Influência da lesão carotídea no pós-operatório de revascularização miocárdica e sua evolução tardia

FUNDAMENTO: Cerca de 30% dos AVE perioperatórios da cirurgia de revascularização do miocárdio (CRM) são decorrentes de lesões carotídeas, sem redução de risco confirmada por intervenção perioperatória. OBJETIVOS: Avaliar o impacto da doença carotídea e a intervenção perioperatória nos pacientes submetidos à CRM. MÉTODOS: Estudo retrospectivo observacional, avaliando 1.169 pacientes com idade > 65 anos submetidos à CRM entre janeiro de 2006 e dezembro de 2010, acompanhados, em média, por 49 meses. Todos foram submetidos à ultrassonografia de carótidas prévia à CRM. Definiu-se doença carotídea quando lesão > 50%. O desfecho primário foi composto pela incidência de AVE, acidente isquêmico transitório (AIT) e óbito por AVE. RESULTADOS: A prevalência da doença carotídea foi de 19,9% dos pacientes. A incidência do desfecho primário entre portadores e não portadores foi de 6,5% e 3,7%, respectivamente (p = 0,0018). Nos primeiros 30 dias, ocorreram 18,2% dos eventos. Relacionaram-se a doença carotídea: disfunção renal (OR 2,03, IC95% 1,34-3,07; p < 0,01), doença arterial periférica (OR 1,80, IC95% 1,22-2,65; p < 0,01) e infarto do miocárdio prévio (OR 0,47, IC95% 0,35-0,65; p < 0,01). Quanto ao desfecho primário, foram associados AIT prévio (OR 5,66, IC95% 1,67-6,35; p < 0,01) e disfunção renal (OR 3,28, IC95% 1,67-6,45; p < 0,01). Nos pacientes com lesão > 70%, a intervenção carotídea perioperatória apresentou incidência de 17% no desfecho primário contra 4,3% na conduta conservadora (p = 0,056) sem diferença entre abordagens percutânea e cirúrgica (p = 0,516). CONCLUSÃO: A doença carotídea aumenta o risco para AVE, AIT ou morte por AVE na CRM. Entretanto, a intervenção carotídea não foi relacionada à redução do desfecho primário.

Polimorfismo G894T da óxido nítrico-sintetase endotelial e o prognóstico na insuficiência cardíaca

FUNDAMENTO: Estudos prévios avaliaram o papel do polimorfismo genético da enzima óxido nítrico-sintetase endotelial sobre o prognóstico na insuficiência cardíaca. Entretanto, faltam estudos relacionando o G894T e a insuficiência cardíaca na população brasileira. OBJETIVO: Avaliar a associação do G894T com o prognóstico de amostra de pacientes brasileiros com insuficiência cardíaca. MÉTODOS: Coorte com 145 pacientes com insuficiência cardíaca sistólica, num segmento de 40 meses (média = 22 meses), em dois hospitais universitários do Estado do Rio de Janeiro. Foi avaliada a relação do G894T com os desfechos: remodelamento reverso; melhora da classe funcional (NYHA); taxas de mortalidade e hospitalização. Os diâmetros do átrio e ventrículo esquerdos e a fração de ejeção do ventrículo esquerdo foram medidos na admissão e após 6 meses, para avaliação do remodelamento reverso. A melhora na classe funcional foi avaliada após 6 meses e as taxas de mortalidade e de hospitalização durante todo o seguimento. A raça foi autodeclarada. O polimorfismo G894T foi analisado por reação em cadeia de polimerase e por análise do polimorfismo dos fragmentos de restrição. RESULTADOS: A frequência genotípica foi GG (40%), GT (48,3%) e TT (11,7%), e a frequência alélica foi guanina (64,1%) e tiamina (35,8%). Não houve diferença entre as frequências genotípica ou alélica conforme a raça autodeclarada, tampouco conforme as características basais. Não houve relação entre o genótipo ou a frequência alélica e os desfechos analisados. CONCLUSÃO: Não se observou associação do polimorfismo G894T (Glu298Asp) com o prognóstico de amostra de pacientes ambulatoriais brasileiros com insuficiência cardíaca sistólica.

