Effects of Exercise Training on Heart Rate Variability in Chagas Heart Disease

Background: Heart rate variability (HRV) is a marker of autonomic dysfunction severity. The effects of physical training on HRV indexes in Chagas heart disease (CHD) are not well established. Objective: To evaluate the changes in HRV indexes in response to physical training in CHD. Methods: Patients with CHD and left ventricular (LV) dysfunction, physically inactive, were randomized either to the intervention (IG, N = 18) or control group (CG, N = 19). The IG participated in a 12-week exercise program consisting of 3 sessions/week. Results: Mean age was 49.5 ± 8 years, 59% males, mean LVEF was 36.3 ± 7.8%. Baseline HRV indexes were similar between groups. From baseline to follow-up, total power (TP): 1653 (IQ 625 - 3418) to 2794 (1617 - 4452) ms, p = 0.02) and very low frequency power: 586 (290 - 1565) to 815 (610 - 1425) ms, p = 0.047) increased in the IG, but not in the CG. The delta (post - pre) HRV indexes were similar: SDNN 11.5 ± 30.0 vs. 3.7 ± 25.1 ms. p = 0.10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms. p = 0.43; TP 943 (731 - 3130) vs. 1780 (921 - 2743) Hz. p = 0.46; low frequency power (LFP) 1.0 (150 - 197) vs. 60 (111 - 146) Hz. p = 0.85; except for high frequency power, which tended to increase in the IG: 42 (133 - 92) vs. 79 (61 - 328) Hz. p = 0.08). Conclusion: In the studied population, the variation of HRV indexes was similar between the active and inactive groups. Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD.

Incrimination of Anopheles (Nyssorhynchus) rangeli and An. (Nys.) oswaldoi as natural vectors of Plasmodium vivax in Southern Colombia

Malaria transmission in the Southern Colombian state of Putumayo continues despite the absence of traditional vector species, except for the presence of Anopheles darlingi near the southeastern border with the state of Amazonas. In order to facilitate malaria vector incrimination in Putumayo, 2445 morphologically identified Anopheles females were tested for natural infection of Plasmodium vivax by ELISA. Specimens tested included An. apicimacula (n = 2), An. benarrochi B (n = 1617), An. darlingi (n = 29), An. mattogrossensis (n = 7), An. neomaculipalpus (n = 7), An. oswaldoi (n = 362), An. peryassui (n = 1), An. punctimacula (n = 1), An. rangeli (n = 413), and An. triannulatus (n = 6). Despite being overwhelmingly the most anthropophilic species in the region and comprising 66.1% of the mosquitoes tested, An. benarrochi B was not shown to be a vector. Thirty-five An. rangeli and one An. oswaldoi were naturally infected with P. vivax VK210. Sequence data were generated for the nuclear second internal transcriber space region of 31 of these 36 vivax positive mosquitoes (86.1%) to confirm their morphological identification. An. oswaldoi is known to be a species complex in Latin America, but its internal taxonomy remains unresolved. Herein we show that the An. oswaldoi found in the state of Putumayo is genetically similar to specimens from the state of Amapá in Brazil and from the Ocama region in the state of Amazonas in Venezuela, and that this form harbors natural infections of P. vivax. That An. rangeli and this member of the An. oswaldoi complex are incriminated as malaria vectors in Putumayo, is a novel finding of significance for malaria control in Southern Colombia, and possibly in other areas of Latin America.

Predição da restrição do crescimento fetal pela medida da altura uterina

OBJETIVO: avaliar o emprego da medida da altura uterina para o diagnóstico da restrição do crescimento fetal (RCF), empregando como padrão curvas conhecidas de evolução da altura uterina do próprio serviço. MÉTODOS: entre julho de 2000 e fevereiro de 2003, 238 gestantes de alto risco foram submetidas a medidas de altura uterina, da 20ª à 42ª semana de gestação. Todas possuíam idade gestacional confirmada por ultra-sonografia precoce. Cinqüenta (21,0%) gestantes tiveram recém-nascidos pequenos para a idade gestacional. O mesmo observador realizou 1617 medidas de altura uterina, com fita métrica, da borda superior da sínfise púbica ao fundo uterino. A confirmação do diagnóstico de RCF foi dada após o nascimento pela curva de Ramos. Para a análise estatística, as gestantes foram comparadas segundo o peso dos recém-nascidos, por meio do teste exato de Fisher ou teste não paramétrico de Kruskal-Wallis, quando aplicável. Foram calculados: sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e negativo (VPN) para o diagnóstico de RCF. Para a análise dos valores contínuos foi utilizado o teste para duas proporções com aproximação normal. RESULTADOS: para a ocorrência de RCF, considerando-se uma medida de altura uterina abaixo do percentil 10 para a idade gestacional, S foi de 78%, E de 77,1%, VPP de 47,6% e VPN de 92,9%. Utilizando como limite o percentil 5, foram obtidos S = 64%, E = 89,9%, VPP = 62,7% e VPN = 90,4%, para o diagnóstico da RCF. CONCLUSÃO: medida de altura uterina abaixo do percentil 10 para a idade gestacional, pela curva local, mostra-se como bom teste para o rastreamento da RCF.