Biologia de Sistemas Aplicada à Insuficiência Cardíaca com Fração de Ejeção Normal

A insuficiência cardíaca com fração de ejeção normal (ICFEN) é, atualmente, o fenótipo clínico mais prevalente de insuficiência cardíaca e os tratamentos disponíveis não apresentam redução na mortalidade. Avanços na disciplina de ciências ômicas e em técnicas de elevado processamento de dados empregados na biologia molecular possibilitaram o desenvolvimento de uma abordagem integrativa da ICFEN baseada na biologia de sistemas. O objetivo deste trabalho foi apresentar um modelo da ICFEN baseado na biologia de sistemas utilizando as abordagens bottom-up e top-down. Realizou-se uma pesquisa na literatura de estudos publicados entre 1991-2013 referentes à fisiopatologia da ICFEN, seus biomarcadores e sobre a biologia de sistemas com o desenvolvimento de um modelo conceitual utilizando as abordagens bottom-up e top-down da biologia de sistemas. O emprego da abordagem de biologia de sistemas para ICFEN, a qual é uma síndrome clínica complexa, pode ser útil para melhor entender sua fisiopatologia e descobrir novos alvos terapêuticos.

Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

Background: High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective: To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). Methods: This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Benefic&#234;ncia Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results: Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Conclusion: Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA.

Predictors of Conversion from Radial Into Femoral Access in Cardiac Catheterization

Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

AbstractBackground:Heart surgery has developed with increasing patient complexity.Objective:To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).Method:All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.Results:Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.Conclusion:Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

A relação K/Mg em plantas jovens de laranjeira (Citrus sinensis L., Var. D.A.C)

A análise das folhas das plantas revelaram que a absorção de Mg e de K aumentaram com a concentração do elemento respectivo na solução. O Mg não interferiu na absorção do K nos tratamentos correspondentes à omissão e dose 2 deste nutriente; nos tratamentos correspondentes à dose 1, 48 p.p.m. de Mg nas, soluções nutritivas estimularam a absorção de K. O K inibiu a absprção de Mg nos tratamentos correspondentes às doses 0 e 2 deste elemento: quanto na presença da dose 1, 234, p.p.m. de K nas soluções nutritivas determinaram maior concentração de Mg nas folhas. O K teve ação antagônica sobre o Ca; o Mg teve efeito semelhante só quando na presença da dose mais elevada de K. Na ausência desse elemento ou na presença de 234 p.p.m. dele o efeito do Mg foi quadrático.

Influência da heterogeneidade ambiental sobre os atributos da comunidade de Chironomidae em lagoas de inundação neotropicais

A estrutura do ambiente é um importante fator que influencia a distribuição das comunidades. Neste sentido, ambientes fisicamente mais complexos sustentam maior riqueza de espécies que aqueles mais simples. Este estudo teve por objetivo avaliar a influ&#234;ncia da heterogeneidade ambiental sobre os atributos da comunidade de Chironomidae, determinando a distribuição espacial do grupo em diferentes lagoas da planície de inundação do alto rio Paraná. As coletas foram realizadas trimestralmente de março a dezembro de 2011, em seis ambientes (tr&#234;s lagoas com conexão e tr&#234;s lagoas sem conexão ao rio principal). A heterogeneidade das lagoas foi determinada pelo Escore Ambiental, o qual foi calculado através da soma das características físicas, químicas e biológicas das lagoas. As correlações entre o Escore Ambiental das lagoas com a riqueza, densidade e a diversidade de larvas de Chironomidae foram significativas. Tais resultados sugerem que as lagoas com maior Escore Ambiental ou maior heterogeneidade são mais propícias à suportar um número mais elevado de indivíduos e de táxons.