Prevalência de Fatores de Risco Cardiovascular em Pacientes em Hemodiálise - O Estudo CORDIAL

Fundamentos: Há uma carência de dados epidemiológicos sobre o perfil de risco cardiovascular nos pacientes renais crônicos em hemodiálise no Brasil. Objetivo: O estudo CORDIAL foi planejado para avaliar fatores de risco cardiovascular e acompanhar a evolução de uma população em programa de hemodiálise numa cidade metropolitana do Brasil. Métodos: Todos os pacientes em hemodiálise por doença renal crônica nos quinze centros de nefrologia de Porto Alegre foram considerados para inclusão na fase inicial do estudo CORDIAL. Dados clínicos, laboratoriais e demográficos foram obtidos nos registros médicos, e em entrevistas individuais estruturadas realizadas com todos os pacientes por pesquisadores treinados. Resultados: Foram incluídos 1215 pacientes (97,3% de todos os que estavam em hemodiálise na cidade de Porto Alegre). A média de idade era 58,3 anos, 59,5% eram homens e 62,8% eram brancos. A prevalência de fatores de risco cardiovascular encontrada foi 87,5% para hipertensão, 84,7% para dislipidemia, 73,1% para sedentarismo, 53,7% para tabagismo e 35,8% para diabetes. Em uma análise multivariada ajustada, sedentarismo (p = 0,032; RP 1,08 - IC95%: 1,01-1,15), dislipidemia (p = 0,019; RP 1,08 - IC95%: 1,01-1,14), e obesidade (p < 0,001; RP 1,96 - IC95%: 1,45-2,63) foram mais frequentes em mulheres; e hipertensão (p = 0,018; PR 1,06 - IC95%: 1,01-1,11) e tabagismo (p = 0,006; RP 2,7 - IC95%: 1,79-4,17) foram mais frequentes naqueles com menos de 65 anos. Sedentarismo apresentou uma associação independente com tempo em diálise inferior a 12 meses (p < 0,001; RP 1,23 - IC95%: 1,14-1,33). Conclusão: Pacientes em hemodiálise nesta metrópole do sul do Brasil apresentaram uma prevalência elevada de fatores de risco cardiovascular similar a diversos países do hemisfério norte.

Value of the Qrs-T Angle in Predicting the Induction of Ventricular Tachyarrhythmias in Patients with Chagas Disease

Background:The QRS-T angle correlates with prognosis in patients with heart failure and coronary artery disease, reflected by an increase in mortality proportional to an increase in the difference between the axes of the QRS complex and T wave in the frontal plane. The value of this correlation in patients with Chagas heart disease is currently unknown.Objective:Determine the correlation of the QRS-T angle and the risk of induction of ventricular tachycardia / ventricular fibrillation (VT / VF) during electrophysiological study (EPS) in patients with Chagas disease.Methods:Case-control study at a tertiary center. Patients without induction of VT / VF on EPS were used as controls. The QRS-T angle was categorized as normal (0-105º), borderline (105-135º) or abnormal (135-180º). Differences between groups for continuous variables were analyzed with the t test or Mann-Whitney test, and for categorical variables with Fisher's exact test. P values < 0.05 were considered significant.Results:Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information / inactive records or due to the impossibility to correctly calculate the QRS-T angle (presence of left bundle branch block and atrial fibrillation). Of 72 patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%, borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio (OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for other variables such as age, ejection fraction (EF) and QRS size, there was a trend for the abnormal QRS-T angle to identify patients with increased risk of inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also emerged as a predictor of induction of VT / VF: for each point increase in EF, there was a 4% reduction in the rate of sustained ventricular arrhythmia on EPS.Conclusions:Changes in the QRS-T angle and decreases in EF were associated with an increased risk of induction of VT / VF on EPS.

Infant Mortality in Novo Hamburgo: Associated Factors and Cardiovascular Causes

Background: Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. Objective: To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. Methods: This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Results: Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. Conclusion: It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Background:Primary graft dysfunction is the main cause of early mortality after heart transplantation. Mechanical circulatory support has been used to treat this syndrome.Objective:Describe the experience with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction.Methods:Between January 2007 and December 2013, a total of 71 orthotopic heart transplantations were performed in patients with advanced heart failure. Eleven (15.5%) of these patients who presented primary graft dysfunction constituted the population of this study. Primary graft dysfunction manifested in our population as failure to wean from cardiopulmonary bypass in six (54.5%) patients, severe hemodynamic instability in the immediate postoperative period with severe cardiac dysfunction in three (27.3%), and cardiac arrest (18.2%). The average ischemia time was 151 ± 82 minutes. Once the diagnosis of primary graft dysfunction was established, we installed a mechanical circulatory support to stabilize the severe hemodynamic condition of the patients and followed their progression longitudinally.Results:The average duration of extracorporeal membrane oxygenation support was 76 ± 47.4 hours (range 32 to 144 hours). Weaning with cardiac recovery was successful in nine (81.8%) patients. However, two patients who presented cardiac recovery did not survive to hospital discharge.Conclusion:Mechanical circulatory support with central extracorporeal membrane oxygenation promoted cardiac recovery within a few days in most patients.

Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

Abstract Background: The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective: To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods: Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results: The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). Conclusion: The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

Floração, produção de néctar e abelhas visitantes de Eriope blanchetii (Lamiaceae) em dunas costeiras, Nordeste do Brasil

As observações sobre a floração, produção de néctar e abelhas visitantes foram realizadas entre outubro de 1999 e outubro de 2000, em uma população natural de Eriope blanchetii (Benth) Harley (Lamiaceae) distribuída em dunas litorâneas, Salvador (12º56'S, 38º21'W), Bahia. Entre as 15 espécies de abelhas registradas, predominaram aquelas de porte corporal médio e grande. Os polinizadores efetivos são Xylocopa cearensis Ducke, 1910 e Colletes petropolitanus Dalla Torre, 1896, considerando seu tamanho, comportamento e freqüência nas flores. A floração contínua da população de E. blanchetii e o grau de sincronia, duração e intensidade da floração entre os indivíduos estimula o movimento interplanta e o transporte de pólen pelos polinizadores com diferentes demandas energéticas e comportamento generalista. A deposição de pólen ocorre na região ventral do corpo do polinizador na região que contata as anteras e o estigma durante o forrageio, mas apenas C. petropolitanus transportou exclusivamente pólen de E. blanchetii. O pólen, removido principalmente durante a fase masculina é, posteriormente, depositado em flores com estigmas receptivos durante a fase feminina. Entre maio e outubro de 2000, o volume de néctar variou de 0,01 a 0,98 ml sendo maior na fase masculina (U=2972,5; P<0,05); a concentração registrada foi de 22% (n=10 flores). A diferença entre o volume de néctar em flores em relação à sua posição na inflorescência (ANOVA=4.478; P>0.05) e entre aquelas ensacadas e não ensacadas (U=3632; P>0.05) não foi significativa. O padrão de floração, a produção e acessibilidade do néctar tornam as flores de E. blanchetii atrativas aos seus polinizadores potenciais.

Diet of Iheringichthys labrosus (Siluriformes, Pimelodidae) in the Ibicuí River, Southern Brazil

The diet of the benthic-feeding fish Iheringichthys labrosus (Lütken, 1874) was analyzed. Samples were taken bimonthly from December 1999 to January 2002, in three sites of the Ibicuí River, a tributary of Uruguay River basin (Rio Grande do Sul, Brazil). In each sampling point the specimens were collected in lentic and lotic environments. Gillnets and trammel nets were examined every 6 hours (6h, 12h, 18h and 24h). Diet description was based on the frequency of occurrence and the volume of each food item to obtain the Alimentary Index (IAi). The average stomach fullness was adopted to detect variations in the feeding activity according to the season, the circadian rhythm and the environment. Chironomids were the most important food item, followed by mollusks, and feeding activity was highest in summer, during daylight (6h and 12h), and in the lotic environment of the second sampling point.

Caracterização sazonal de acúmulos isolados de própolis em colônias de Plebeia emerina (Hymenoptera, Apidae) no sul do Brasil

Em colônias de abelhas sem ferrão a aplicação da própolis é ampla, sendo utilizada como matéria-prima nas construções e defesa contra inimigos. Há registros de armazenamento de própolis viscosa, sob forma de acúmulos isolados. Neste trabalho propõe-se a caracterização sazonal da área, do número e da distribuição espacial dos acúmulos isolados de própolis em colônias de Plebeia emerina (Friese, 1900). Colônias foram avaliadas entre outubro/2003 e setembro/2004, medindo-se mensalmente os acúmulos isolados de própolis e registrando-se a posição relativa dos mesmos nas colméias. Entre outubro e março, a área dos acúmulos de própolis nas colônias variou entre 0,50 e 4,92 cm² e o número de acúmulos foi de 3 a 16. No período de abril a setembro, a área foi de 4,54 a 18,48 cm² e o número de acúmulos de 9 a 36. Sugere-se que o aumento da própolis acumulada possa estar relacionado à preparação das colônias para o outonoinverno quando a coleta do produto é reduzida. A análise sazonal da distribuição dos depósitos isolados de própolis corrobora com os registros da área total, indicando preferência da posição anterior da colônia para acumular a própolis. Esta constatação fortalece a hipótese do uso da própolis viscosa dos depósitos isolados na defesa, principalmente junto à entrada das colônias.

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 influência 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 (três lagoas com conexão e três 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.

