Echocardiographic parameters associated with pulmonary congestion in outpatients with Chagas' cardiomyopathy and non-chagasic cardiomyopathy

INTRODUCTION: Despite significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas' cardiomyopathy (CC). This study sought to identify echocardiographic parameters associated with pulmonary congestion in CC and in dilated cardiomyopathy of other etiologies, such as non-CC (NCC), and to compare pulmonary venous hypertension between the two entities. METHODS: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed using Doppler echocardiography and chest radiography. Pulmonary venous vessel abnormalities were graded using a previously described pulmonary congestion score, and this score was compared with Doppler echocardiographic parameters. RESULTS: NCC patients were older than CC patients (62.4 ± 13.5 × 47.8 ± 11.2, p = 0.00), and there were more male subjects in the CC group (66.2% × 58.5%, p = 0.4). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p = 0.0), the mean lung congestion score being 3.2 ± 2.3 and 5.9 ± 2.6 (p = 0.0), respectively. On linear regression multivariate analysis, the E/e' ratio (β = 0.13; p = 0.0), LV diastolic diameter (β = 0.06; p = 0.06), left atrial diameter (β = 0.51; p = 0.08), and right ventricular (RV) end-diastolic diameter (β = 0.02; p = 0.48) were the variables that correlated with pulmonary congestion in both groups. CONCLUSIONS: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e' ratio was the hallmark of pulmonary congestion in both groups.

Phenotypic and molecular characterization of antimicrobial resistance and virulence factors in Pseudomonas aeruginosa clinical isolates from Recife, State of Pernambuco, Brazil

INTRODUCTION: The emergence of carbapenem resistance mechanisms in Pseudomonas aeruginosa has been outstanding due to the wide spectrum of antimicrobial degradation of these bacteria, reducing of therapeutic options. METHODS: Sixty-one clinical strains of P. aeruginosa isolated from five public hospitals in Recife, Pernambuco, Brazil, were examined between 2006 and 2010, aiming of evaluating the profiles of virulence, resistance to antimicrobials, presence of metallo-β-lactamase (MBL) genes, and clonal relationship among isolates. RESULTS: A high percentage of virulence factors (34.4% mucoid colonies; 70.5% pyocyanin; 93.4% gelatinase positives; and 72.1% hemolysin positive) and a high percentage of antimicrobial resistance rates (4.9% pan-resistant and 54.1% multi-drug resistant isolates) were observed. Among the 29 isolates resistant to imipenem and/or ceftazidime, 44.8% (13/29) were MBL producers by phenotypic evaluation, and of these, 46.2% (6/13) were positive for the blaSPM-1 gene. The blaIMP and blaVIM genes were not detected. The molecular typing revealed 21 molecular profiles of which seven were detected in distinct hospitals and periods. Among the six positive blaSPM-1 isolates, three presented the same clonal profile and were from the same hospital, whereas the other three presented different clonal profiles. CONCLUSIONS: These results revealed that P. aeruginosa is able to accumulate different resistance and virulence factors, making the treatment of infections difficult. The identification of blaSPM-1 genes and the dissemination of clones in different hospitals, indicate the need for stricter application of infection control measures in hospitals in Recife, Brazil, aiming at reducing costs and damages caused by P. aeruginosa infections.

New focus of active transmission of Chagas disease in indigenous populations in the Peruvian Amazon basin

Introduction Several cases of acute Chagas disease (ACD) have been reported in the Peruvian Amazon basin. Methods The objective was to describe and investigate 6 ACD cases in children from indigenous Amazon communities in the province of Datem del Marañón in Loreto department (2006-2010). Results The mean age was 3.6 years. All patients had fever, 4/6 hepatomegaly, 2/6 splenomegaly, and 5/6 had trypomastigotes of Trypanosoma cruzi on thick smears. The fatality rate was 33.3%. Rhodnius pictipes and Rhodnius robustus adults were found inside the homes and in the peri-domiciles. Conclusions All cases reported were isolated cases. We report a new focus of ACD in indigenous populations.

Snakebite cases in the municipalities of the State of Paraiba, Brazil

Introduction This study investigated the epidemiological and clinical profile of snakebite cases reported from 2007 to 2012 in the municipalities of the Curimataú region, State of Paraíba, in northeastern Brazil. Methods Data were collected from the Health Department of the State of Paraíba using the Injury Notification Information System data banks of the Health Ministry. Results A total of 304 snakebite cases were studied. The cases occurred most frequently from April to June. The genera Bothrops, Crotalus, and Micrurus were responsible for 74.6%, 6.2%, and 1.3% of cases, respectively. Snakebite cases predominated in males living in rural areas and between 10 and 19 years old. The highest incidence of bites occurred on the feet. The majority of the victims received medical assistance within 1 to 3h after being bitten. With regard to severity, 48% of the cases were classified as mild, 26% as moderate, and 2.6% as severe. Successful cures predominated, and no deaths were reported. The average antivenom ampoule dose used for the treatment in some snakebite cases was lower than that recommended by the Health Ministry. Conclusions Although our results show that Paraíba has a good level of medical care, there are serious deficiencies in recording snakebite information. These data indicate the need to improve the recording process for snakebite cases. Further training for health professionals seems to be necessary to optimize their skills in treating snakebite victims.

