Prevalência de obesidade visceral estimada por equação preditiva em mulheres jovens pernambucanas

FUNDAMENTO: O acúmulo de gordura visceral é considerado o principal fator de risco para doenças cardiovasculares e metabólicas. OBJETIVO: Determinar a prevalência de obesidade visceral e avaliar sua associação com fatores de risco cardiovasculares em mulheres jovens do Estado de Pernambuco. MÉTODOS: Estudo transversal, realizado com dados da "III Pesquisa Estadual de Saúde e Nutrição", envolvendo mulheres entre 25 e 36 anos. Avaliaram-se as variáveis: Índice de Massa Corporal (IMC), Circunferência da Cintura (CC), Razão Cintura-Estatura (RCE), Volume de Gordura Visceral (VGV) estimado por equação preditiva, Pressão Arterial Sistólica e Diastólica (PAS, PAD), Colesterol Total (CT), Triglicerídeo (TG), Glicemia de Jejum (GJ). RESULTADOS: Foram avaliadas 517 mulheres, com mediana de idade de 29 anos (27-32) e prevalência de obesidade visceral de 30,6%. Valores de IMC, PAS, PAD e TG foram superiores no grupo com obesidade visceral: IMC = 28,0 kg/m² (25,0 - 21,4) vs 23,9 kg/m² (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 correlação positiva e significante com o VGV: r = 0,171; 0,224; 0,163; 0,278; 0,124; respectivamente, p < 0,005. CONCLUSÃO: Verificou-se uma elevada prevalência de obesidade visceral, estando estatisticamente correlacionada a fatores de risco cardiovasculares.

Idosos hipertensos apresentam menor desempenho cognitivo do que idosos normotensos

FUNDAMENTO: A hipertensão arterial tem sido associada à redução do desempenho cognitivo, contudo a literatura é conflitante. OBJETIVO: Comparar o desempenho cognitivo entre idosos normotensos ("N"; n = 17; idade 68 ± 1; pressão arterial = 133 ± 3/74 ± 2 mmHg) e hipertensos ("H"; n = 28; idade 69 ± 1, pressão arterial = 148 ± 4/80 ± 1 mmHg) com pelo menos cinco anos de escolaridade. MÉTODOS: A avaliação neuropsicológica ampla constou do "Cambridge Cognition-Revised" (CAMCOG-R), dos "Trail Making Test A and B" (TMT A e B) e do "Rey Auditory Verbal Learning Test" (RAVLT). RESULTADOS: Os idosos hipertensos apresentaram menor escore do CAMCOG-R (N = 87,6 ± 1,8; H = 78,6 ± 1,4; p = 0,002). Os idosos hipertensos necessitaram de maior tempo para realizar o TMT A e B (TMT A: N = 39 ± 3s; H = 57 ± 3,4s; p = 0,001; TMT B: N = 93 ± 7s; H = 124 ± 7s; p = 0,006), o que também é demonstrado pelos percentis significativamente menores obtidos nestes testes. O somatório do RAVLT foi significativamente menor nos idosos hipertensos (N = 51,8 ± 1,7; H = 40,7 ± 1,5; p < 0,0001). Mesmo ajustado para idade, sexo, escolaridade e sintomas de depressão, a hipertensão arterial foi um fator preditor independente do desempenho cognitivo medido pelo CAMCOG-R, TMT A e o somatório do RAVLT. CONCLUSÃO: O desempenho cognitivo em idosos hipertensos é menor do que em idosos normotensos.

Reproducibility of Left Ventricular Mass by Echocardiogram in the ELSA-Brasil

Background: Echocardiography, though non-invasive and having relatively low-cost, presents issues of variability which can limit its use in epidemiological studies. Objective: To evaluate left ventricular mass reproducibility when assessed at acquisition (online) compared to when assessed at a reading center after electronic transmission (offline) and also when assessed by different readers at the reading center. Methods: Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the left ventricular mass online during the acquisition from 124 studies before transmitting to the reading center, where studies were read according to the study protocol. Half of these studies were blindly read by a second reader in the reading center. Results: From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had structural myocardial abnormalities. Images were considered to be optimal/ good by the reading center for 110 (92.4%) cases. No significant difference existed between online and offline measurements (1,29 g, CI 95% −3.60-6.19), and the intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For images read by two readers, the intraclass correlation coefficient was 0.86 (CI 95% 0.78-0.91). Conclusion: There were no significant drifts between online and offline left ventricular mass measurements, and reproducibility was similar to that described in previous studies. Central quantitative assessment of echocardiographic studies in reading centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical and epidemiological studies performed in our setting.

