Intervenções nutricionais em Síndrome Metabólica: uma revisão sistemática

Não existe consenso sobre a estratégia nutricional mais adequada para tratar a Síndrome Metabólica (SM), de tal forma que ocorra redução do risco cardiovascular. O presente estudo foi desenhado para avaliar a força de evidência dos benefícios de diferentes intervenções nutricionais na remissão da SM. A busca virtual foi realizada nas bases de dados Medline, Cochrane Library e PubMed, de ensaios clínicos randomizados publicados no período entre 1999 a 2009, em qualquer língua, em indivíduos com 18 anos ou mais e diagnóstico de SM, independente do critério. O operador booleano and foi utilizado na combinação dos MeSH terms "Metabolic Syndrome", "Síndrome x Metabólica" e "Metabolic Syndrome X"; dos entry terms "Dysmetabolic Syndrome X", Metabolic Cardiovascular Syndrome", "Metabolic X Syndrome", "Syndrome X, Metabolic" adicionados dos termos "diet", "intervention and diet", "treatment and diet" e "supplementation". Para cada estudo incluído na revisão foi estimada a Prevalência de SM e o Cálculo da Eficácia após o período de seguimento. Medidas de risco relativo para cada estudo foram descritas pelo Forest Plot. Foram identificados 131 artigos, os quais após critérios de elegibilidade resultaram em 15 estudos. Estes foram separados em quatro grupos: dieta normocalórica associada a exercícios; dieta normocalórica isolada; dieta hipocalórica associada a exercícios; e dieta hipocalórica isolada. Os ensaios com dieta hipocalórica associada à prática de exercícios apresentaram valores mais elevados de eficácia, colaborando para ressaltar os aspectos globais da mudança do estilo de vida no tratamento da SM, onde a alimentação saudável e reduzida em calorias deve ser complementada com a prática de atividade física.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

A determinação dos números de indivíduos mínimos necessários na experimentação genética

