Evidence for polymicrobial communities in explanted vascular filters and atheroma debris.

RATIONALE: Microbial communities have been implicated in a variety of disease processes and have been intermittently observed in arterial disease; however, no comprehensive unbiased community analysis has been performed. We hypothesize that complex microbial communities may be involved in chronic vascular diseases as well and may be effectively characterized by molecular assays. OBJECTIVE: The main objective is to survey vascular debris, atheroma, and vascular filters for polymicrobial communities consisting of prokaryotic and eukaryotic microbes, specifically eukaryotic microbes. METHODS AND RESULTS: We examined vascular aspirates of atheromatous debris or embolic protection filters in addition to matched peripheral blood samples, from fifteen patients, as well as three cadaveric coronary arteries from two separate patients, for microbial communities. General fluorescence microscopy by Höechst and ethidium bromide DNA stains, prokaryotic and eukaryotic community analysis by Next Generation DNA Sequencing (NGS), and a eukaryotic microbial 9 probe multiplexed quantitative PCR were used to detect and characterize the presence of putative polymicrobial communities. No prokaryotes were detected in peripheral blood; however, in 4 of 9 sequenced filters and in 2 of 7 sequenced atheroma debris samples, prokaryotic populations were identified. By DNA sequencing, eukaryotic microbes were detected in 4 of 15 blood samples, 5 of the 9 sequenced filters, and 3 of the 7 atheroma debris samples. The quantitative multiplex PCR detected sequences consistent with eukaryotic microbes in all 9 analyzed filter samples as well as 5 of the 7 atheroma debris samples. Microscopy reveals putative polymicrobial communities within filters and atheroma debris. The main contributing prokaryotic species in atheroma debris suggest a diverse and novel composition. Additionally, Funneliformis mosseae, an arbuscular mycorrhizal fungus in the Glomeraceae family, was detected in the coronary hard plaque from two patients. Well studied biofilm forming bacteria were not detectable in circulating peripheral blood and were not universally present in atheroma or filters. Analyses of the sequenced eukaryotes are consistent with a diverse of array poorly studied environmental eukaryotes. In summary, out of 15 patients, 6 exhibited molecular evidence of prokaryotes and 14 had molecular evidence of eukaryotic and/or polymicrobial communities in vivo, while 2 post-mortem coronary plaque samples displayed evidence of fungi. CONCLUSION: Prokaryotes are not consistently observed in atheroma debris or filter samples; however, detection of protozoa and fungi in these samples suggests that they may play a role in arterial vascular disease or atheroma formation.

Effect of a pro-breastfeeding intervention on the maintenance of breastfeeding for 2 years or more: randomized clinical trial with adolescent mothers and grandmothers.

BACKGROUND: Being an adolescent mother and cohabiting with the maternal grandmother have been shown to be risk factors for a shorter breastfeeding duration. The objective of this study was to assess whether the positive effects of a pro-breastfeeding intervention aimed at adolescent mothers and maternal grandmothers on the prevalence of breastfeeding observed in the first year of life were maintained at 2 years of age. METHODS: This study is the continuation of a randomized clinical trial initiated in 2006 involving 323 adolescent mothers, their newborns and maternal grandmothers when cohabiting. The intervention consisted of six breastfeeding counseling sessions, the first one held at the maternity ward and the others at the participants' homes at 7, 15, 30, 60, and 120 days postpartum. The present study reports data collected when the children were 4 to 7 years old, concerning the maintenance of breastfeeding at 2 years. Data were analyzed using multivariable Poisson regression model with robust variance, with breastfeeding at 2 years of age as the outcome. RESULTS: Maintenance of breastfeeding for 2 years or more was present in 32.2% of the sample. When the intervention and control groups were compared, the prevalence of breastfeeding at 2 years was similar (29.9 vs. 34.3%, respectively; p = 0.605). Multivariable analysis failed to reveal an association between exposure to the intervention and maintenance of breastfeeding at 2 years in the different models tested. CONCLUSIONS: The positive impact of the intervention on the prevalence of breastfeeding observed in the first year of life was not maintained at 2 years of age. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov on May 28, 2009 under protocol no. NCT00910377.