Is autonomic function associated with left ventricular systolic function in Chagas heart disease patients undergoing treatment for heart failure?

Introduction The association between cardiac autonomic and left ventricular (LV) dysfunction in Chagas disease (ChD) is controversial. Methods A standardized protocol that includes the Valsalva maneuver, a respiratory sinus arrhythmia (RSA) test, and an echocardiographic examination was used. Spearman correlation coefficients (rho) were used to investigate associations. Results The study population consisted of 118 ChD patients undergoing current medical treatment, with an average LV ejection fraction of 51.4±2.6%. The LV ejection fraction and diastolic dimension were correlated with the Valsalva index (rho=0.358, p<0.001 and rho=-0.266, p=0.004, respectively) and the RSA (rho=0.391, p<0.001 and rho=-0.311, p<0.001, respectively). Conclusions The impairment of LV function is directly associated with a reduction of cardiac autonomic modulation in ChD.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

IntroductionFew studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil.MethodsWe reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging.ResultsHCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases.ConclusionsThese results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.

Evaluation of efficacy, reliability, and tolerability of sibutramine in obese patients, with an echocardiographic study

This is a double-blind, placebo-controlled study of the efficacy, safety, and tolerability of sibutramine in the management of obese patients for a 6-month period. METHOD: Sixty-one obese patients (BMI >30, <40 kg/m2), aged 18-65 years were evaluated. In the first phase of the study (30 days), the patients were given a placebo. We monitored compliance with a low-calorie diet (1200 kcal/day) and to the placebo. In the next stage, the double-blind phase (6 months), we compared placebo and sibutramine (10 mg/day). The criteria for evaluating efficacy were weight loss, reduction in body mass index (BMI), and abdominal and hip circumferences. Tolerability was assessed based on reported side effects, variation in arterial blood pressure and heart rate, metabolic profile (fasting glucose, total cholesterol and its fractions, and triglycerides), laboratory tests (renal and hepatic functions), and flow Doppler echocardiogram. RESULTS: We observed a greater weight loss (7.3 kg, 8% vs 2.6 kg, 2.8%) and a reduction in body mass index (7.4% vs 2.1%) in the sibutramine group than in the placebo group. Classifying the patients into 4 subgroups according to weight loss (weight gain, loss <5%, loss of 5% to 9.9%, and loss >10%), we observed a weight loss of >5% in 40% of the patients on sibutramine compared with 12.9% in the placebo group. We also detected weight gain in 45.2% of the placebo group compared to 20% in the sibutramine group. The sibutramine group showed improvement in HDL- cholesterol values (increased by 17%) and triglyceride values (decreased by 12.8%). This group also showed an increase in systolic blood pressure (6.7%, 5 mmHg). There were no changes in echocardiograms comparing the beginning and end of follow-up, and side effects did not lead to discontinuation of treatment. DISCUSSION: Sibutramine proved to be effective for weight loss providing an 8% loss of the initial weight. Compliance to prolonged treatment was good, and side effects did not result in discontinuation of treatment. These data confirmed the good efficacy, tolerability, and safety profiles of sibutramine for treatment of obesity.

Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population

OBJECTIVE: To determine the prevalence of systemic hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia in a Brazilian population in relation to body mass index. METHOD: Retrospective evaluation of 1213 adults (mean age: 45.2 ± 12.8; 80.6% females) divided into groups according to body mass index [normal (18.5 - 24.4 kg/m²); overweight (25 - 29.9 kg/m²); grade 1 obesity (30 - 34.9 kg/m²); grade 2 obesity (35 - 39.9 kg/m²), and grade 3 obesity (> 40 kg/m²)]. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were analyzed in each group. The severity of cardiovascular risk was determined. High-risk patients were considered those reporting 2 or more of the following factors: systemic hypertension, HDL < 35 mg/dL, total cholesterol > 240 mg/dL, triglycerides > 200 mg/dL when HDL < 35 mg/dL, and glycemia > 126 mg/dL. Moderate-risk patients were those reporting 2 or more of the following factors: systemic hypertension, HDL < 45, triglycerides > 200 mg/dL, and total cholesterol > 200 mg/dL. RESULTS: The prevalence of systemic hypertension, diabetes mellitus, hypertriglyceridemia, and low HDL-cholesterol levels increased along with weight, but the prevalence of hypercholesterolemia did not. The odds ratio adjusted for gender and age, according to grade of obesity compared with patients with normal weight were respectively 5.9, 8.6, and 14.8 for systemic hypertension, 3.8, 5.8, and 9.2 for diabetes mellitus and 1.2, 1.3, and 2.6 for hypertriglyceridemia. We also verified that body mass index was positively related to cardiovascular high risk (P < .001) CONCLUSION: In our population, cardiovascular risk increased along with body mass index.

Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity

PURPOSE: Aerobic capacity and respiratory function may be compromised in obesity, but few studies have been done in highly obese bariatric candidates. In a prospective study, these variables were documented in the preoperative period, aiming to define possible physiologic limitations in a apparently healthy and asymptomatic population. METHOD: Forty-six consecutively enrolled adults (age 39.6 ± 8.4 years, 87.0% females, body mass index /BMI 49.6 ± 6.3 kg/m² ) were analyzed. Ventilatory variables were investigated by automated spirometry, aerobic capacity was estimated by a modified Bruce test in an ergometric treadmill, and body composition was determined by bioimpedance analysis. RESULTS: Total fat was greatly increased (46.4 ± 4.6% of body weight) and body water reduced (47.3 ± 4.6 % body weight), as expected for such obese group. Spirometric findings including forced vital capacity of 3.3 ± 0.8 L and forced expiratory volume-1 second of 2.6 ± 0.6 L were usually acceptable for age and gender, but mild restrictive pulmonary insufficiency was diagnosed in 20.9%. Aerobic capacity was more markedly diminished, as reflected by very modest maximal time (4.5 ± 1.1 min) and distance (322 ±142 m) along with proportionally elevated maximal oxygen consumption (23.4 ± 9.5 mL/kg/min) achieved by these subjects during test exercise. CONCLUSIONS: 1) Cardiopulmonary evaluation was feasible and well-tolerated in this severely obese population; 2) Mean spirometric variables were not diminished in this study, but part of the population displayed mild restrictive changes; 3) Exercise tolerance was very negatively influenced by obesity, resulting in reduced endurance and excessive metabolic cost for the treadmill run; 4) More attention to fitness and aerobic capacity is recommended for seriously obese bariatric candidates;

Estrutura da floresta equatorial úmida da estação experimental de silvicultura tropical do INPA

Analisam a estrutura da floresta equatorial úmida próxima a Manaus, introduzindo a qualidade de fuste na. análise. Utilizam 8 amostras de 20m x 500m para indivíduos com DAP > 20cm, 24 subamostras de 10m x 100m para. indivíduos com DAP entre 5cm e 20cm e 120 subamostras de 2m x 10m para indivíduos com DAP < 5cm. Determinam valores mínimos de 2,6 e 22 amostras para composição florística é de 6,18 e 80 para a abundância em cada fração da floresta. Concluem que a floresta é muito heterogênea, com 324 espécies, 173 gêneros e 57 fiamílias e com grande diferença entre a regeneração e o povoamento adulto. Eschweilera odora, Corythophora alta., Protium apiculatum e Radlkoferella sp. são as espécies mais importantes. A floresta em geral apresenta a estrutura diamétrica regular esperada para florestas nativas devido às espécies do estrato inferior e sub-bosque.

CANTINONA DE SIMABA POLYPHYLLA(CAVALC.) THOMAS (SIMAROUBACEAE)

Uma cantin-2,6-diona (1) foi isolada do extrato etanólico da madeira de Simaba polyphylla (Cavale.) Thomas coletada próximo a Manaus. O composto 1 foi previamente isolado de S. multiflora, S. guianensis e S. cedron, sendo essa a primeira citação de ocorrência em S. polyphylla.

Fenologia e produtividade do Abacate (Persea americana Mill.) na Amazônia Central1

O abacateiro (Persea americana Mill., Lauraceae) é nativo da Mesoamérica e chegou à Amazônia antes dos europeus. Acredita-se que a raça aqui introduzida foi a antilhana, similar a da maioria dos abacateiros pé-franco da Amazônia de hoje. Estudos de sua fenologia podem ajudar o planejamento de seu manejo e comercialização. A floração iniciou-se na segunda metade da estação chuvosa (março/abril) e durou até meados da estação de estiagem (agosto/setembro). As árvores produziram 25±15 mil flores em 1980 e 38±28 mil flores em 1981. A frutificação iniciou-se no final da estação chuvosa (maio/junho) e a safra ocorreu em plena estação de estiagem (agosto/outubro). As árvores produziram 634±299 frutos em 1980 e 1.054±456 frutos em 1981. O vingamento foi de 2,6±1,8%, menor que os valores na literatura. Os frutos pesaram 177,7±41,2 g na safra de 1980, com 51,1±4,5% de polpa. A produtividade, estimado em 112 kg/árvore em 1980 e 187 kg/árvore em 1981, foi abaixo da média de uma árvore bem manejada no sul do Brasil. As flores foram visitadas por oito espécies de abelhas, destacando-se Trigona branneri Ckll, Frieseomelitta sp. e Partamona pseudomusarum Camargo.