Plastic ingestion by sea turtles in Paraíba State, Northeast Brazil

ABSTRACT Currently, plastics are recognized as a major pollutant of the marine environment, representing a serious threat to ocean wildlife. Here, we examined the occurrence and effects of plastic ingestion by sea turtles found stranded along the coast of Paraíba State, Brazil from August 2009 to July 2010. Ninety-eight digestive tracts were examined, with plastic found in 20 (20.4%). Sixty five percent (n = 13) of turtles with plastic in the digestive tract were green turtles (Chelonia mydas), 25% (n = 5) were hawksbills (Eretmochelys imbricata), and 10% (n = 2) were olive ridley (Lepidochelys olivacea). More plastic was found in the intestine (85%) than in other parts of the gastrointestinal tract. We observed complete blockage of the gastrointestinal tract due to the presence of plastic in 13 of the 20 turtles that had ingested plastic. No correlation was found between the curved carapace length (CCL) and the number or mass of the plastic ingested items. Significant differences were found between the intake of hard and soft plastic and the ingestion of white/transparent and colored plastic, with soft and white/transparent plastics being more commonly ingested. This study reveals the serious problem of plastic pollution to sea turtles at the area.

Evolutionary Control of Infectious Disease: Prospects for Vectorborne and Waterborne Pathogens

Evolutionary theory may contribute to practical solutions for control of disease by identifying interventions that may cause pathogens to evolve to reduced virulence. Theory predicts, for example, that pathogens transmitted by water or arthropod vectors should evolve to relatively high levels of virulence because such pathogens can gain the evolutionary benefits of relatively high levels of host exploitation while paying little price from host illness. The entrance of Vibrio cholerae into South America in 1991 has generated a natural experiment that allows testing of this idea by determining whether geographic and temporal variations in toxigenicity correspond to variation in the potential for waterborne transmission. Preliminary studies show such correspondences: toxigenicity is negatively associated with access to uncontaminated water in Brazil; and in Chile, where the potential for waterborne transmission is particularly low, toxigenicity of strains declined between 1991 and 1998. In theory vector-proofing of houses should be similarly associated with benignity of vectorborne pathogens, such as the agents of dengue, malaria, and Chagas' disease. These preliminary studies draw attention to the need for definitive prospective experiments to determine whether interventions such as provisioning of uncontaminated water and vector-proofing of houses cause evolutionary reductions in virulence

Frequency of Strongyloides stercoralis Infection in Alcoholics

Several studies have shown that chronic alcoholics have increased susceptibility to infections due to higher exposure to infectious agents as well as breakdown in their immune defenses. As Strongyloides stercoralis infection is usually more relevant in immunocompromised patients, the aim of this study was to evaluate the frequency of S. stercoralis infection in alcoholics. Thus, coproparasitological examination was carried out in 145 subjects, from which 45 were chronic alcoholics (mean age of 45.7 ± 11.0 years), 10 were nonalcoholic cirrhotic patients (mean age of 50.2 ± 13.1 years), and 90 were asymptomatic nonalcoholic subjects (mean age of 46.7 ± 10.1 years), which served as controls. From the alcoholics, 9 had hepatic cirrhosis, 9 had chronic pancreatitis and 27 had neither cirrhosis nor pancreatitis. For the diagnosis of strongyloidiasis, the Baermann-Moraes and Lutz methods were used in three fecal samples from each subject. Samples were collected at alternated days, and three slides of each sample were analyzed for each method, thus totalizing 2,610 slides examined. The frequency of strongyloidiasis in the total alcoholic group (33.3%) and in the subgroups of alcoholics, i.e., patients with hepatic cirrhosis (44.4%), with chronic pancreatitis (33.3%), and those with no cirrhosis or pancreatitis (29.6%) was statistically higher than that found in the control group (5.5%). None of the individuals with nonalcoholic hepatic cirrhosis had S. stercoralis infection. Our results showed that the chronic alcoholism itself is an important factor that predisposes to strongyloidiasis.

Screening of Brazilian basidiomycetes for antimicrobial activity

A total of 103 isolates of basidiomycetes, representing 84 species from different Brazilian ecosystems, were evaluated for their antifungal and antibacterial activity in a panel of pathogenic and non-pathogenic microorganisms. Tissue plugs of the fruiting bodies were cultivated in liquid media and the whole culture extracted with ethyl acetate. Crude extracts from Agaricus cf. nigrecentulus, Agrocybe perfecta, Climacodon pulcherrimus, Gloeoporus thelephoroides, Hexagonia hydnoides, Irpex lacteus, Leucoagaricus cf. cinereus, Marasmius cf. bellus, Marasmius sp., Nothopanus hygrophanus, Oudemansiella canarii, Pycnoporus sanguineus, Phellinus sp., and Tyromyces duracinus presented significant activity against one or more of the target microorganisms. Eight isolates were active only against bacteria while three inhibited exclusively the growth of fungi. Two extracts presented wide antimicrobial spectrum and were active against both fungi and bacteria. Differences in the bioactivity of extracts obtained from isolates from the same species were observed.