Ocorrência e recrutamento larval de Teredinidae (Mollusca, Bivalvia) na região do Sistema Costeiro Cananéia-Iguape, São Paulo, Brasil

A ocorr&#234;ncia e o recrutamento larval de Teredinidae na região do Sistema Costeiro Cananéia-Iguape foram acompanhados por doze meses utilizando-se coletores laminados de pinho, instalados em tr&#234;s estações dentro do bosque de mangue (mediolitoral) e em uma estação, localizada no infralitoral. No manguezal, a colonização por larvas de teredinídeos ocorreu após quatro meses de perman&#234;ncia dos coletores na estação mais frequentemente inundada pela maré e somente após oito meses nas duas estações com menor frequ&#234;ncia de inundação. No infralitoral, após quatro meses, os coletores já estavam consideravelmente danificados. Ao longo do experimento, houve um decréscimo no número de teredinídeos, especialmente no infralitoral, ocasionado possivelmente pela competição por alimento e espaço entre teredinídeos e foladídeos. Foram encontrados 2.658 indivíduos, sendo 704 de Teredinidae e 1.954 de Pholadidae. Entre os teredinídeos, Bankia fimbriatula foi a espécie mais abundante tanto no infralitoral quanto no manguezal, seguida de Bankia gouldi e Lyrodus floridanus que ocorreram somente no infralitoral, e Nausitora fusticula encontrada somente no manguezal. Martesia striata, único foladídeo, ocorreu somente no infralitoral.

Colonização de macroinvertebrados bentônicos em detritos foliares em um riacho de primeira ordem na Floresta Atlântica do nordeste brasileiro

O objetivo do estudo foi avaliar a colonização de macroinvertebrados bentônicos em detritos foliares de Inga ingoides (Leguminosae) em experimentos de campo em um riacho de primeira ordem da Mata Atlântica do Estado de Pernambuco no nordeste do Brasil. Um total de 270 bolsas de folhiço, distribuídas em tr&#234;s trechos do riacho com características similares em relação à morfologia e parâmetros físicos e químicos da água foram submersas, entre fevereiro a julho de 2013 e retiradas após 7, 30, 60, 90 e 120 dias. Dois tratamentos foram utilizados: colonização e exclusão da macrofauna. O percentual de biomassa remanescente final (%R) foi maior para bolsas de colonização do que para as de exclusão, evidenciando a efetiva participação dos macroinvertebrados no processo de decomposição. Os fragmentadores apresentaram menor participação no processo de decomposição foliar de I. ingoides, sendo Tripletides (Trichoptera: Leptoceridae), Polypedillum e Stenochironomus (Diptera, Chironomidae) os táxons predominantes na macrofauna. Filtrador foi o grupo trófico funcional predominante (45,6%), seguido por predador (31,2%), coletor (11,8%), raspador (6,7%) e fragmentador (4,8%).

Distribuição espacial e temporal de espécies de Bledius (Coleoptera, Staphylinidae) em praias arenosas no sul do Brasil

Besouros da família Staphylinidae são comuns em zonas costeiras inundáveis pelas marés, como praias arenosas, manguezais, estuários e marismas. O objetivo desse trabalho foi estudar a distribuição espacial e a variação temporal da abundância ao longo de um ano, das espécies ocorrentes em duas praias arenosas (Assenodi e Cem) no Pontal do Paraná, Paraná, Brasil. Coletas semanais com um cilindro de PVC com 15 cm de diâmetro (0,017 m²) enterrado a 5 cm de profundidade, foram realizadas de janeiro a dezembro de 2012. A praia Assenodi apresentou altos valores de umidade de sedimento no supralitoral e pós-praia. Nesta praia, Bledius bonariensis foi dominante, mas também houve registro de B. fernandezi, ambas distribuídas nas porções superiores do perfil praial e ocorreram ao longo de todo o ano. A praia Cem apresentou valores altos de umidade do sedimento apenas no mesolitoral, em decorr&#234;ncia da subida e descida da maré, neste estrato B. hermani, foi a espécie dominante. Bledius bonariensis teve ocorr&#234;ncia ocasional em alguns meses do outono e inverno, associada a um aumento nas precipitações. A variação na abundância de B. hermani foi grande, sendo os maiores valores associados às altas temperaturas do verão. As espécies de Bledius mostraram uma clara separação espacial relacionada a distintos requerimentos ambientais, o que possibilita a coocorr&#234;ncia das tr&#234;s espécies na mesma praia em função de variações ambientais ao longo do ano.