The main object of the present paper consists in giving formulas and methods which enable us to determine the minimum number of repetitions or of individuals necessary to garantee some extent the success of an experiment. The theoretical basis of all processes consists essentially in the following. Knowing the frequency of the desired p and of the non desired ovents q we may calculate the frequency of all possi- ble combinations, to be expected in n repetitions, by expanding the binomium (p-+q)n. Determining which of these combinations we want to avoid we calculate their total frequency, selecting the value of the exponent n of the binomium in such a way that this total frequency is equal or smaller than the accepted limit of precision n/pª{ 1/n1 (q/p)n + 1/(n-1)| (q/p)n-1 + 1/ 2!(n-2)| (q/p)n-2 + 1/3(n-3) (q/p)n-3... < Plim - -(1b) There does not exist an absolute limit of precision since its value depends not only upon psychological factors in our judgement, but is at the same sime a function of the number of repetitions For this reasen y have proposed (1,56) two relative values, one equal to 1-5n as the lowest value of probability and the other equal to 1-10n as the highest value of improbability, leaving between them what may be called the "region of doubt However these formulas cannot be applied in our case since this number n is just the unknown quantity. Thus we have to use, instead of the more exact values of these two formulas, the conventional limits of P.lim equal to 0,05 (Precision 5%), equal to 0,01 (Precision 1%, and to 0,001 (Precision P, 1%). The binominal formula as explained above (cf. formula 1, pg. 85), however is of rather limited applicability owing to the excessive calculus necessary, and we have thus to procure approximations as substitutes. We may use, without loss of precision, the following approximations: a) The normal or Gaussean distribution when the expected frequency p has any value between 0,1 and 0,9, and when n is at least superior to ten. b) The Poisson distribution when the expected frequecy p is smaller than 0,1. Tables V to VII show for some special cases that these approximations are very satisfactory. The praticai solution of the following problems, stated in the introduction can now be given: A) What is the minimum number of repititions necessary in order to avoid that any one of a treatments, varieties etc. may be accidentally always the best, on the best and second best, or the first, second, and third best or finally one of the n beat treatments, varieties etc. Using the first term of the binomium, we have the following equation for n: n = log Riim / log (m:) = log Riim / log.m - log a --------------(5) B) What is the minimun number of individuals necessary in 01der that a ceratin type, expected with the frequency p, may appaer at least in one, two, three or a=m+1 individuals. 1) For p between 0,1 and 0,9 and using the Gaussean approximation we have: on - ó. p (1-p) n - a -1.m b= δ. 1-p /p e c = m/p } -------------------(7) n = b + b² + 4 c/ 2 n´ = 1/p n cor = n + n' ---------- (8) We have to use the correction n' when p has a value between 0,25 and 0,75. The greek letters delta represents in the present esse the unilateral limits of the Gaussean distribution for the three conventional limits of precision : 1,64; 2,33; and 3,09 respectively. h we are only interested in having at least one individual, and m becomes equal to zero, the formula reduces to : c= m/p o para a = 1 a = { b + b²}² = b² = δ2 1- p /p }-----------------(9) n = 1/p n (cor) = n + n´ 2) If p is smaller than 0,1 we may use table 1 in order to find the mean m of a Poisson distribution and determine. n = m: p C) Which is the minimun number of individuals necessary for distinguishing two frequencies p1 and p2? 1) When pl and p2 are values between 0,1 and 0,9 we have: n = { δ p1 ( 1-pi) + p2) / p2 (1 - p2) n= 1/p1-p2 }------------ (13) n (cor) We have again to use the unilateral limits of the Gaussean distribution. The correction n' should be used if at least one of the valors pl or p2 has a value between 0,25 and 0,75. A more complicated formula may be used in cases where whe want to increase the precision : n (p1 - p2) δ { p1 (1- p2 ) / n= m δ = δ p1 ( 1 - p1) + p2 ( 1 - p2) c= m / p1 - p2 n = { b2 + 4 4 c }2 }--------- (14) n = 1/ p1 - p2 2) When both pl and p2 are smaller than 0,1 we determine the quocient (pl-r-p2) and procure the corresponding number m2 of a Poisson distribution in table 2. The value n is found by the equation : n = mg /p2 ------------- (15) D) What is the minimun number necessary for distinguishing three or more frequencies, p2 p1 p3. If the frequecies pl p2 p3 are values between 0,1 e 0,9 we have to solve the individual equations and sue the higest value of n thus determined : n 1.2 = {δ p1 (1 - p1) / p1 - p2 }² = Fiim n 1.2 = { δ p1 ( 1 - p1) + p1 ( 1 - p1) }² } -- (16) Delta represents now the bilateral limits of the : Gaussean distrioution : 1,96-2,58-3,29. 2) No table was prepared for the relatively rare cases of a comparison of threes or more frequencies below 0,1 and in such cases extremely high numbers would be required. E) A process is given which serves to solve two problemr of informatory nature : a) if a special type appears in n individuals with a frequency p(obs), what may be the corresponding ideal value of p(esp), or; b) if we study samples of n in diviuals and expect a certain type with a frequency p(esp) what may be the extreme limits of p(obs) in individual farmlies ? I.) If we are dealing with values between 0,1 and 0,9 we may use table 3. To solve the first question we select the respective horizontal line for p(obs) and determine which column corresponds to our value of n and find the respective value of p(esp) by interpolating between columns. In order to solve the second problem we start with the respective column for p(esp) and find the horizontal line for the given value of n either diretly or by approximation and by interpolation. 2) For frequencies smaller than 0,1 we have to use table 4 and transform the fractions p(esp) and p(obs) in numbers of Poisson series by multiplication with n. Tn order to solve the first broblem, we verify in which line the lower Poisson limit is equal to m(obs) and transform the corresponding value of m into frequecy p(esp) by dividing through n. The observed frequency may thus be a chance deviate of any value between 0,0... and the values given by dividing the value of m in the table by n. In the second case we transform first the expectation p(esp) into a value of m and procure in the horizontal line, corresponding to m(esp) the extreme values om m which than must be transformed, by dividing through n into values of p(obs). F) Partial and progressive tests may be recomended in all cases where there is lack of material or where the loss of time is less importent than the cost of large scale experiments since in many cases the minimun number necessary to garantee the results within the limits of precision is rather large. One should not forget that the minimun number really represents at the same time a maximun number, necessary only if one takes into consideration essentially the disfavorable variations, but smaller numbers may frequently already satisfactory results. For instance, by definition, we know that a frequecy of p means that we expect one individual in every total o(f1-p). If there were no chance variations, this number (1- p) will be suficient. and if there were favorable variations a smaller number still may yield one individual of the desired type. r.nus trusting to luck, one may start the experiment with numbers, smaller than the minimun calculated according to the formulas given above, and increase the total untill the desired result is obtained and this may well b ebefore the "minimum number" is reached. Some concrete examples of this partial or progressive procedure are given from our genetical experiments with maize.

Amonização de superfosfato simples

Superfosfato simples separado em peneiras 20-40-60-100 e mais de 100 "mesh" foi tratado com 3% em peso de amônia anidra para avaliar a reversão do fosfato em presença de "amônia livre".