Reverse Auction: A Potential Strategy for Reduction of Pharmacological Therapy Cost

Background:Polypharmacy is a significant economic burden.Objective:We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients.Methods:We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost.Results:The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively.Conclusion:RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Abstract Background: More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. Objectives: To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Methods: Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. Results: After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters. Conclusion: Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

Análise conjunta para experimentos em blocos casualizados completos aumentados

O presente estudo visa a efetuar uma análise conjunta de experimentos em blocos casualizados completos aumentados. Cada experimento apresenta os mesmos t = c + z tratamentos, distribuídos em r blocos, onde os c tratamentos são considerados comuns, pois aparecem nos r blocos, e os z tratamentos são considerados regulares, pois aparecem uma única vez em um dos r blocos. Os blocos são formados por k parcelas, sendo k = c + Pj,onde pj (j = 1, ..., r) é o número de tratamentos regulares no bloco j. Para desenvolvê-lo, considerou-se o conjunto dos experimentos como um delineamento comum em blocos incompletos. Admitindo-se que os experimentos apresentassem variâncias residuais semelhantes. No exemplo estudado, os tratamentos se repartem em seis classes de associação, com diferenças mínimas significativas (para o teste de Tukey) (Δ) entre dois deles dadas a seguir: 1 - Dois tratamentos comuns: Δ 5% = 15,955 t/ha; Δ 1% - 13,755 t/ha. 2 - Um tratamento comum e um regular: Δ 5% de 23,047 a 23,216 t/ha; Δ 1% de 26,733 a 26,930 t/ha. 3 - Dois tratamentos regulares, com λ = 3: Δ 5% de 28,515 a 28,659 t/ha; Δ 1% de 33,075 a 33,243 t/ha. 4 - Dois tratamentos regulares, com λ = 2: Δ 5% de 29,064 a 29,950 t/ha; Δ 1% de 33,711 a 34,739 t/ha. 5 - Dois tratamentos regulares, λ = 1: Δ 5% de 29,160 a 29,994 t/ha; Δ 1% de 33,823 a 34,791 t/ha. 6 - Dois tratamentos regulares, com λ = 0: Δ 5% de 30,281 a 30,628 t/ha; Δ 1% de 35,124 a 35,526 t/ha. Verifica-se, pois, que essas diferenças mínimas significativas são bem menores no caso de dois tratamentos comuns, mas não são muito discrepantes nos demais casos.

Morbidade da doença de Chagas: III. Estudo longitudinal, de seis anos, em Virgem da Lapa, MG, Brasil

Um estudo longitudinal clínico, radiológico e eletrocardiográfico do tipo caso-controle realizado no município de Virgem da Lapa, Minas Gerais, Brasil, com o acompanhamento de 124 chagásicos crônicos durante seis anos, revelou que 62,1% dos pacientes permaneceram com o quadro inicial inalterado, a maioria deles na forma indeterminada, 32,3% evoluíram com progressão da doença e 5,6% tiveram normalização do eletrocardiograma. Os resultados mencionados, quando comparados aos obtidos no grupo controle composto de pares não chagásicos da mesma idade e sexo, demonstraram uma progressão de 27,4% maior entre os pacientes com sorologia positiva, o que representa o excesso de risco ou componente exclusivamente chagásico na evolução da doença. Não houve diferença de progressão da doença em relação ao sexo, porém ela foi mais precoce e sete vezes mais freqüente em relação à cardiopatia do que ao megaesôfago, ambas ocorrendo na maioria das vezes em grau leve ou moderada. Em 192 chagásicos e 188 não chagásicos observados na área, no referido período, houve uma mortalidade 3,6 vezes maior entre os chagásicos, com uma letalidade pela cardiopatia de 8,9%, sem diferença entre os sexos, porém mais precoce no sexo masculino. A morte súbita foi mais freqüente do que a morte por insuficiência cardíaca. O prognóstico foi bom para os pacientes da forma indeterminada e digestiva e reservado para os casos de cardiopatia, principalmente os de graus mais elevados.