A doença de Chagas no Paraná

In recent speech in Curitiba (May 22nd, 1954), Dr. Mario Pinotti, Director, Serviço Nacional da Malaria, informed that his personnel started on February, 1953, a survey upon chagas Disease in 23 counties of the State of Paraná, South Brazil. out of 895 places surveyed, 678, or 75.7%, were infected by Triatoma infestans klug 1834 and in 234 out of those 678, or 34.5%, this vector was infected by Trypanosoma cruzi. The general natural infection of the insects examined reached 18.86%. The serological survey (Machado-Guerreiro test) was positive in 10.7% of the persons examined in jacarezinho and in 28.3% of those living in Bôa Vista. These data suggested the author to actualise the subject. During his control of severe outbreack of malaria in the North part of Paraná, from march to June 1917 he worked in 8 counties. March 1917 he photographed in Boa Vista four girls, severe cases of chronic malaria, two of which showed bi-palpebral oedema, later on considered by Dr. Pinho Simões (1943) as Romanã syndrome (created in 1935) and Prof. Salvador Mazza (1946) classified as typical cases of Chagas' Disease. now, being elapsed 36 years, the National Service of Malaria confirmed the discovery. The region surveyed was populated, in the beginning of this century, by immigrants from the State of Minas Gerais, from where the author believes that were imported the disease and its vectors. In April 1917 the A. discovered that the old town Jatahy was a big focus of Triatoma megista (now Panstrongylus megistus0. All its 43 houses were strongly infested by such hematophagus and amongst the 200 inhabitants seen many were suspicious cases of chronic cases of Chagas's Disease. In the Indians town (three tribes) of S. Pedro D' Alcantara, situated in front of Jatahy, in the left side of the river Tibagy, there were no Triatomas nor suspicious cases of trypanosomiasis. In 1919 the author started the control of the endemics by destroying the foci of Triatomas and reforming the housing. In 1946 he returned to jatahy and found the sanitary conditions of the town and its inhabitants much better. Climate of the region is favorable to spreading of all tropical diseases, being very suitable one for an extensive sanitary survey. In 1943 Dr. Pinho Simões examined 85 triatomas ( T. infestans) from six counties of the North region and found 40, or 46% infected by Trypanosoma cruzi. The highest incidences were; Joaquim Tavora 74.2% and Carlópolis 26.9%. These counties seem to be infested by Itaporanga county of São Paulo State. in 1953 Serviço nacional da Malária proved that 19 out of 23 counties surveyed were infested by Triatoma infestans. They examined 7,701 of this insect and found 1,453 positive for Trypanosoma cruzi, or 18.9%. in two counties, Jacarezinho and Sengés, were examined 2,588 human bloods, not selected, and 323, or 12.6% of such samples were positive for Chagas' Disease. This year the Malaria Service is doing insects survey in 25 other counties and DDTising infested domiciles of another eight. Such activity is very promising and should be extended to other places.

Morbidade da esquistossomose mansoni no Brasil: III Estudo evolutivo em uma área endêmica no período de dez anos

Quatro estudos sobre a morbilidade da esquistossomose mansoni foram realizados na localidade de Capitão Andrade, município de Itanhomi, no Vale do Rio Doce, em Minas Gerais, Brasil, respectivamente em 1973, 1974, 1979 e 1983, constando basicamente do exame de fezes quantitativo e do exame clínico da população residente, acrescidos do estudo da dinâmica e índices de infecção dos planorbídeos e do contacto homem-água entre os dois primeiros estudos. O presente trabalho compara a situação da infecção na localidade em 1973 a 1983 e estuda a evolução da doença em uma amostra de 324 pessoas residentes na área desde o primeiro estudo, dos quais 190 eram infectados com S. mansoni naquela época (26,3% dos infectados) e 134 não infectados (27,6% dos não infectados). A prevalência da infecção era de 60,8% entre as 1.234 pessoas examinadas em 1973 e de 26,2% entre 1.269 examinadas em 1983, havendo, portanto, uma redução de 24,6% sem nenhum tipo de intervenção dirigida. Entretanto, a grande mobilidade da população da área e o tratamento por iniciativa própria de 7% das pessoas estudadas podem justificar essa redução da prevalência. Embora tenha havido uma redução de mais de 50% do número mediano de ovos de S. mansoni eliminados pela população, não se modificou a morbilidade da doença nem a proporção entre as formas clínicas no período. A incidência da infecção entre os 134 casos negativos acompanhados, foi de 40,3% nos dez anos (média anual de 4%), com 61,9% entre os indivíduos do sexo masculino. A incidência das formas clínicas nesse grupo foi de 51,8% para o tipo I (infecção), 38,9% para o tipo II (hepatointestinal) e 9,3% para o tipo III (hepatoesplênica). A evolução clínica dos 190 casos anteriormente infectados ficou inalterada em 75,3%, evoluiu progressivamente em 12,1% (agravamento) e regressivamente em 12,6% (melhora), entre os quais 8,4% ou seja, dois terços fizeram tratamento específico por conta própria.

