Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations

Cardiovascular diseases are the main causes of mortality and morbidity in Brazil. Their primary and secondary preventions are a priority for the health system and require multiple approaches for increased effectiveness. Biomarkers are tools used to identify with greater accuracy high-risk individuals, establish a faster diagnosis, guide treatment, and determine prognosis. This review aims to highlight the importance of biomarkers in clinical cardiology practice and raise relevant points regarding their application and perspectives for the next few years. This document was divided into two parts. This second part addresses the application of biomarkers in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism, and cardiorenal syndrome.

Morphological development of Corydoras aff. paleatus (Siluriformes, Callichthyidae) and correlation with the emergence of motor and social behaviors

Here we examine major anatomical characteristics of Corydoras aff. paleatus (Jenyns, 1842) post-hatching development, in parallel with its neurobehavioral evolution. Eleutheroembryonic phase, 4.3-8.8 days post-fertilization (dpf); 4.3-6.4 mm standard length (SL) encompasses from hatching to transition to exogenous feeding. Protopterygiolarval phase (8.9-10.9 dpf; 6.5-6.7 mm SL) goes from feeding transition to the commencement of unpaired fin differentiation, which marks the start of pterygiolarval phase (11-33 dpf; 6.8-10.7 mm SL) defined by appearance of lepidotrichia in the dorsal part of the median finfold. This phase ends with the full detachment and differentiation of unpaired fins, events signaling the commencement of the juvenile period (34-60 dpf; 10.8-18.0 mm SL). Eleutheroembryonic phase focuses on hiding and differentiation of mechanosensory, chemosensory and central neural systems, crucial for supplying the larval period with efficient escape and nutrient detection-capture neurocircuits. Protopterygiolarval priorities include visual development and respiratory, digestive and hydrodynamic efficiencies. Pterygiolarval priorities change towards higher swimming efficacy, including carangiform and vertical swimming, necessary for the high social interaction typical of this species. At the end of the protopterygiolarval phase, simple resting and foraging aggregations are seen. Resting and foraging shoals grow in complexity and participant number during pterygiolarval phase, but particularly during juvenile period.

Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system

Opportunistic infections, which affect acquired immunodeficiency syndrome (Aids) patients, are frequently disseminated and may cause bloodstream infections (BSI). The aim of this study was to evaluate the main causes of BSI in Aids patients with advanced stage of the disease, with special emphasis on the identification of fungemia. During a 21 months period, all patients with Aids (CD4 < 200) and febrile syndrome admitted to 3 university hospitals were systematically evaluated. For each patient presenting fever, a pair of blood cultures was collected and processed by using a commercial lysis-centrifugation system. One hundred and eleven patients (75 males) with a mean age of 36 years (median 33 years) and mean CD4 count of 64 cells/ml were included. Among the 111 patients evaluated we documented 54 episodes of BSI, including 46 patients with truly systemic infections and 8 episodes considered as contaminants. BSI were caused by gram-positive bacteria (43%), fungi (20%), gram-negative bacteria (15%), mycobacteria (15%), and mixed flora (7%). The crude mortality rate of our patients was 39%, being 50% for patients with BSI and 31% for the others. In conclusion, BSI are a common related to systemic infections on Aids patients with advanced stage of disease and is associated with a high rate of mortality.

Serological evidence of hantavirus infection in rural and urban regions in the state of Amazonas, Brazil

Hantavirus disease is caused by the hantavirus, which is an RNA virus belonging to the family Bunyaviridae. Hantavirus disease is an anthropozoonotic infection transmitted through the inhalation of aerosols from the excreta of hantavirus-infected rodents. In the county of Itacoatiara in the state of Amazonas (AM), Brazil, the first human cases of hantavirus pulmonary and cardiovascular syndrome were described in July 2004. These first cases were followed by two fatal cases, one in the municipality of Maués in 2005 and another in Itacoatiara in 2007. In this study, we investigated the antibody levels to hantavirus in a population of 1,731 individuals from four different counties of AM. Sera were tested by IgG/IgM- enzyme-linked immune-sorbent assay using a recombinant nucleocapsid protein of the Araraquara hantavirus as an antigen. Ten sera were IgG positive to hantavirus (0.6%). Among the positive sera, 0.8% (1/122), 0.4% (1/256), 0.2% (1/556) and 0.9% (7/797) were from Atalaia do Norte, Careiro Castanho, Itacoatiara and Lábrea, respectively. None of the sera in this survey were IgM-positive. Because these counties are distributed in different areas of AM, we can assume that infected individuals are found throughout the entire state, which suggests that hantavirus disease could be a local emerging health problem.