Dinâmica reprodutiva de Oligosarcus jenynsii e O. robustus (Characiformes, Characidae) na lagoa Fortaleza, Rio Grande do Sul, Brasil

Oligosarcus jenynsii (Günther, 1864) and O. robustus Menezes, 1969 are fish species distributed in Rio Grande do Sul, Brazil, Uruguay, and northern Argentina. The reproductive period and recruitment, sex ratio, absolute and relative fecundity, and body length at first gonadal maturation of the two carnivorous species from Fortaleza Lagoon were analized. The specimens were sampled monthly, from May 2000 to April 2001, with fishing effort of 24 hours/month, using stationary gillnets of different mesh sizes and seine net (three samples per edge). The records of each individual included total length, total weight, gonad weight, sex and gonadal maturity stage. The reproductive period of both O. jenynsii and O. robustus ranges from May/June to November/December, according to the bimonthly variation of the mean values of gonosomatic index, and the relative frequencies of the gonadal maturation stages. Recruitment of new individuals to the population occurs from November/December to March/April. The sex ratio is different from 1:1 for O. jenynsii and similar to 1:1 for O. robustus. The mean absolute fecundity, calculated by counting sub-sampled oocytes from mature females, was 14,483 oocytes for O. jenynsii, and 16,308 oocytes for O. robustus. The first maturation curve shows that O. jenynsii begins to reproduce between 84 mm and 104 mm (total length), and O. robustus between 126 mm and 146 mm, probably at similar ages.

Spatio-temporal variation of the pink shrimp Farfantepenaeus paulensis (Crustacea, Decapoda, Penaeidae) associated to the seasonal overture of the sandbar in a subtropical lagoon

On the southern Brazilian coast, the penaeid pink shrimp Farfantepenaeus paulensis (Pérez-Farfante, 1967) is intensively captured by both artisanal and industrial fisheries. In the Ibiraquera Lagoon, artisanal fishing of juvenile stocks has declined sharply over the last 15 years. The traditional management methods used by fishermen are no longer sustainable due to conflicts with the demands of tourism and weak environmental and public agencies. The dynamics of the timing of the artificial opening and natural reformation of a sandbar across the mouth of the lagoon are regarded as a central socio-ecological problem. We evaluated the abundance and biomass variation of F. paulensis throughout the year and along a spatial gradient measured from the sandbar into the lagoon. We also explored the influence of opening the sandbar on the shrimp population. Samples were collected monthly from February 2004 to February 2005, using a 27 mm mesh cast net, in four different areas, with three sites being sampled per area. Small numbers of large shrimps were captured in the upper area, while greater biomass and abundance of small shrimps were observed near the sandbar, suggesting the role of the inner area as a refuge for growing. The highest records for biomass and abundance were recorded during warm months, regardless if the lagoon was open or closed by the sandbar. The Ibiraquera Lagoon could be more productive for fishermen if the sandbar opening was coincident to the period of natural post-larvae influx. Furthermore, coastal stocks could be improved by opening the sandbar again during summer in conjunction with fishing quotas.

Fish assemblages in two sandy beaches in lower Purus river, Amazonas, Brazil

Fish assemblages from two sandy beaches in the lower Purus river (Amazonas, Brazil) were compared. Four sampling groups were represented by: day and night samples in sandy beach inside the Reserva Biológica de Abufari (biological reserve) and day and night samples in the Reserva de Desenvolvimento Sustentável Piagaçu-Purus (sustainable development reserve). Samples were collected during low water levels (November) in 2007. The fish were sampled by means of seines with mesh size of 5 mm between opposing knots, 11 m long and 6 m wide. A total of 112 fish species belonging to nine orders and 27 families was captured. The vast majority of the dominant forms consisted of small fishes (< 100 mm SL) or juveniles. Samples collected in Abufari at night presented more specimens (3,540), higher richness (84 spp.), larger total biomass (76,614 g) and higher diversity (H'= 2.57) than the other groups. The composition of fish assemblages was significantly different among all analyzed groups (ANOSIM, p < 0.0001, R= 0.71). NMDS analysis also clustered all species in four distinct groups according to species composition per period and site. SIMPER analyses showed that 80% of variation of species composition among the groups examined was due to 12 species. However, fish composition did not show any correlation with the abiotic factors examined. Different levels of use in both reserves may explain differences in fish composition.