The identification and characterization of new immunogenic egg components: implications for evaluation and control of the immunopathogenic T cell response in schistosomiasis

In schistosomiasis, granuloma formation to parasite eggs signals the beginning of a chronic and potentially life-threatening disease. Granulomas are strictly mediated by CD4+ T helper (Th) cells specific for egg antigens; however, the number and identity of these T cell-sensitizing molecules are largely unknown. We have used monoclonal T cell reagents derived from egg-sensitized individuals as probes to track down, isolate and positively identify several egg antigens; this approach implicitly assures that the molecules of interest are T cell immunogens and, hence, potentially pathogenic. The best studied and most abundant egg component is the Sm-p40 antigen. Sm-p40 and its peptide 234-246 elicit a strikingly immunodominant Th-1-polarized response in C3H and CBA mice, which are H-2k strains characterized by severe egg-induced immunopathology. Two additional recently described T cell-sensitizing egg antigens are Schistosoma mansoni phosphoenolpyruvate carboxykinase (Sm-PEPCK) and thioredoxin peroxidase-1 (Sm-TPx-1). In contrast to Sm-p40, both of these molecules induce a more balanced Th-1/Th-2 response, and are relatively stronger antigens in C57BL/6 mice, which develop smaller egg granulomas. Importantly, Sm-p40 and Sm-PEPCK have demonstrated immunogenicity in humans. The findings in the murine model introduce the important notion that egg antigens can vary significantly in immunogenicity according to the host's genetic background. A better knowledge of the principal immunogenic egg components is necessary to determine whether the immune responses to certain antigens can serve as indicators or predictors of the form and severity of clinical disease, and to ascertain whether such responses can be manipulated for the purpose of reducing pathology.

Antiretroviral resistance and genetic diversity of human immunodeficiency virus type 1 isolates from the Federal District, Central Brazil

In the context of universal access to antiretroviral therapy, the surveillance of human immunodeficiency virus type 1 (HIV-1) genetic diversity and resistance becomes pivotal. In this work our purpose was to describe the genetic variability; prevalence of drug-resistance mutations; and genotypic resistance profiles in HIV-1 infected individuals under antiretroviral treatment, from the Federal District, Brasília, Central Brazil. The entire viral protease and codons 19 to 234 of the reverse transcriptase gene from 45 HIV-1 isolates were amplified and sequenced for subtyping and genotyping. By phylogenetic analysis, 96% of the samples clustered with subtype B and the remaining 4% with HIV-1 subtype F sequences. One major protease inhibitor resistance-associated mutation, I50V, was detected in 38% of the samples. Minor mutations were also found at the protease gene: L10I/V (7%), K20M (2%), M36I (11%), L63P (20%), A71T (2%), and V77I (7%). Many mutations associated with reduced susceptibility to nucleoside or non-nucleoside reverse transcriptase inhibitors were detected: M41L (11%), E44D (4%), D67N (11%), T69D (2%), K70R (11%), L74V (2%), L100I (4%), K103N (18%), V118I (9%), Y181C (11%), M184V (18%), G190A (4%), T215Y (4%), and K219E (4%). This study has shown that 84% of the studied population from the Federal District, showing evidences of therapy failure, presented viral genomic mutations associated with drug resistance. The main antiretrovirals to which this population showed resistance were the PI amprenavir (38%), the NNRTIs delavirdine, nevirapine (31%), and efavirenz (24%), and the NRTIs lamivudine (18%), abacavir, and zidovudine (13%).

