Predictive factors for Leishmania infantum infection in dogs examined at a veterinary teaching hospital in Teresina, State of Piau��, Brazil

Abstract: INTRODUCTION: In Brazil, culling of seropositive dogs is one of the recommended strategies to control visceral leishmaniasis. Since infectiousness is correlated with clinical signs, control measures targeting symptomatic dogs could be more effective. METHODS: A cross-sectional study was carried out among 1,410 dogs, predictive models were developed based on clinical signs and an indirect immunofluorescence antibody test. RESULTS: The validated predictive model showed sensitivity and specificity of 86.5% and 70.0%, respectively. CONCLUSIONS: Predictive models could be used as tools to aid control programs in focusing on a smaller fraction of dogs contributing more to infection dissemination.

Prevention of respiratory syncytial virus infections

Respiratory syncytial virus is the most important cause of viral lower respiratory illness in infants and children worldwide. By the age of 2 years, nearly every child has become infected with respiratory syncytial virus and re-infections are common throughout life. Most infections are mild and can be managed at home, but this virus causes serious diseases in preterm children, especially those with bronchopulmonary dysplasia. Respiratory syncytial virus has also been recognized as an important pathogen in people with immunossupressive and other underlying medical problems and institutionalizated elderly, causing thousands of hospitalizations and deaths every year. The burden of these infections makes the development of vaccines for respiratory syncytial virus highly desirable, but the insuccess of a respiratory syncytial virus formalin-inactivated vaccine hampered the progress in this field. To date, there is no vaccine available for preventing respiratory syncytial virus infections, however, in the last years, there has been much progress in the understanding of immunology and immunopathologic mechanisms of respiratory syncytial virus diseases, which has allowed the development of new strategies for passive and active prophylaxis. In this article, the author presents a review about novel approaches to the prevention of respiratory syncytial virus infections, such as: passive immunization with human polyclonal intravenous immune globulin and humanized monoclonal antibodies (both already licensed for use in premature infants and children with bronchopulmonary dysplasia), and many different vaccines that are potential candidates for active immunization against respiratory syncytial virus.

Haematophagic behavior in laboratory of Lutzomyia cruzi (Mangabeira) (Diptera: Psychodidae) in relation to three mammalian blood sources in Manaus, Brazil

The sand fly Lutzomyia cruzi is considered as one of vectors of visceral leishmaniasis in Brazil. This work examined optimum feeding age, feeding time, host preference, fecundity rates, and female blood meal volume taken by single females from a closed colony of L. cruzi. Mean feeding time was longer on hamsters, 6.6 minutes, than on humans, 5.7 minutes. 49.1% of the 48h-old flies fed on humans and 43.3% of 72h-old flies fed on hamsters. Of a total of 120 females, 61% fed on humans and 25% fed on hamsters. Total fecundity was significantly higher in females fed on hamster than on human or opossum. Laboratory-reared L. cruzi females fed earlier, more promptly, and preferably on humans than on hamsters when offered these blood-meal sources simultaneously. The blood-meal volume is higher in females fed on hamsters than other hosts (human and opossum).

Diversity of sand flies in domiciliary environment of Santar��m, state of Par��, Brazil: species composition and abundance patterns in rural and urban areas

This paper aimed to evaluate the richness, abundance and frequency of sand fly occurrence in rural and urban areas American visceral Leishmaniasis -AVL is endemic in the study area of Santar��m municipality, Par�� state. Sand flies were collected during 1995-2000, using CDC light traps placed in neighborhoods and rural areas of the municipality. A total of 53.454 individuals and 26 species of sand flies were collected. The most abundant species in both urban and rural environments was Lutzomyia longipalpis, vector of AVL in the area. The highest species richness by capture was in rural area. In all years sampled, the largest number of species of sand fly collected was always in rural areas. The species of sand flies in urban and rural area were similar in 11 species. In the rural area other 11 species were found, a total of 22 species. Shannon-Wiener index ranged from 0.12 to 0.84 at rural areas and 0.08 to 0.34 at urban ones. In general, rural localities showed higher diversity (H') of phlebotomines than urban ones. Individual-based rarefaction curves for each area demonstrated that urban localities had the lowest expected number of phlebotomine species and the richest rural ones reach higher expected values with lower amount of individuals than urban sites. The most frequent species were Lutzomyia longipalpis, Evandromyia carmelinoi and Bichromomyia flaviscutellata.