Space-time variation of the relative abundance of Limnoperna fortunei in deep zones of São Gonçalo Channel, Rio Grande do Sul, Brazil

This work describes the spatial-temporal variation of the relative abundance and size of Limnoperna fortunei (Dunker, 1857) collected in São Gonçalo Channel through bottom trawl with a 0.5 cm mesh, at depths between 3 and 6 m. The estimative of mean relative abundance (CPUE) ranged from 2,425.3 individuals per drag (ind./drag) in the spring to 21,715.0 ind./drag in the fall, with an average of 9,515.3 ind./drag throughout the year. The estimated mean density of L. fortunei for the deep region of São Gonçalo Channel ranged from 1.2 to 10.3 ind./m², and it was recorded a maximum density of 84.9 ind./m² in the fall of 2008. The method of sampling using bottom trawl enabled the capture of L. fortunei under the soft muddy bottom of the channel, in different sizes ranging from 0.4 to 3.2 cm. This shows that the structure of the L. fortunei adult population under the bottom of the São Gonçalo Channel is composed mostly of small individuals (<1.4 cm), which represent up to 74% of the population collected.

The diet of the South American sea lion (Otaria flavescens) at Río Negro, Patagonia, Argentina, during the winter-spring period

The South American sea lion, Otaria flavescens (Shaw, 1800) population is steadily expanding along the Patagonian coast of Argentina in the last decades. However, little is known about the feeding ecology of the species in the area. The aim of this study was to analyze the food habits of O. flavescens from 91 scats collected at Río Negro province, during the winter and spring of 2005. Fish occurred in 96% of scats containing prey remains, followed by cephalopods (26%). Raneya brasiliensis (Kaup, 1856) was the most frequent and abundant species occurring in 58.6% of samples and constituting almost 50% of fish predated. Second in importance were Porichthys porosissimus (Cuvier, 1829) and Cynoscion guatucupa (Cuvier, 1830) in terms of occurrence (%FO 20.7) and numbers (29.6%) respectively. The squid Loligo gahi (d'Orbigny, 1835) was the most frequent cephalopod prey (42.1%), whereas Octopus tehuelchus (d'Orbigny, 1834) was the most abundant (77%). The higher amount and diversity of prey found in the spring in comparison with the winter season might be related to a higher feeding activity of seals or to a seasonal increase in food availability in the area.

Planorbis meridaensis Preston, 1907 (Gastropoda: Planorbidae), a synonym of Biomphalaria prona (Martens, 1873)

Biomphalaria prona from Lake Valencia, Venezuela (type locality) has a polymorphic shell wich in the great majority of specimens is wider, with fewer rapidly expanding whorls, the outer one subcarinate on the left side and more or less strongly deflected leftward. Besides those modal forms there are little frequent variants characterized by narrower shell with less rapidly expanding, regularly curved whorls directed forward. Recent studies have shown that such variants constitute the predominant shell phenotype in extralacustrine populations, but are anatomically and biochemically indistinguishable from the modal class of the Lake. In the present paper it is demonstrated that the nominal species Planorbis meridaensis Preston, 1907, from Mérida, Venezuela, is identical with B. prona (Martens, 1873) of wich it must be considered a junior synonym.

Análise faunística dos helmintos de pardais (Passer domesticus L., 1758) capturados em Campo Grande, Rio de Janeiro, RJ

Sparrows captured in Campo Grande, Rio de Janeiro, RJ, were examined through necropsy and the helmints found were identified. The prevalence, intensity of infection and the habitat of each helminth species found are showed. An analysis of the helminth fauna using the importance value of the species collected indicated that in the sparrow the dominant species are: Leucochloridium parcum, Tanaisia inopina, Choanotaenia passerina, Dispharynx nasuta and Tetrameres minima; and the co-dominant species are: Echinostoma revolutum, Eumegacetes mediximus and Mediorhynchus papillosus. According to the host specificity were classified as specialist species: L. parcum, T. inopina, C. passerina and T. minima; and as generalist species: E. revolutum, E. medioximus, D. nasuta and M. papillosus. Echinostoma revolutum was found for the first time in P. domesticus. The species E. medioximus , T. minima and D. nasuta were found for the first time in the sparrow in Brazil. The species C. passerina and M. papillosus were found for the first time in Brazil, expanding their distribution to the Neotropical region.