Assessment of schistosomiasis, through school surveys, in the Forest Zone of Pernambuco, Brazil

This work had the objective of assessing the present epidemiological situation regarding schistosomiasis through performing Kato-Katz coproscopic tests on representative samples of schoolchildren from each of the 43 municipality of endemic area of the state of Pernambuco, Brazil. The methodology is recommended by the World Health Organization to conduct sampled surveys among children at elementary school levels, ideal target group for baseline surveys: (i) schools are accessible; (ii) the greatest prevalence of schistosomiasis is found within this group; (iii) the data gathered from this age group can be used for intervention within the community as a whole. The following infection indicators were utilized: positivity (percentage of individuals examined with eggs of Schistosoma mansoni in the feces) and severity (geometric mean number of eggs per gram of feces, epg). These indicators allowed the area in general and the municipalities in particular to be categorized into prevalence and severity classes for S. mansoni. The prevalence classes were: low (<10%), medium (> 10 and < 50%), and high (> 50%); the severity classes were: low (1-99 epg), moderate (100-399 epg), and severe (> 400 epg). For the geohelminthic diseases, the following indicators were used: positivity for each geohelminth (percentage of individuals examined with eggs of geohelminths), and cumulative positivity (percentage of individuals examined with eggs of at least one geohelminth). The municipalities were categorized by means of their cumulative positivity into the following geohelminth prevalence classes (WHO 2002): low (< 50%), medium (> 50 and < 70%), and high (> 70%). The study covered 271 schools in 179 different localities, thus giving a total of 11,234 examinations performed. The overall positivity for S. mansoni was 14.4% and the egg count for this parasite in the feces gave a geometric mean of 67.9 epg which suggests a low general state of infection. These results allow this mesoregion to be categorized as presenting medium prevalence and low severity of schistosomiasis. The overall positivity rates for the geohelminths, Ascaris lumbricoides, Ancylostomidae, and Trichuris trichiura were, respectively, 30.4, 10.1, and 27.8%; the cumulative positivity was 45.4%. These results allow this mesoregion to be categorized as presenting low prevalence of geohelminthic diseases. The data show some municipalities in Pernambuco with prevalence greater than 20%, while others presented parasite loads greater than 100 epg. These indicators attest to the significant morbidity due to schistosomiasis regarding to the severity of infections established in young populations.

Molecular characterization of astrovirus in stool samples from children in São Paulo, Brazil

The purpose of this study was to characterize astrovirus in faecal samples collected from children with and without diarrhea in São Paulo, Brazil, grouped into two sets: EPM and HU. Detection and genotyping were carried out using reverse transcription nested polymerase chain reaction (RT-PCR) with specific primers directed towards the genome open reading frame 2 (ORF2). Results for EPM set showed that 66/234 (28.2%) were positive: 28/94 (29.7%) from children with acute diarrhea, 14/45 (31.1%) with persistent diarrhea, and 9/55 (16.3%) from control individuals. No data was available for 15/40 (37.5%) of samples. Mixed infections with other viruses were found in 33 samples. In the HU, 18/187 (9.6%) were positive: 12/158 (7.6%) from individuals with acute diarrhea and 6/29 (20.7%) from control children. Four samples were mixed with other viruses. Out of 66 astrovirus positive EPM samples, 18 (27.2%) were characterized as human astrovirus type-1 (HAstV-1), two (3.0%) as HAstV-2, two (3.0%) as HAstV-3, and three (4.5%) as HAstV-8. Among 18 astrovirus positive HU samples, one (5.5%) was characterized as HAstV-1, six (33.3%) as HAstV-2, and one (5.5%) as HAstV-8. Two HAstV-8 genotyped samples were further confirmed by nucleotide sequencing. Our results shows that astroviruses are circulating in a constant manner in the population, with multiple serotypes, in higher frequency than it was described for other Brazilian regions. For the first time in Sao Paulo, Brazil, it was shown that astroviruses play an important role in children gastroenteritis, as described for most locations where they were detected.