Aneurysmal dilation of the reimplant segment of the visceral vessels after thoracoabdominal aneurysm correction

We present a case of aneurysmal dilation of the aortic residual segment, involving abdominal vessels in corrective surgeries for thoracoabdominal aortic aneurysm, through the identification of risk groups for recurrent dilation, aiming at using a specific operative technique with a branched graft, to prevent aneurysm relapse.

Valida����o para o portugu��s do Maugerl CaRdiac preventiOn-Questionnaire (MICRO-Q)

FUNDAMENTO: O Maugerl CaRdiac preventiOn-Questionnaire (MICRO-Q) �� um instrumento espec��fico, validado e utilizado para avaliar o conhecimento do paciente coronariano sobre aspectos relacionados �� preven����o secund��ria da doen��a arterial coronariana (DAC). OBJETIVO: Traduzir, adaptar e validar o MICRO-Q para a l��ngua portuguesa do Brasil. M��TODOS: Duas tradu����es iniciais independentes foram realizadas para o portugu��s. Ap��s sua compara����o foi feita a tradu����o reversa, que foi revisada por um comit�� e gerou a vers��o final, testada em um estudo-piloto. O instrumento foi aplicado em 212 pacientes coronarianos, com idade m��dia de 60 a 72 anos (desvio padr��o = 9,4; m��n = 35; m��x = 86), participantes de programas de reabilita����o card��aca. A consist��ncia interna foi verificada por meio do coeficiente Alpha de Cronbach, a correla����o atrav��s do Spearman Rho e a validade de construto foi verificada por an��lise fatorial explorat��ria. As m��dias foram analisadas comparando as escalas das quest��es corretas em fun����o de vari��veis, como idade, sexo, comorbidades associadas, grau de escolaridade, renda familiar, entre outros. RESULTADOS: A vers��o brasileira do MICRO-Q possui 25 quest��es. Essa vers��o, quanto �� confiabilidade, apresentou Alpha de Cronbach de 0,64 e Spearman Rho das respostas corretas de 0,65. A an��lise fatorial revelou a exist��ncia de 6 fatores, relacionados aos dom��nios de conhecimento do question��rio. A an��lise das caracter��sticas da popula����o, em fun����o das escalas das quest��es corretas, apresentou diferen��as significativas apenas em fun����o da renda familiar mensal e grau de escolaridade. CONCLUS��O: A vers��o brasileira do MICRO-Q aprovada apresenta validade e confiabilidade adequadas para sua utiliza����o em futuras pesquisas.

Avalia����o por imagem da ��rea de gordura visceral e suas correla����es com altera����es metab��licas

FUNDAMENTO: A obesidade androg��nica est�� associada a um risco maior de dist��rbios metab��licos, favorecendo assim a ocorr��ncia de doen��as cardiovasculares e outras morbidades. OBJETIVO: Verificar a influ��ncia da ��rea de tecido adiposo visceral (ATAV), medida pela tomografia computadorizada, sobre altera����es metab��licas em adultos e idosos. M��TODOS: Tomografias computadorizadas e valores de lipoprote��nas: o colesterol total e fra����es, os triglic��rides, a glicemia e o ��cido ��rico foram obtidos de 194 indiv��duos estratificados por sexo, grupo et��rio e massa corporal, e analisados utilizando os testes de correla����o e de m��dia. RESULTADOS: Os idosos apresentaram maiores valores da ATAV, glicemia, ��cido ��rico e colesterol total. As maiores correla����es foram encontradas entre a ATAV, os triglic��rides e o VLDL-c (r &gt; 0,5; p < 0,01), em ambos os grupos et��rios. A m��dia da ��rea de tecido adiposo visceral mostrou-se sempre mais elevada quando os valores de triglic��rides e de glicemia estavam alterados, em ambos os grupos et��rios. CONCLUS��O: A maioria dos exames apresentou forte correla����o com a ATAV considerada de risco para altera����es metab��licas. Em idosos, a ��rea de tecido adiposo visceral de risco parece ser superior a de adultos.

