicas. Ao contrário dos gatos infectados com formas vegetativas (17), nenhum gato morreu de toxoplasmose; microscopicamente as lesões com toxoplasmas foram de pouca intensidade e o número de reações de Sabin-Feldman (RSF) negativas foi, relativamente, elevado. Foram vistas raras formas evolutivas do T. gondii no epitélio intestinal de um gato, não parasitado por Isospora as quais são menores que as de I. felis e I. rivolta, do mesmo modo que os seus oocistos. Assim como parece não existir imunidade entre as Isospora (I. felis e I. rivolta), também parece não existir imunidade entre estas e o T. gondii. Em 185 gatos examinados, foi encontrado um deles com oocistos de T. gondii em condições naturais (0,54%). É discutida a importância do gato na epidemilogia da toxoplasmose, destacando-se que a descoberta do ciclo sexuado, decisiva para a classificação do parasito, parece não ter tido repercussão semelhante na epidemiologia.

Polypeptides reactive with antibodies eluted from the surface of Babesia bovis-infected erythrocytes

A technique was sought that would enable identification of surface-exposed parasite antigens on Babesia bovis-infected erythrocytes (BbIE) that are not detectable by surface-specific immunoprecipitations. Antibodies which bind to the surface of BbIE were recovered from intact cells using a low pH wash procedure. The eluted antibodies were then used in conventional immunoprecipitation assays to identify parasite-synthesized polypeptides carrying epitopes that are exposed on the surface or are cross reactive with shuch epitopes. The results of these experiments support our previous data, obtained using a surface-specific immunoprecipitation technique, in the identification of a repertoire of parasite-derived antigens on the surface of infected erythrocytes (Allred et al., 1991). In addition, two polypeptides of Mr 68,000 and 185,000 were identified wich react strongly with the eluted antibodies but wich are not detected by surface-immunoprecipitation. These data illustrate the potential of this approach for identification of parasite polypeptides wich carry epitopes exposed on, or cross-reactive with exposed epitopes of the infected erythrocyte surface.

Development of Rhodnius prolixus (Hemiptera: Reduviidae) under Constant and Cyclic Conditions of Temperature and Humidity

Development of Rhodnius prolixus after eclosion until the adult stage was studied at constant temperatures (T), 15, 20, 25, 28, 35°C, and relative humidities (RH), 75, 86 and 97%, and fluctuating (16/8 hr) temperatures, T I/II, 15/28°C, 20/25°C, 25/28°C and 25/35°C, and relative humidities, RH I/II, 86/75% and 97/75%. Eclosion or molting were not observed at 15°C and 86 or 97% RH, respectively. At 35°C and 75% RH only few insects molted. By alternating T I/II, 15/28°C and 25/35°C, insects developed at high frequency. Cumulating the average lengths of the interphases within independent groups for each instar, R. prolixus reached the adult stage most rapidly (86.7 days) and at highest frequency per instar (mean: 91.8%) at 28°C and 75% RH. Under fluctuating T I/II, development was completed within 100 days or less at 25/28°C and 25/35°C with high rates of hatch and molting. Development was slowest at fluctuating TI/II, 15/28°C and 20/25°C (>185 days), and at constant 20°C (>300 days). Mortality was higher at constant 97% RH or fluctuating RH I, 97%, than at constant or fluctuating 86% RH. Refeeding was minimal at optimal conditions of T and RH for development. The most refeeding was observed at a constant 35°C.

Geographical distribution of Biomphalaria snails in the State of Minas Gerais, Brazil

Published and unpublished observations on geographical distribution of Biomphalaria snails in the State of Minas Gerais, Brazil, were compiled. This work is aimed at knowing the present occurrence of Biomphalaria species in this region, and at contributing to the elaboration of the planorbid chart of Minas Gerais. In malacological surveys, performed by several researchers, the presence of seven species of this genus was recorded. Those planorbids were found in 12 mesoregions, in 283 (33.1%) municipalities out of 853 with the following distribution: B. glabrata (185 municipalities), B. straminea (125), B. tenagophila (58), B. peregrina (57), B. schrammi (26), B. intermedia (20) and B. occidentalis (2). B. glabrata and B. tenagophila are found naturally infected by Schistosoma mansoni in Minas Gerais. In 24 municipalities the three snail hosts of S. mansoni in Brazil, B. glabrata, B. tenagophila and B. straminea, are present.

Small todents fleas from the bubonic plague focus located in the Serra dos Órgãos Mountain Range, State of Rio de Janeiro, Brazil

Eleven species of fleas were collected from 601 small rodents, from November 1995 to October 1997, in areas of natural focus of bubonic plague, including the municipalities of Nova Friburgo, Sumidouro and Teresópolis, State of Rio de Janeiro, Brazil. Among 924 fleas collected, Polygenis (Polygenis) rimatus (Rhopalopsyllidae) was the predominant species regarding the frequency, representing 41.3% (N:382), followed by P. (Neopolygenis) pradoi, representing 20% (N:185) and Craneopsylla minervaminerva (Stephanocircidae), representing 18.9% (N:175). The host Akodon cursor harbored 47.9% of these fleas. Other six host species were infested by 52.1% of the remaining fleas. Fleas were found on hosts and in places within the focus not previously reported by the literature.