Metazoan Parasite Infracommunities in Five Sciaenids from the Central Peruvian Coast

Parasitological analysis of 237 Menticirrhus ophicephalus, 124 Paralonchurus peruanus, 249 Sciaena deliciosa, 50 Sciaena fasciata and 308 Stellifer minor from Callao (Perú) yielded 37 species of metazoan parasites (14 Monogenea, 11 Copepoda, 4 Nematoda, 3 Acanthocephala, 1 Digenea, 1 Aspidobothrea, 1 Eucestoda, 1 Isopoda and 1 Hirudinea). Only one species, the copepoda Bomolochus peruensis, was common to all five hosts. The majority of the components of the infracommunities analyzed are ectoparasites. The Brillouin index (H) and evenness (J´) were applied to the fully sampled metazoan parasite infracommunities. High values of prevalence and mean abundance of infection are associated to the polyonchoinean monogeneans; the low values of J' reinforce the strong dominance of this group in the studied communities. The paucity of the endoparasite fauna may be a consequence of the unstable environment due to an upwelling system, aperiodically affected by the El Niño Southern Oscillation phenomena.

Aspects related to productivity for four generations of a Lutzomyia longipalpis laboratory colony

A closed colony of Lutzomyia longipalpis was established with specimens collected in the Raposa - Serra do Sol indian reservoir, one of the main foci of visceral leishmaniasis in the State of Roraima, Brazil. Biological observations were made on four generations of a L. longipalpis colony with emphasis on productivity. Aspects studied were the number of laid and retained eggs, and the number of adults (male and female) per generation. During the four generations the percentage of engorged females that laid eggs varied from 64.2% (third generation-F3) to 90.3% (second generation-F2). The mean number of eggs laid per female varied from 23.6 (F3) to 39.9 (first generation-F1). The maximum number of eggs laid per female varied from 84 (F3) to 124 (F1). The mean number of retained eggs per female was 12.7 (parental generation-P and F1) to 22.1 (F2). The number of females exceeded the number of males in all generations. However, significant difference for male/female ratio was found only for F3. Fecundity rates were between 42.1 (F3) and 58.3 (F2). From a total of 439 blood-fed females, 355 females laid 12,257 eggs that yield 5,354 adults (2,525 males and 2,829 females) in four generations. F2 presented maximum productivity and fecundity rates.

Development of an enzyme-linked immunosorbent assay for detection of IgM antibodies to Babesia bigemina in cattle

A crude antigenic preparation of Babesia bigemina was used to develop an ELISA for the detection of IgM antibodies. Optimal dilutions of the antigen, using positive and negative reference sera, were determined by checkerboard titrations. Negative sera from cattle imported from tick-free areas, serum samples collected from infected B. bigemina cattle were used to validate the test. The specificity was 94% and sensitivity of the Elisa 87.5%. Sera from 385 cattle deriving from areas free from tick-borne diseases, which were submitted to a preimmunization process, were screened by this technique. The Elisa detected seroconversion on the 14th day post-inoculation in animals either infested with Boophilus microplus ticks (infected with B. bigemina), or inoculated with B. bigemina infected blood. Antibody titers decreased after day 33; however, all animals remained positive until the end of the experiment (124 days). The ELISA described may prove to be an appropriate serological test for the detection of IgM antibodies against B. bigemina.

Aspects of the Maintenance of the Life Cycle of Fasciola hepatica in Lymnaea columella in Minas Gerais, Brazil

Fascioliasis is a parasitic disease of domestic ruminants that occurs worldwide. The lymnaeid intermediate hosts of Fasciola hepatica include Lymnaea columella, which is widely distributed in Brazil. A colony of L. columella from Belo Horizonte, MG, was reared in our laboratory to be used in studies of the F. hepatica life cycle, the intermediate host-parasite relationship and development of an anti-helminthic vaccine. In the first experiment 1,180 snails were exposed to miracidia of F. hepatica eggs removed from the biliary tracts of cattle from the State of Rio Grande do Sul. In the second and third experiments the snails were exposed to miracidia that had emerged from F. hepatica eggs from Uruguay, maintained in rabbits. The rates of infection in the first, second and third experiments were 0, 42.1 and 0% respectively. Over 15,806 metacercariae were obtained and stored at 4ºC. Four rabbits weighing 1.5 kg each were infected with 32-44 metacercariae and two with 200. Three rabbits begin to eliminate eggs of the parasite in the feces from 84 days after infection onwards. The biological cycle of F. hepatica in L. columella and the rabbit was completed within 124 days.