The Effect of a Pro-Breastfeeding and Healthy Complementary Feeding Intervention Targeting Adolescent Mothers and Grandmothers on Growth and Prevalence of Overweight of Preschool Children.

INTRODUCTION: The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood. OBJECTIVE: To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding. METHODS: This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants' maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis. RESULTS: BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. CONCLUSION: Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years. TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.

Use of ACIST™ contrast injection device in carotid artery stenting in high-surgical-risk patients.

OBJECTIVE: The objective is to see if use of the ACIST™ device during carotid stenting would be feasible without an increase in primary end points when compared to historic controls. BACKGROUND: Carotid stenting has been studied as an effective alternative to endarterectomy in high-surgical-risk patients. Traditional angiography involves manual contrast injection. It leads to excess contrast volume and greater fluoroscopy times. The Acist contrast injection device helps with the regulation and lowering of contrast volume. METHODS: This is a consecutive, non-randomized, open-label, multiple-operator-based study. Inclusion criteria were as follows: (a) subject is considered at high risk for carotid endarterectomy, (b) subject requires percutaneous carotid angioplasty and stenting for carotid disease, and (c) subject must be asymptomatic with ≥80% stenosis of the internal and/or common carotid artery. The primary end points measured were, death from any cause, myocardial infarction, transient ischemic attack or stroke within 30 days of intervention. Secondary end points were contrast volume and fluoroscopy time. RESULTS: Four operators in one institution performed interventions from June 2007 to May 2012 on 133 consecutive patients. They were predominantly men (59.4%). The mean age (SD) was 73.64 (7.952) years. Stroke occurred in 3% (N=4), transient ischemic attack in 0.8% (N=1) and myocardial infarction in 0.8% (N=1). Three study subjects died (2.3%). The mean (SD) contrast volume was 121.24 (67.79) mL. The mean (SD) fluoroscopy time was 18.34 (11.31) minutes. CONCLUSIONS: The use of the ACIST™ device was feasible in carotid stenting in a high-risk population without an increase in end points when compared to historic controls.

Associação entre aleitamento materno e estado nutricional atual de crianças e adolescentes atendidos em um hospital do sul do Brasil / Association between breastfeeding and current nutritional status of children and adolescents in a hospital in southern Brazil

Introdução: O leite materno é o alimento adequado para crianças nos primeiros meses de vida. O padrão de aleitamento materno pode estar relacionado ao estado nutricional de crianças e adolescentes. A escolaridade, a idade materna e a presença de filhos anteriores também podem estar relacionadas com a duração da amamentação. Objetivo: Avaliar a relação entre o tempo de aleitamento materno com o estado nutricional atual de crianças e adolescentes atendidos no Hospital de Clínicas de Porto Alegre (HCPA) - RS. Métodos: Estudo transversal realizado na unidade geral de internação pediátrica e no ambulatório geral de pediatria do HCPA com 106 crianças e adolescentes. Os participantes foram avaliados por meio da caderneta da criança, instrumento formulado para o estudo e avaliação antropométrica. Resultados: Não foram encontradas diferenças estatisticamente significativas em relação ao estado nutricional quando comparado com aleitamento materno, aleitamento materno exclusivo, tempo de amamentação exclusiva e tipo de leite utilizado após a interrupção do aleitamento materno exclusivo. Também não foram encontradas diferenças em relação ao tempo de aleitamento materno exclusivo quando comparado com idade da mãe no nascimento do bebê, escolaridade materna e filhos anteriores. Conclusão: Não foi encontrada associação estatisticamente significativa entre as variáveis analisadas. Entretanto, os dados percentuais sugerem que o aleitamento materno exclusivo pode influenciar positivamente no perfil nutricional das crianças, que mães com maior escolaridade e mães que possuem filhos anteriores amamentam exclusivamente por mais tempo.