Hepatitis C prevalence and risk factors in hemodialysis patients in Central Brazil: a survey by polymerase chain reaction and serological methods

An hemodialysis population in Central Brazil was screened by polymerase chain reaction (PCR) and serological methods to assess the prevalence of hepatitis C virus (HCV) infection and to investigate associated risk factors. All hemodialysis patients (n=428) were interviewed in eight dialysis units in Goiânia city. Blood samples were collected and serum samples screened for anti-HCV antibodies by an enzyme-linked immunosorbent assay (ELISA). Positive samples were retested for confirmation with a line immunoassay (LIA). All samples were also tested for HCV RNA by the PCR. An overall prevalence of 46.7% (CI 95%: 42-51.5) was found, ranging from 20.7% (CI 95%: 8.8-38.1) to 90.4% (CI 95%: 79.9-96.4) depending on the dialysis unit. Of the 428 patients, 185 were found to be seropositive by ELISA, and 167 were confirmed positive by LIA, resulting in an anti-HCV prevalence of 39%. A total of 131 patients were HCV RNA-positive. HCV viremia was present in 63.5% of the anti-HCV-positive patients and in 10.3% of the anti-HCV-negative patients. Univariate analysis of risk factors showed that the number of previous blood transfusions, transfusion of blood before mandatory screening for anti-HCV, length of time on hemodialysis, and treatment in multiple units were associated with HCV positivity. However, multivariate analysis revealed that blood transfusion before screening for anti-HCV and length of time on hemodialysis were significantly associated with HCV infection in this population. These data suggest that nosocomial transmission may play a role in the spread of HCV in the dialysis units studied. In addition to anti-HCV screening, HCV RNA detection is necessary for the diagnosis of HCV infection in hemodialysis patients.

Siphonaptera parasites of wild rodents and marsupials trapped in three mountain ranges of the Atlantic Forest in Southeastern Brazil

A study of the associations between small mammals and fleas was undertaken in three areas of the Atlantic Forest in Souhtheastern Brazil: Serra da Fartura, SP, Serra da Bocaina, SP, and Itatiaia, RJ. Trapping of small rodents and marsupials was done every 3 months during 2 years, from June 1999 to May 2001. A total 502 rodents (13 species) and 50 marsupials (7 species) were collected, and 185 hosts out of 552 (33.5%) captured in the traps were parasitized by 327 fleas belonging to 11 different species. New host records were determined for several flea species, and 5 significant associations between fleas and hosts were also found.

Monitoring of the dissemination of Salmonella in the chicken Frankfurt-sausage productionline of a sausage factory in the state of São Paulo, Brazil

Poultry meat and its derivatives are among the foodstuffs considered by environmental health authorities to present the highest risks to the public. A total of 185 samples were collected in five monthly batches, from different processing stages in a sausage plant that uses mechanically-deboned chicken meat (MDCM), and testedfor the presence of Salmonella. Enrichment was carried out in both Kauffman's tetrathionate broth and Rappaport-Vassiliadis broth and isolation on Salmonella-Shigella agar and brilliant-green agar. Live Salmonella bacteria were isolated from six samples of the raw meat and from the emulsion, in batches three, four, and five, but not from any sample in batches one or two. The six isolated strains were all classified as Salmonella Albany, which has not previously been reported in MDCM. Of the two enrichment broths, Rappaport-Vassiliadis gave the better results. The pattern of contamination suggests a probable common source, given that a new supplier was used in the third, fourth, and fifth months. It was also shown that the industrial cooking was effective in preventing Salmonella surviving in the final product.

Drug susceptibility of Brazilian strains of Mycobacterium bovis using traditional and molecular techniques

Transmission of Mycobacterium bovis from cattle to humans has been reported and can cause tuberculosis (Tb) and a problem in certain risk populations. Therefore, knowledge of resistance of M. bovis towards antibiotics used for therapy of human Tb could help avoiding cure delay and treatment cost increase when dealing with drug resistant organisms. We therefore evaluated the susceptibility of M. bovis isolates towards streptomycin, isoniazide, rifampicin, ethambutol, and ethionamide, the first line antibiotics for human Tb. Therefore, 185 clinical samples from cattle with clinical signs of tuberculosis were processed and submitted to culturing and bacterial isolates to identification and drug susceptibility testing using the proportion method. Among 89 mycobacterial strains, 65 were identified as M. bovis and none were resistant to any of the antibiotics used. Confirmation of present results by future studies, enrolling a large number of isolates and designed to properly represent Brazilian regions, may favor the idea of using isoniazide preventive therapy as part of a Tb control strategy in special situations. Also, nucleic acids from bacterial isolates were submitted to rifoligotyping, a recently described reverse hybridization assay for detection of mutations causing resistance towards rifampicin. Concordance between the conventional and the molecular test was 100%, demonstrating the use of such methodology for rapid evaluation of drug susceptibility in M. bovis.

Mycobacterium tuberculosis strains of the Beijing genotype are rarely observed in tuberculosis patients in South America

The frequency of the Beijing genotype of Mycobacterium tuberculosis as a cause of tuberculosis (TB) in South America was determined by analyzing genotypes of strains isolated from patients that had been diagnosed with the disease between 1997 and 2003 in seven countries of the subcontinent. In total, 19 of the 1,202 (1.6%) TB cases carried Beijing isolates, including 11 of the 185 patients from Peru (5.9%), five of the 512 patients from Argentina (1.0%), two of the 252 Brazilian cases (0.8%), one of the 166 patients from Paraguay (0.6%) and none of the samples obtained from Chile (35), Colombia (36) and Ecuador (16). Except for two patients that were East Asian immigrants, all cases with Beijing strains were native South Americans. No association was found between carrying a strain with the Beijing genotype and having drug or multi-drug resistant disease. Our data show that presently transmission of M. tuberculosis strains of the Beijing genotype is not frequent in Latin America. In addition, the lack of association of drug resistant TB and infection with M. tuberculosis of the Beijing genotype observed presently demands efforts to define better the contribution of the virulence and lack of response to treatment to the growing spread of Beijing strains observed in other parts of the world.