Preval��ncia de obesidade visceral estimada por equa����o preditiva em mulheres jovens pernambucanas

FUNDAMENTO: O ac��mulo de gordura visceral �� considerado o principal fator de risco para doen��as cardiovasculares e metab��licas. OBJETIVO: Determinar a preval��ncia de obesidade visceral e avaliar sua associa����o com fatores de risco cardiovasculares em mulheres jovens do Estado de Pernambuco. M��TODOS: Estudo transversal, realizado com dados da "III Pesquisa Estadual de Sa��de e Nutri����o", envolvendo mulheres entre 25 e 36 anos. Avaliaram-se as vari��veis: ��ndice de Massa Corporal (IMC), Circunfer��ncia da Cintura (CC), Raz��o Cintura-Estatura (RCE), Volume de Gordura Visceral (VGV) estimado por equa����o preditiva, Press��o Arterial Sist��lica e Diast��lica (PAS, PAD), Colesterol Total (CT), Triglicer��deo (TG), Glicemia de Jejum (GJ). RESULTADOS: Foram avaliadas 517 mulheres, com mediana de idade de 29 anos (27-32) e preval��ncia de obesidade visceral de 30,6%. Valores de IMC, PAS, PAD e TG foram superiores no grupo com obesidade visceral: IMC = 28,0 kg/m�� (25,0 - 21,4) vs 23,9 kg/m�� (21,5 - 26,4); PAS = 120,0 mmHg (110,0 - 130,0) vs 112,0 mmHg (100,0 - 122,0); PAD = 74 mmHg (70 - 80) vs 70 mmHg (63 - 80); TG = 156,0 mg/dL (115,0 - 203,2) vs 131,0 mg/dL (104,0 - 161,0), respectivamente, p < 0,01. Idade, PAS, PAD, TG e CT apresentaram correla����o positiva e significante com o VGV: r = 0,171; 0,224; 0,163; 0,278; 0,124; respectivamente, p < 0,005. CONCLUS��O: Verificou-se uma elevada preval��ncia de obesidade visceral, estando estatisticamente correlacionada a fatores de risco cardiovasculares.

Prevention of Pazopanib-Induced Prolonged Cardiac Repolarization and Proarrhythmic Effects

Background: Pazopanib (PZP) may induce prolonged cardiac repolarization and proarrhythmic effects, similarly to other tyrosine kinase inhibitors. Objectives: To demonstrate PZP-induced prolonged cardiac repolarization and proarrhythmic electrophysiological effects and to investigate possible preventive effects of metoprolol and diltiazem on ECG changes (prolonged QT) in an experimental rat model. Methods: Twenty-four Sprague-Dawley adult male rats were randomly assigned to 4 groups (n = 6). The first group (normal group) received 4 mL of tap water and the other groups received 100 mg/kg of PZP (Votrient&#174; tablet) perorally, via orogastric tubes. After 3 hours, the following solutions were intraperitoneally administered to the animals: physiological saline solution (SP), to the normal group and to the second group (control-PZP+SP group); 1 mg/kg metoprolol (Beloc, Ampule, AstraZeneca), to the third group (PZP+metoprolol group); and 1mg/kg diltiazem (Diltiazem, Mustafa Nevzat), to the fourth group (PZP+diltiazem group). One hour after, and under anesthesia, QTc was calculated by recording ECG on lead I. Results: The mean QTc interval values were as follows: normal group, 99.93 &#177; 3.62 ms; control-PZP+SP group, 131.23 &#177; 12.21 ms; PZP+metoprolol group, 89.36 &#177; 3.61 ms; and PZP+diltiazem group, 88.86 &#177; 4.04 ms. Both PZP+metoprolol and PZP+diltiazem groups had significantly shorter QTc intervals compared to the control-PZP+SP group (p < 0.001). Conclusion: Both metoprolol and diltiazem prevented PZP-induced QT interval prolongation. These drugs may provide a promising prophylactic strategy for the prolonged QTc interval associated with tyrosine kinase inhibitor use.

South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: &#8226; Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; &#8226; Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; &#8226; Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Background:Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.Objective:To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.Methods:We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.Results:Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.Conclusions:Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.