Ecological interactions of visceral leishmaniasis in the state of Bahia, Brazil

The laboratory and field observations summarized in this paper on visceral leishmaniasis ecology in the State of Bahia, Brazil are based on the author's observations over the past 35 years in a number of state's foci, public health records and literature citations. The disease is endemic with epidemic outbreaks occurring every ten years and its geographical distribution is expanding rapidly in the last years. Leishmania chagasi is the main ethiologic agent of the visceral leishmaniasis but Le. amazonensis s. lato was the only leishmania isolated by other authors from some visceral leishmaniasis human cases in the state. Lutzomyia longipalpis (with one or two spots on tergites III and IV and two sized different populations) was epidemiologically incriminated as the main vector. It was found naturally infected with promastigotes, and it was infected with four species of leishmanias in the laboratory. Although the experimental transmission of Le. amazonensis by the bite of Lu. longipalpis to hamsters was performed, the author was not successful in transmitting Le. chagasi in the same way. The dog is the most important domestic source for infection of the vector, however it is not a primary reservoir. The opossum Didelphis albiventris was found naturally infected with Le. chagasi but its role as reservoir is unknown. Foxes and rodents were not found infected with leishmanias in Bahia.

Evaluation of the acarofauna of the domiciliary ecosystem in Juiz de Fora, State of Minas Gerais, Brazil

From August 1999 to January 2000, samples of house dust were collected from 160 domiciles in the city of Juiz de Fora, State of Minas Gerais, Brazil. In 36 of these domiciles kitchen samples were obtained. Prevalence rate was 77.5%, varying according to the geographical sector. There were found 2,278 specimens of mites, with 1,530 (67.2%) in the adult stage and 748 (32.8%) in immature forms. The main species found were Dermatophagoides pteronyssinus, D. farinae, Euroglyphus maynei, Blomia tropicalis and Tyrophagus putrescentiae. In a minor incidence we found Lepidoglyphus destructor, Suidasia pontificiae, Chortoglyphus arcuatus, Cheyletus malaccensis, C. fortis, Ker bakeri, Cheletonella vespertilionis, C. caucasica and others. C. vespertilionis and C. caucasica were identified for the first time in the domiciliary ecosystem and in Brazil. The abundance rate and the infestation intensity were analyzed. There was a varied correlation between climatic conditions and positive domiciles and number of mites. The difference between the number of positive domiciles in the urban area and in the expanding urban area was significant and so was the difference between samples from the domiciles compared to those from the kitchens.

New insights into the anti-inflammatory actions of aspirin- induction of nitric oxide through the generation of epi-lipoxins

Aspirin has always remained an enigmatic drug. Not only does it present with new benefits for treating an ever-expanding list of apparently unrelated diseases at an astounding rate but also because aspirin enhances our understanding of the nature of these diseases processe. Originally, the beneficial effects of aspirin were shown to stem from its inhibition of cyclooxygenase-derived prostaglandins, fatty acid metabolites that modulate host defense. However, in addition to inhibiting cyclooxygenase activity aspirin can also inhibit pro-inflammatory signaling pathways, gene expression and other factors distinct from eicosanoid biosynthesis that drive inflammation as well as enhance the synthesis of endogenous protective anti-inflammatory factors. Its true mechanism of action in anti-inflammation remains unclear. Here the data from a series of recent experiments proposing that one of aspirin's predominant roles in inflammation is the induction of nitric oxide, which potently inhibits leukocyte/endothelium interaction during acute inflammation, will be discussed. It will be argued that this nitric oxide-inducing effects are exclusive to aspirin due to its unique ability, among the family of traditional anti-inflammatory drugs, to acetylate the active site of inducible cyclooxygenase and generate a family of lipid mediators called the epi-lipoxins that are increasingly being shown to have profound roles in a range of host defense responses.

The development of an enzyme-linked immunosorbent assay for Trypanosoma vivax antibodies and its use in epidemiological surveys

There are data indicating that the distribution of Trypanosoma vivax in the Brazilian territory is expanding with potential to reach other areas, where the vectors are present. The detection of anti-trypanosomal antibodies in serum provides important information of the trypanosomal status in cattle herds. For this reason, an enzyme-linked immunosorbent assay (Tv-ELISA-Ab) with crude antigen from one Brazilian isolate of T. vivax was developed and evaluated. The sensitivity and specificity were respectively 97.6 and 96.9%. In the evaluation of cross-reactions, three calves inoculated with T. evansi trypimastigotes blood forms showed optical densities (OD) under the cut-off during the whole experimental period, except one at 45 days post-inoculation. With relation to Babesia bovis, B. bigemina, and Anaplasma marginale, which are endemic hemoparasites in the studied area, the cross-reactions were shown to be 5.7, 5.3, and 1.1%, respectively. The first serological survey of Pantanal and state of Pará showed that T. vivax is widespread, although regions within both areas had significantly different prevalences. Therefore, this Tv-ELISA-Ab may be a more appropriate test for epidemiological studies in developing countries because the diagnostic laboratories in most countries may be able to perform an ELISA, which is not true for polymerase chain reaction.