Exercise and heart failure. Relation of the severity of the disease to the anaerobic threshold and the respiratory compensation point

OBJECTIVE - To identify, the anaerobic threshold and respiratory compensation point in patients with heart failure. METHODS - The study comprised 42 Men,divided according to the functional class (FC) as follows: group I (GI) - 15 patients in FC I; group II (GII) - 15 patients in FC II; and group III (GIII) - 12 patients in FC III. Patients underwent a treadmill cardiopulmonary exercise test, where the expired gases were analyzed. RESULTS - The values for the heart rate (in bpm) at the anaerobic threshold were the following: GI, 122±27; GII, 117±17; GIII, 114±22. At the respiratory compensation point, the heart rates (in bpm) were as follows: GI, 145±33; GII, 133±14; GIII 123±22. The values for the heart rates at the respiratory compensation point in GI and GIII showed statistical difference. The values of oxygen consumption (VO2) at the anaerobic threshold were the following (in ml/kg/min): GI, 13.6±3.25; GII, 10.77±1.89; GIII, 8.7±1.44 and, at the respiratory compensation point, they were as follows: GI, 19.1±2.2; GII, 14.22±2.63; GIII, 10.27±1.85. CONCLUSION - Patients with stable functional class I, II, and III heart failure reached the anaerobic threshold and the respiratory compensation point at different levels of oxygen consumption and heart rate. The role played by these thresholds in physical activity for this group of patients needs to be better clarified.

Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

Background:The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe.Objective:To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP).Methods:Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP.Results:Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus.Conclusion:Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective: Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results: We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

4-Second Exercise Test: Reference Values for Ages 18–81 Years

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. Objective: To present reference data for 4sET in healthy adults. Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18–30, 31–40, 41–45, 46–50, 51–55, 56–60, 61–65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.

Phylogeny of Thylamys (Didelphimorphia, Didelphidae) species, with special reference to Thylamys karimii

The genus Thylamys Gray, 1843 lives in the central and southern portions of South America inhabiting open and shrub-like vegetation, from prairies to dry forest habitats in contrast to the preference of other Didelphidae genera for more mesic environments. Thylamys is a speciose genus including T. elegans (Waterhouse, 1839), T. macrurus (Olfers, 1818), T. pallidior (Thomas, 1902), T. pusillus (Desmarest, 1804), T. venustus (Thomas, 1902), T. sponsorius (Thomas, 1921), T. cinderella (Thomas, 1902), T. tatei (Handley, 1957), T. karimii (Petter, 1968), and T. velutinus (Wagner, 1842) species. Previous phylogenetic analyses in this genus did not include the Brazilian species T. karimii, which is widely distributed in this country. In this study, phylogenetic analyses were performed to establish the relationships among the Brazilian T. karimii and all other previously analyzed species. We used 402-bp fragments of the mitochondrial cytochrome b gene, and the phylogeny estimates were conducted employing maximum parsimony (MP), maximum likelihood (ML), Bayesian (BY), and neighbor-joining (NJ). The topologies of the trees obtained in the different analyses were all similar and pointed out that T. karimii is the sister taxon of a group constituted of taxa from dry and arid environments named the dryland species. The dryland species consists of T. pusillus, T. pallidior, T. tatei, and T. elegans. The results of this work suggest five species groups in Thylamys. In one of them, T. velutinus and T. kariimi could constitute a sister group forming one Thylamys clade that colonized Brazil.

Influência de elementos climáticos na mortalidade de cidades brasileiras

In this paper, preliminary to a series of investigations that the A. has the purpose to make about the influence of climatic factors particularly upon the prevalence of the most important acute infectious diseases in Brazil, he raises the question whether such factors do affect in this country the total death rates, as it is reasonable to suppose, according to what has been observed in temperate zones of northern and southern hemispheres. The inclusion of absolute humidity among other climatic factors to be dealt with seems justifiable according to Rogers and Stallybrass. Owing to scarcety of reliable data the A. was obliged to limit to a five-years period (1940-1944) the complete proposed investigation, which includes seven of the most important cities, scattered throughout the brazilian territory, from north to south - Belém, recife, Salvador, Rio, S. Paulo, Curitiba and Porto Alegre. Reference is made to their normal climatic conditions and monthly death-rates variations with their mean values and standard deviations. In a first part dealing with seasonal variations only for purposes of comparison, he points out that in there tropical cities of Brazil, without very clear seasonal differentiation, the curve of general mortality reached its highest point in austral autumn season and the remaining four (including Rio near the tropic) in the spring, with the exception of Curitiba, where the peak coincided with the summer season. He shows how such important causes of deaths, as diarrheas, common respiratory diseases and tuberculosis, whose seasonal distribution for each one of the seven cities is referred, may explain such seasonal variations. On a second part, a study is made of the general mortality distribution by four-months periods selected in accordance respectively with the highest or lowest values of rainfall and of mean temperature and humidity during period 1940-1944. Finally he compares the monthly waves of such climatic factors and the corresponding waves of total death - rates and finds through correlation coefficients 17 significant values with respect to their standard errors. Variations in the death - rates seemed to be perhaps more closely and uniformly associated with variations of mean humidity, as is indicated by coefficients ranging from + 0.3 to 0.6.