Background: Human breast milk is the appropriate food for infants in the first months of life. The pattern of breastfeeding may be related to nutritional status of children and adolescents. Education, maternal age, and the presence of previous children may also be related to duration of breastfeeding. Aim: To evaluate the relationship between duration of breastfeeding and the current nutritional status of children and adolescents treated at the Hospital de Clínicas de Porto Alegre - RS. Methods: Cross-sectional study in a pediatric inpatient unit and an outpatient pediatric clinic with 106 children and adolescents. Participants were assessed by the Child Health Card, an instrument designed to study and anthropometric measurements. Results: There were no statistically significant differences in relation to nutritional status when compared with breastfeeding, exclusive breastfeeding, exclusive breastfeeding duration, and type of milk used after discontinuation of exclusive breastfeeding. We also found no differences in exclusive breastfeeding duration when compared with age of mother at birth, maternal education level, and the presence of previous children. Conclusion: There was no statistically significant association between the variables analyzed. However, the percentage data suggest that exclusive breastfeeding may positively affect the nutritional status of children. Mothers with higher education level or those with previous children are more likely to exclusively breastfeed longer.

Comparação do estado nutricional obtido através de antropometria e bioimpedância em crianças e adolescentes submetidos a tratamento quimioterápico em um hospital no Sul do Brasil / Comparison of nutritional status based on anthropometric measures and bioelectrical impedance in children and adolescents submitted to chemotherapy at a hospital in southern Brazil

Introdução: Estudos demonstram o impacto do estado nutricional na qualidade de vida e prognóstico de pacientes pediátricos com câncer. A composição corporal pode afetar a mortalidade e morbidade, porém poucos trabalhos utilizam a bioimpedância nessa população. Objetivo: Comparar o estado nutricional obtido através de antropometria com a bioimpedância em crianças e adolescentes submetidos a tratamento quimioterápico. Materiais e métodos: Foram incluídos pacientes internados no Hospital de Clínicas de Porto Alegre, com idade entre 4 e 18 anos que haviam realizado pelo menos um ciclo de quimioterapia. Foram coletados dados de peso, estatura, circunferência do braço, prega cutânea tricipital e área muscular do braço. Também foi realizada a análise por bioimpedância. Resultados: Foram avaliados um total de 19 pacientes. Segundo os valores de escore-z de índice de massa corporal para idade 10,5% dos pacientes foram classificados como magreza, 52,6% eutrofia e 36,8% excesso de peso. Os valores de percentil de prega cutânea tricipital e área muscular do braço correlacionaram-se com a classificação do estado nutricional segundo o índice de massa corporal para idade, r=0,81 e 0,67 respectivamente. O percentil da prega cutânea tricipital apresentou correlação positiva com o percentual de massa gorda (r= 0,74) e correlação negativa com o percentual de massa magra (r= 0,76). Conclusões: Parâmetros antropométricos apresentaram boa correlação entre si e com valores obtidos por bioimpedância. A bioimpedância parece ser um método acurado para avaliação nutricional e aferição de compartimentos corporais em pacientes pediátricos portadores de neoplasias.

Background: Studies have shown the impact of nutritional status on quality of life and prognostic of pediatric cancer patients. Body composition may affect mortality and morbidity; however, there are few studies using bioelectrical impedance in this population. Aim: To compare the nutritional status based on anthropometric measurements and bioelectrical impedance in children and adolescents submitted to chemotherapy. Methods: Patients admitted to the Hospital de Clínicas de Porto Alegre, aged between 4 and 18 years, who had attended at least one cycle of chemotherapy, participated in the study. We collected data on weight, height, arm circumference, triceps skinfold thickness, and arm muscle area. Bioelectrical impedance analysis was performed. Results: A total of 19 patients were evaluated. According to the z-score values of body mass index for age, 10.5% of patients were considered malnourished, 52.6% had normal weight, and 36.8% were overweight. The percentile values of triceps skinfold and arm muscle area correlated with the nutritional status according to body mass index for age, r=0.81 and 0.67, respectively. The percentile of triceps skinfold thickness correlated positively with the percentage of fat mass (r=0.74) and negatively with the percentage of lean body mass (r=0.76). Conclusions: Anthropometric parameters showed good correlation between them and with values obtained by means of bioelectrical impedance. Bioelectrical impedance seems to be an accurate method for nutritional assessment and measurement of body compartments in pediatric patients with malignancies.