Infections with human coronaviruses NL63 and OC43 among hospitalised and outpatient individuals in São Paulo, Brazil

The incidence and clinical features of human coronaviruses (HCoVs) among Brazilian patients with respiratory illness are not well known. We investigated the prevalence of HCoVs among Brazilian outpatients and hospitalised patients with respiratory illnesses during 2009 and 2010. To identify the HCoVs, pancoronavirus and species-specific reverse-transcriptase polymerase chain reaction assays were performed. Five of 394 samples were positive for HCoVs (1.2%): 1/182 (0.5%) outpatients and 4/212 (1.8%) hospitalised patients. The OC43 and NL63 HCoVs were identified. Two patients were admitted to the intensive care unit. Underlying chronic disease was reported in cases and one diabetic adult died. HCoVs can cause lower respiratory infections and hospitalisation. Patients with pre-existing conditions and respiratory infections should be evaluated for HCoV infections.

Detection of respiratory viruses by real-time polymerase chain reaction in outpatients with acute respiratory infection

Viruses are the major contributors to the morbidity and mortality of upper and lower acute respiratory infections (ARIs) for all age groups. The aim of this study was to determine the frequencies for a large range of respiratory viruses using a sensitive molecular detection technique in specimens from outpatients of all ages with ARIs. Nasopharyngeal aspirates were obtained from 162 individuals between August 2007-August 2009. Twenty-three pathogenic respiratory agents, 18 respiratory viruses and five bacteria were investigated using multiplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) and indirect immunofluorescence assay (IIF). Through IIF, 33 (20.4%) specimens with respiratory virus were recognised, with influenza virus representing over half of the positive samples. Through a multiplex real-time RT-PCR assay, 88 (54.3%) positive samples were detected; the most prevalent respiratory viral pathogens were influenza, human rhinovirus and respiratory syncytial virus (RSV). Six cases of viral co-detection were observed, mainly involving RSV. The use of multiplex real-time RT-PCR increased the viral detection by 33.9% and revealed a larger number of respiratory viruses implicated in ARI cases, including the most recently described respiratory viruses [human bocavirus, human metapneumovirus, influenza A (H1N1) pdm09 virus, human coronavirus (HCoV) NL63 and HCoV HKU1].

Viral aetiology of common colds of outpatient children at primary care level and the use of antibiotics

Although antibiotics are ineffective against viral respiratory infections, studies have shown high rates of prescriptions worldwide. We conducted a study in Brazil to determine the viral aetiologies of common colds in children and to describe the use of antibiotics for these patients. Children up to 12 years with common colds were enrolled from March 2008-February 2009 at a primary care level facility and followed by regular telephone calls and medical consultations. A nasopharyngeal wash was obtained at enrollment and studied by direct fluorescence assay and polymerase chain reaction for nine different types of virus. A sample of 134 patients was obtained, median age 2.9 years (0.1-11.2 y). Respiratory viruses were detected in 73.9% (99/134) with a coinfection rate of 30.3% (30/99). Rhinovirus was the most frequent virus (53/134; 39.6%), followed by influenza (33/134; 24.6%) and respiratory syncytial virus (8/134; 13.4%). Antibiotic prescription rate was 39.6% (53/134) and 69.8% (37/53) were considered inappropriate. Patients with influenza infection received antibiotics inappropriately in a greater proportion of cases when compared to respiratory syncytial virus and rhinovirus infections (p = 0.016). The rate of inappropriate use of antibiotics was very high and patients with influenza virus infection were prescribed antibiotics inappropriately in a greater proportion of cases.

Reproduction and fertility life table of three aphid species (Macrosiphini) at different temperatures

Temperature is a key abiotic factor influencing the development and reproduction of aphids. The effect of temperature on the reproduction of three aphid species Aulacorthum solani (Kaltenbach), Macrosiphum euphorbiae (Thomas) and Uroleucon ambrosiae (Thomas) (Aphididae, Macrosiphini) has been investigated and fertility life tables were determined. Nymphs were reared in climatic chambers at temperatures of 16, 19, 22, 25, and 28 ± 1ºC, RH 70 ± 10% and 12 h photophase. Female adult aphids developed at these temperatures were then used in experiments in which pre-reproductive and reproductive periods were evaluated every 24 h. In addition, the number of nymphs produced and longevity were determined at each temperature. The reproduction period of A. solani and M. euphorbiae decreased with increasing temperature, whereas that of U. ambrosiae was maintained between 19 and 25ºC. The total number of nymphs produced by the aphids decreased as the temperature increased. The longevities of A. solani and M. euphorbiae decreased with increasing temperature but remained stable for U. ambrosiae between 19 and 25ºC. The largest survival rate (l x) and specific fertility (m x) values were found at 16 and 22ºC for all three species. The most favourable temperature for reproduction of A. solani, M. euphorbiae and U. ambrosiae was 22ºC, as demonstrated by the l x and m x profiles, the high values of net reproductive rates and intrinsic rates of increase, and the short intervals between generation and doubling times.