The patterns of tungiasis in Araruama township, state of Rio de Janeiro, Brazil

This paper describes patterns of infestation with Tunga penetrans (L., 1758) within the poor community of Araruama municipality, State of Rio de Janeiro, Brazil, assessed by the number of persons and domestic animals parasitized. The overall prevalence of infestation was 49.2% (211 parasitized hosts) of the 429 examined. Humans (p < 0.01) and dogs (p < 0.01) were the most important hosts with 62.6% and 35.6% respectively. Dogs were considered as the potential infestation source to humans. Considering sex and age groups, both measures showed a significant difference (p < 0.01): female (62.2% infested of 143 examined) and male (43.9% infested of 98 examined). All age classes were found infested with significant difference (G = 42.5; p < 0.01) and most of the infestation occurred in children in the 0-9-year old category (27.3%). In contrast and based on mean of chigoe burden per person, the parasitic intensity was significantly higher on male than on female in all age categories, except for the 50+ (H = 27.1; p < 0.01) and decreasing with the increase of age (chi2 = 69.7, A = -124.6, p < 0.01). Growing urbanization, improved housing and sewage systems, use of appropriate footwear, examination of the feet principally in young children, antitetanus prophylaxis and reduction of stray dogs population are the major prophylactic methods recommended.

Shared and non-shared antigens from three different extracts of the metacestode of Echinococcus granulosus

Hydatid cyst fluid (HCF), somatic antigens (S-Ag) and excretory-secretory products (ES-Ag) of Echinococcus granulosus protoscoleces are used as the main antigenic sources for immunodiagnosis of human and dog echinococcosis. In order to determine their non-shared as well as their shared antigenic components, these extracts were studied by ELISA-inhibition and immunoblot-inhibition. Assays were carried out using homologous rabbit polyclonal antisera, human sera from individuals with surgically confirmed hydatidosis, and sera from dogs naturally infected with E. granulosus. High levels of cross-reactivity were observed for all antigenic extracts, but especially for ES-Ag and S-Ag. Canine antibodies evidenced lesser avidity for their specific antigens than antibodies from human origin. The major antigenic components shared by HCF, S-Ag, and ES-Ag have apparent molecular masses of 4-6, 20-24, 52, 80, and 100-104 kDa, including doublets of 41/45, 54/57, and 65/68 kDa. Non-shared polypeptides of each antigenic extract of E. granulosus were identified, having apparent masses of 108 and 78 kDa for HCF, of 124, 94, 83, and 75 kDa for S-Ag, and of 89, 66, 42, 39, 37, and 35 kDa for ES-Ag.

Raphidascaris (Sprentascaris) lanfrediae sp. nov. (Nematoda: Anisakidae) from the fish Satanoperca jurupari (Osteichthyes: Cichlidae)

Raphidascaris (Sprentascaris) lanfrediae sp. nov. is described from the intestine of the freshwater fish Satanoperca jurupari (Heckel) (Cichlidae) from the Guamá River, state of Pará, Brazil. The prevalence in fish (n = 59) was 27% with intensity of one-124 (mean 16) nematodes per fish. The new species is characterized mainly by the markedly larger size of ventricular appendix in relation to the oesophagus, presence of short male caudal alae, 14-16 subventral pairs of preanal papillae and six pairs of postanal papillae.

Clinical data and molecular analysis of Mycobacterium tuberculosis isolates from drug-resistant tuberculosis patients in Goiás, Brazil

Drug resistance is one of the major concerns regarding tuberculosis (TB) infection worldwide because it hampers control of the disease. Understanding the underlying mechanisms responsible for drug resistance development is of the highest importance. To investigate clinical data from drug-resistant TB patients at the Tropical Diseases Hospital, Goiás (GO), Brazil and to evaluate the molecular basis of rifampin (R) and isoniazid (H) resistance in Mycobacterium tuberculosis. Drug susceptibility testing was performed on 124 isolates from 100 patients and 24 isolates displayed resistance to R and/or H. Molecular analysis of drug resistance was performed by partial sequencing of the rpoB and katGgenes and analysis of the inhA promoter region. Similarity analysis of isolates was performed by 15 loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. The molecular basis of drug resistance among the 24 isolates from 16 patients was confirmed in 18 isolates. Different susceptibility profiles among the isolates from the same individual were observed in five patients; using MIRU-VNTR, we have shown that those isolates were not genetically identical, with differences in one to three loci within the 15 analysed loci. Drug-resistant TB in GO is caused by M. tuberculosis strains with mutations in previously described sites of known genes and some patients harbour a mixed phenotype infection as a consequence of a single infective event; however, further and broader investigations are needed to support our findings.