Observation on the morphology of Australorbis glabratus

The present morphological study of A. glabratus was based on the observation of shell, radula, renal region and genitalia of 50 specimens having a shell diameter of 18 mm. In this summary we record the data pertaining to the chracteristics that can be used in systematics. The numerals refere to the mean and their standard deviation; no special reference being made, they correspond to length measurements. Shell: 18 mm in diameter, 5.59 ± 0.24 mm in greatest width, 5 to 6 whorls. Right side umbilicated, left one weakly depressed. Last whorl about thrice as tall as the penultimate one at the aperture, the measurements being taken on the right side. Aperture perpendicular or a little oblique. Body, extended: 47.06 ± 3.31 mm. Renal tube: Narrow and elongated, 23.84 ± 1.90 mm, showing a pigmented ridge along its ventral surface. Ovotestis: 12.78 ± 1.50 mm. Mainly trifurcate diverticula attaching in fan-like manner to the collecting canal (this arrangement is seen to best advantage in the cephalic middle of the ovotestis). The collecting canal greatly swells at the cephalic end, narrowing suddenly as it leaves the ovotestis. Ovisperm duct: 13.70 ± 1.68 mm, including the non-unwound seminal vesicle. The latter, situated about 1 mm from the beginning af the ovisperm duct, was 1.14 ± 0.29 mm in greatest diameter, and is beset by numerous short diverticula. Sperm duct: 14.16 ± 1.27 mm, pursuing a sinous course along the oviduct. Prostate: Prostate duct 5.53 ± 0.74 mm, collecting a row of long diverticula, the latter 21.6 ± 3.5 in number. Last diverticulum generally simple or bifurcate, penultimate generally arborescent, bifurcate or simple, antepenultimate nearly always arborescent, the remaining ones arborescent. The arborescent diverticula frequently give off secondary branches. Vas deferens: 17.50 ± 2.05 mm. The ratio vas deferens/vergic sac was 4.7 ± 0.6. Verge: 3.70 ± 0.54 mm long, 0.12 ± 0.03 mm wide. Free end tapering to a point where the sperm canal opens. No penial stylet. Vergic sac: 3.77 ± 0.50 mm long, 0.19 ± 0.01 mm wide. The length ratio vergic sac/preputium was 1 ± 0.02. Preputium: Deeply pigmented, 3.79 ± 0.40 mm long, 0.89 ± 0.12 mm wide in the middle. Muscular diaphragm between it and the vergic sac. Two muscular pilasters along its lateral walls. Oviduct: 10.24 ± 1.29 mm, suddenly swollen at the cephalic end so that it forms a folded pouch capping the beginning of the uterus. Uterus: 10.58 ± 1.18 mm. Vagina: 2.06 ± 0.15 mm long, 0.32 ± 0.05 mm wide, showing a swelling at its caudal portion, just above the opening of the spermathecal duct. Spermatheca: 1.57 ± 0.41 mm long, 0.92 ± 0.23 mm wide. Spermathecal duct 1.15 ± 0.23 mm. Radula: 125 to 163 rows of teeth (mean 141.4 ± 9.8). Radula formula 27-1-27 to 34-1-34 (mean 30.9 ± 1.7).

Observations on the distribution of anophelines in Suriname with particular reference to the malaria vector Anopheles darlingi

A study was made on the distribution of anophelines in Suriname with special emphasis on the principal malaria vector Anopheles darlingi and on the occurrence of other possible vector species. Peridomestic human bait collections of adult mosquitoes and collections of larvae were made in many localities with a recent history of malaria transmission. Stable population of An. darlingi were only found in the interior, south of the limit of tidal influence, due to year-round availability of breeding habitats in quietly sunlit places in flooded forest areas and along river banks. In the area with tidal movement of the rivers, breeding is limited to flooded areas in the west season. Anopheles darlingi was only incidentally collected in low densities. In the interior, malaria transmission occurred in all places where An. darlingi was found. The absence of malaria transmission along the Upper Suriname River could be explained by the absence of An. darlingi. In the malaria endemic areas, An darlingi was the most numerous mosquito biting on man. In the tidal region, malaria outbreak are infrequent and might be explained by the temporary availability of favourable beeding habitats for An. darlingi. However, evidence is insufficient to incriminate an. darlingi as the vector of malaria in this region and the possible vectorial role of other anophelines is discussed.