Effects of thermal environment and supplementation levels on the physiological parameters of moxotó goats in confined and semi-confined rising systems

The objective of this work was to determine the effect of environmental variables and supplementation levels on physiological parameters of Moxotó goats in confined and semi-confined rising systems, in the Brazilian semi-arid region. The semi-confined individuals were kept on a grass based diet during the day and arrested in the end of the afternoon. The confined animals were kept in a management center, receiving two diets composed by forage cactus and maniçoba hay into two different levels (0.5 and 1.5% of the body weight). Inside the management center and in the external environment the environmental comfort parameters were set high during the afternoon period characterizing a situation of thermal discomfort for the animals. During the morning the semi-confined animals presented an average respiratory frequency (69.5 mov min-1) and rectal temperature (39.5 ºC) higher than the confined ones (62.6 mov min-1 and 39.0 ºC, respectively). The confined and semi-confined animals were able to maintain their rectal temperature within normal limits, with increase in the cardiac beatings rate and respiratory frequency. The greater percentage of the used supplementations (1.5%) seemed to increase rectal temperature in the two studied rising systems.

Behavior, performance and physiological parameters of pigs reared in deep bedding

An experiment was conducted to evaluate the behavior, performance and physiological parameters of pigs in different production systems. Twenty four animals in the growth phase were distributed in a randomized block design in three treatments: T1 - concrete floor, T2 - deep bedding with wood shaving, and T3 - deep bedding with coffee husks. The behavioral study was carried out by observing the animal behavior for an uninterrupted period of eight hours throughout seven weeks. The proportions of time spent in each behavior were characterized using the frequency histogram composition. Environmental (IBGTH), physiological (rectal and skin temperature and respiratory rate) and performance (weight gain, feed intake and feed conversion) parameters were measured in animals during the period. The production systems of deep bedding showed higher values of IBGTH. There was no effect of production systems evaluated on the performance parameters. Rectal temperature was higher in animals reared on deep bedding with coffee husks in relation to the concrete floor. The use of deep bedding benefited the behavior of piglets in the growth phase and it reduced the agonistic behavior among individuals.

Evaluation of covering materials in individual shelters and its effects on physiological responses and performance of dairy calves

In Tropical regions, the animal performance is often affected by climate conditions. This study aimed to evaluate covering materials in individual shelters, normally used to house dairy calves, and its influence on the calves physiology and performance. The design used was completely randomized, with a 2x3 factorial arrangement to compare the averages of 5% through the Tukey's test, i.e., both genders- and three types of covering in the shelters (Z - zinc; AC - asbestos cement; and WPAC - white-painted asbestos cement). Parameters evaluated included daily weight gain (DWG), dry matter intake (DMI), feed conversion (FC), rectal temperature (RT), and respiratory frequency (RF). Results showed significant differences (P < 0.05) among males (1.04kg/day) and females (0.74kg/day) for DWG and interaction between gender and treatment (P < 0.05) for zinc covering (0.562kg/day for females and 1.120kg/day for males). Significant differences were also observed in FI of animals housed under shelters with the covering of zinc (48.35kgDM/day for females and 96.91 kgDM/day for males). There were no significant differences (P > 0.05) in the FC and the RT, and there were significant differences (P < 0.05) for RF in the Z treatments (56.9 mov.min-1), WPAC (62.2 mov.min-1) and FC (70.25 mov.min-1). It was concluded that different covering materials did not affect performance and dry matter intake of dairy calves. However, the animals' physiology of thermoregulation was altered by the different covering materials used in individual shelters.

The impact of evaporative cooling on the thermoregulation and sensible heat loss of sows during farrowing

Pigs are more sensitive to high environmental temperatures explained by the inability of sweating and panting properly when compared to other species of farmed livestock. The evaporative cooling system might favor the thermal comfort of animals during exposure to extreme environmental heat and reduce the harmful effects of heat stress. The purpose of this study was to assess the sensible heat loss and thermoregulation parameters from lactating sows during summer submitted to two different acclimatization systems: natural and evaporative cooling. The experiment was carried out in a commercial farm with 72 lactating sows. The ambient variables (temperature, relative humidity and air velocity) and sows physiological parameters (rectal temperature, surface temperature and respiratory rate) were monitored and then the sensible heat loss at 21days lactation was calculated. The results of rectal temperature did not differ between treatments. However, the evaporative cooling led to a significant reduction in surface temperature and respiratory rate and a significant increase in the sow's sensible heat loss. It was concluded that the use of evaporative cooling system was essential to increase sensible heat loss; thus, it should reduce the negative effects of heat on the sows' thermoregulation during summer.