Caracterização de sintomas de carências nutricionais em mudas de pupunheira cultivadas em solução nutritiva

Os conhecimentos de nutrição mineral da pupunheira (Bactris gasipaes Kunth, Palmae) são relativamente escassos e incipientes, faltando dados consistentes sobre sua demanda nutricional desde a fase de viveiro até a fase de produção. Com o objetivo de caracterizar os sintomas de carências de macro e micronutrientes, e identificar os níveis analíticos associados às carências minerais em mudas de pupunheira, foi conduzido um ensaio em casa de vegetação, pertencente ao Instituto Nacional de Pesquisas da Amazônia, Manaus, AM. Plantas de pupunheira foram cultivadas em solução nutritiva, tendo como substrato areia lavada. Os tratamentos foram: completo e omissão individual de nitrogênio, fósforo, potássio, cálcio, magnésio, enxofre, ferro, boro, cobre, manganês, zinco e molibdênio. O delineamento experimental foi inteiramente casualizado com treze tratamentos e quatro repetições. As deficiências dos nutrientes nas mudas de pupunheiras se traduziram por sintomas típicos e facilmente identificáveis, e os níveis analíticos de adequação e deficiência obtidos nas folhas foram: N (g kg-1) 30.7 - 10.1; P (g kg-1) 3.4 - 1.0; K (g kg-1) 27.8 - 4.7; Ca (g kg-1) 12.7 - 2.6; Mg (g kg-1) 3.5 - 0.9; Fe (mg kg-1) 175 - 191; Zn (mg kg-1) 33 - 41.

Cultivo do Pirarucu (Arapaima gigas) em viveiro escavado

Foi avaliado o desempenho de juvenis de pirarucu em criação intensiva em viveiros escavados. Oitenta e cinco peixes com peso médio inicial de 133,3 ± 1,3g foram estocados em dois viveiros de 120m² cada (densidade de 1 peixe/3m²), com profundidade média de 1m e alimentados duas vezes ao dia (9:00 e 14:00h) com ração extrusada para peixes carnívoros contendo 40% de proteína bruta. Foi verificado diariamente o consumo de ração, enquanto mensalmente os peixes foram amostrados para a realização de biometrias com a finalidade de verificar seu desempenho em peso e comprimento. Após 12 meses de cultivo os peixes atingiram peso médio de 7,0 ± 1,1kg, comprimento total de 88,2 ±6,4cm, com conversão alimentar de 1,5 e produtividade de 2,5kg/m². Estes resultados mostram o grande potencial do pirarucu para a piscicultura intensiva na Amazônia.

Compuestos volátiles libres y enlazados glicosídicamente en la pulpa de la uva Caimarona (Pourouma cecropiifolia Mart.)

Los componentes volátiles presentes en la pulpa de la uva Caimarona se estudiaron mediante GC-MS. Éstos se extrajeron por tres técnicas: evaporación del aroma asistida con solvente (Solvent Assisted Flavour Evaporation SAFE), extracción continua líquido-líquido (LL) y destilación por arrastre con vapor-extracción simultanea con solvente orgánico (DES). En general los componentes volátiles predominantes en la pulpa fueron alcoholes alifáticos y terpénicos. Las notas olfativas del extracto SAFE fueron descritas como floral tenue y verde herbal similares a las exhibidas por la pulpa fresca. Este extracto presentó como componentes mayoritarios linalol 1,2-propanodiol y salicilato de metilo. En contraste, el extracto LL presentó notas que recuerdan la uva pasa y el vino moscatel y sus componentes mayoritarios fueron el ácido acético, el salicilato de metilo y el 2,6-dimetil-2(Z),7-octadien-1,6-diol. El extracto DES fue descrito con notas fresca, floral, cereal y amargo y está constituido por un reducido número de componentes mostrando el efecto negativo de la temperatura en la extracción; sus componentes mayoritarios fueron 1,2-propanodiol, linalol y salicilato de metilo. Adicionalmente, los componentes volátiles mayoritarios liberados por hidrólisis enzimática (Rohapect D5L) de los glicósidos de la pulpa fueron ácido acético, ácido benzoico y vainillina. Cabe destacar que aunque el linalol no se encontró entre las agliconas volátiles, se detectaron los dioles biogenéticamente relacionados: 3,7-dimetil-1,5-octadien-3,7-diol y los isómeros E y Z del 2,6-dimetil-2,7-octadien-1,6-diol.