A preliminary checklist and key to the genera and subgenera of Tabanidae (Diptera) of Bolivia with particular reference to Santa Cruz Department

This paper documents 32 genera and 167 species of Tabanidae reported from Bolivia. All available data are cited for each species. A key to genera and subgenera is presented and includes illustrations. This preliminary checklist and key is intended as a baseline for further study, the aim of which is to establish which species are of greatest economic importance.

The dermal leishmaniases of Brazil, with special reference to the eco-epidemiology of the disease in Amazonia

Six species of Leishmania are at present known to cause cutaneous and/or mucocutaneous leishamniasis in Brazil, and they are all to be found in the Amazon region of this country. The eco-epidemiology of each is discussed, with the observation that the Amazonian leishmaniases are all zoonoses, with their source in silvatic mammals and phlebotomine sandfly vectors. With man's destruction of the natural forest in southern Brazil, some sandfly species have survived by adapting to a peridomestic or domiciliary habitat in rural areas. Some domestic animals, such as dogs and equines are seemingly now involved in the epidemiology of the disease. No such process has yet been reported in the Amazon region, but may well take place with the continuing devastation of its forest.

Present development concerning antimalarial activity of phospholipid metabolism inhibitors with special reference to in vivo activity

The systematic screening of more than 250 molecules against Plasmodium falciparum in vitro has previously shown that interfering with phospholipid metabolism is lethal to the malaria parasite. These compounds act by impairing choline transport in infected erythrocytes, resulting in phosphatidylcholine de novo biosynthesis inhibition. A thorough study was carried out with the leader compound G25, whose in vitro IC50 is 0.6 nM. It was very specific to mature parasites (trophozoïtes) as determined in vitro with P. falciparum and in vivo with P. chabaudi -infected mice. This specificity corresponds to the most intense phase of phospholipid biosynthesis activity during the parasite cycle, thus corroborating the mechanism of action. The in vivo antimalarial activity (ED50) against P. chabaudi was 0.03 mg/kg, and a similar sensitivity was obtained with P. vinckei petteri, when the drug was intraperitoneally administered in a 4 day suppressive test. In contrast, P. berghei was revealed as less sensitive (3- to 20-fold, depending on the P. berghei-strain). This difference in activity could result either from the degree of synchronism of every strain, their invasion preference for mature or immature red blood cells or from an intrinsically lower sensitivity of the P. berghei strain to G25. Irrespective of the mode of administration, G25 had the same therapeutic index (lethal dose 50 (LD50)/ED50) but the dose to obtain antimalarial activity after oral treatment was 100-fold higher than after intraperitoneal (or subcutaneous) administration. This must be related to the low intestinal absorption of these kind of compounds. G25 succeeded to completely inhibiting parasitemia as high as 11.2% without any decrease in its therapeutic index when administered subcutaneously twice a day for at least 8 consecutive days to P. chabaudi -infected-rodent model. Transition to human preclinical investigations now requires a synthesis of molecules which would permit oral absorption.

Validity of serology for American Trypanosomiasis with eluates from filter paper

This study evaluates whether blood collected on filter paper kept at 4 degrees C and tested at different intervals of time (1, 7, 15, 30 and 60 days after collection) would present similar results when compared to the serum samples and whether the type of filter paper influences the results. Eluates from filter paper samples were tested for Trypanosoma cruzi antibodies using indirect immunofluorescence antibody test (IFAT), indirect haemagglutination (IHA) and enzyme-linked immunosorbent assay (ELISA) as reference, the antibody titer in sera. Analysis of data showed that results obtained with IFAT, IHA (cut off point = 1:40) and ELISA in sera had similar sensitivity and good concordance among reactions. The use of a multiple linear regression model indicated that titer fall in eluates occurs up to the 7th day after the collection, and it is more marked for samples with lower antibodies titers. However, no significant differences were observed by IFAT, IHA (cut off point = 1:20) and ELISA in the proportion of positive reactions between sera and eluates. The results also showed that Melitta, Klabin or Whatman (reference) filter papers could be indicated for surveys, since they have shown similar capacity of maintenance of anti-T. cruzi immunoglobulins.