Long term dietary deficiency in steers: vital functions and T3 and IGF-1 relationships

To evaluate the influence of diets with different degrees of energy deficiency on the hormonal profile and vital functions, 12 steers were randomly distributed into 3 groups of 4 animals. For 140 days, each group received (G1) a diet to promote a weight gain of 900gr/day (17.7 Mcal/d DE and 13% CP), (G2) 80% of the maintenance requirements (5.8 Mcal/d DE and 7% CP), or (G3) 60% of the maintenance requirements (4.7 Mcal/d DE and 5% CP). In G2 and G3, the energy deficit caused a marked decrease in the heart rate and respiratory rate and a reduction in the blood levels of Insulin like growth factor-1 (IGF-1) and triiodothyronine (T3). The decrease in heart rate, respiratory movement and, to a lesser extent, reduction of the rectal temperature, reflected the low status of energy and was negatively impacted by the low levels of T3. There was a strong correlation between the hormones T3 and IGF-1 (r=0.833). There were also strong correlations between T3 and HR (r=0.701), T3 and RR (r=0.632), IGF-1 and HR (r=0.731), and IGF-1 and RR (r=0.679). There were intermediate correlations between T3 and TºC (r=0.484), T3 and insulin (r=0.506), IGF-1 and insulin (r=0.517), and IGF-1 and TºC (r=0.548). This study showed the influence of a long period of providing an energy-deficient diet on animal performance, correlating hormonal status and vital functions in growing cattle. The results indicated that the evaluated parameters represent an important tool for the early detection of dietary deficiency.

Clinical and blood gasometric parameters during Vaquejada competition

ABSTRACT: Clinical and complementary analysis are good alternatives to evaluate physiological demand in performance horses. The aim of this study was to assess whether the physical effort variation of the three-day Vaquejada competition (a Brazilian form of bullfighting) reflected in clinical and blood gasometric changes. During the competition eight sprints have been performed on the first day (D1), eight on the second (D2) and three on the last one (D3). Ten horses were evaluated by checking heart and respiratory rates and collecting blood samples for use in portable chemistry analyzer. Through that, it was assessed potential of hydrogen ion (pH), carbon dioxide pressure (pCO2), bicarbonate (HCO3-) and titratable base concentration (cBase). Evaluations were carried with resting of at least twenty hours, before physical activity (D0), as control parameter, and up to thirty minutes after each sprint. Clinical parameters have increased on D1, D2 and D3, when compared to D0, which demonstrated the increased demand for substrate and oxygen to the cells.. Blood gasometric trial showed reductions of all variables, most marked between D1 and D2. It was verified less alteration of all clinical and blood gasometric parameters in D3 against D0. We concluded that the change effort between days of competition influenced the clinical and blood gas parameters, demonstrating appropriate physiological response. The data were presented as mean and standard error of the mean (mean ± SEM) obtained in different days. Normality was confirmed by the Kolmogorov-Sminov test and data were compared by one-way ANOVA, followed by post-test Holm-Sidak (GraphPad Prism 2.6 for Windows, GraphPad Software, San Diego, CA, USA). P≤0.05 was considered as statistically significant.

Growth and reproduction of the understory palm Geonoma schottiana Mart. in the gallery forest in Central Brazil

To understand the growth and reproduction of the palm Geonoma schottiana in the gallery forest of Central Brazil, two hypotheses were raised: (i) production of leaves and reproductive structures are concentrated in the period of the year with high light availability; (ii) leaf production and reproductive activity are related to plant length. However, it is expected that senility effects will cause fast reduction in growth and reproduction activities in higher plants. Growth and reproduction were concentrated in the dry season, when insolation is higher than in the wet season, suggesting that leaf and inflorescence production on G. schottiana in the gallery forest understory is more limited by light than by soil humidity. As the individual grows, leaf number and blade area increase, but reproduction activity is independent of plant length. Resources stored in the stem are important to growth, but exogenous factors, as canopy openness, should be more important to reproduction. Plant senescence seems to have a lesser effect on the production of vegetative and reproductive structures in G. schottiana than has been detected in congeneric species with greater clonal activity.