Alternative additives associated in the feeding of laying hens: performance, biometrics, bone traits, and economic evaluation-an unsupervised machine learning approach.

Given the current bans on the use of some growth promoting antibiotics in poultry nutrition, the need to use alternative additives which could replace traditional promoters in diets has arisen. The objective of this study was to evaluate the effect of alternative additives, associated or not, in replacing the antibiotic growth promoter in the diets of laying hens on performance, egg quality, biometry, bone characteristics, and economic viability. A total of 378 birds at 97 weeks of age, weighing 1691 ± 80g with an average production of 79.96 ± 4.9%, were randomly distributed and submitted to different diets: negative control - NC (no additive); positive control - PC, conventional growth promoter (Enramycin); associated organic acids (OA); symbiotic (S); Essential oil (EO); OA + S; and S+EO. The diet did not influence (P > 0.05) performance, egg quality, biometry, and bone traits. However, the use of alternative additives and their associations with the exception of S+OA, provided better economic indices when compared to NC and CP. The first component showed a negative relationship between feed conversion per mass and dozen eggs with gut length, Seedor index, egg production, and egg mass; the second component showed a positive relationship between yolk, pancreas, proventriculus, and gizzard; and, finally, the third component showed that feed consumption has a negative relationship with bone strength and deformity. The first two canonical functions were significant and discriminated 100% of the differences between the diets. Moreover, 50% of the birds were correctly classified in their group of origin, in which the positive control group (83.3%) and OA+S presented the highest rates of correct responses (66.7%). Bone deformity and bowel length were the only two variables with discriminatory power. Natural growth promoters alone or in association do not harm performance, egg quality, digestive organs biometry or bird bone characteristics, in addition to promoting greater economic return. Thus, they can be considered possible substitutes for traditional antibiotics. Finally, unsupervised machine learning methods are useful statistical techniques to study the relationship of variables and point out the main biomarkers of poultry production.

Does dietary supplementation with phytases affect the thermoregulatory and behavioral responses of pullets in a tropical environment?

Dietary supplementation of two types of phytases (fungal and bacterial) with different dosages (300 and 900 FTUs) was evaluated in the thermoregulatory and behavioral responses of replacement pullets in a tropical environment. 288 Hy-Line White laying birds with a mean weight of 639.60 ± 6.05 g, clinically healthy, and eight weeks old were used in the study. Respiratory rate (RR, breaths. min-1), Cloacal temperature (CT, °C), Surface temperature with feathers (STWF, °C), and Surface temperature featherless (STF, °C) were measured in the morning and afternoon. Behavioral data were observed through the following activities: sitting, eating, drinking, exploring feathers (EF), non-aggressive pecking (NAP), and object pecking (OP) recorded every 10 min from 6 a.m. to 5 p.m. Environmental variables were measured along with thermoregulatory and behavioral responses. There was an interaction for RR between phytase and period of the day (P < 0.05). The lowest RR (morning) was observed in fungal phytase. STF and STWF were higher (P < 0.05) in the afternoon. Birds supplemented with fungal phytase showed lower STWF (P < 0.05). The variables that contributed to explain physiological and behavioral responses are shown in order of importance for (i) periods of day: morning (sitting, STWF, drinking, eating, and CT) and afternoon (STF, STWF, OP, drinking, eating, RR and sitting); (ii) phytases: fungal (STF, STWF, RR, sitting, eating and drinking); and bacterial (RR, STF, STWF, CT and sitting). Thermoregulatory and behavioral responses were similar between dosages, but different between types of phytases. Birds supplemented with fungal phytase used sensible heat dissipation mechanisms and exhibited thermal comfort behaviors. The 300 and 900 FTUs phytase doses did not influence the thermoregulatory and behavioral responses of birds, while they showed natural heat dissipation and heat stress behaviors in the afternoon. We recommend a dietary supplementation of 300 FTUs fungal phytases.

Thermoregulatory, behavioral and productive responses of laying hens supplemented with different types and dosages of phytases raised in a hot environment: An integrative approach.

This study had the following objectives: (i) to evaluate the thermoregulatory and behavioral responses of light laying hens supplemented with different types and dosages of phytases in the two day shifts; and (ii) to integrate the thermoregulatory and behavioral responses with performance of these birds raised in a hot environment. 270 light laying hens of the Hy-Line White lineage, with a body weight of 1.60 ± 0.092 kg were distributed in a completely randomized design in a 2 × 2 + 1 factorial model with two types of phytases (bacterial and fungal) and two dosages (450 and 900 FTU), and a control diet. The day shift (morning and afternoon) was considered as a fixed effect in the factorial arrangement. Principal component analysis (PCA), correspondence analysis (CA) and canonical discriminant analysis (CDA) were used. There was no interaction (P > 0.05) between phytases and dosages for thermoregulatory responses. Respiratory rate (RR), cloacal temperature (CT), and surface temperature with feathers (STWF) and featherless (STF) were higher (P < 0.001) in the afternoon. Birds show different thermoregulatory and behavioral responses in the two shifts of the day. We also observed that birds supplemented with bacterial and fungal phytase showed similar thermoregulatory and behavioral responses to the control group in both day shifts. Expression of the "eating" activity was greater in the morning, while the birds remained sitting longer in the afternoon. Egg production was higher (P < 0.001) in birds supplemented with bacterial phytase. The phytase dosages had no effect on thermoregulatory, behavioral or performance responses. Egg production, feed conversion per dozen eggs corresponded to 81.1% of the differences between bacterial and fungal phytase supplementation and group control. Thus, we conclude that: (i) phytase dietary supplementation has no effect on the thermoregulatory responses of laying hens reared in a hot environment; (ii) birds supplemented with bacterial phytase showed higher egg production; and (iii) phytases (450 and 900 FTU) do not interfere with productive, behavioral and thermoregulatory responses.

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study.

OBJECTIVE: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. METHODS: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. RESULTS: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). CONCLUSIONS: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

Early childhood growth and cognitive outcomes: Findings from the MAL-ED study.

Although many studies around the world hope to measure or improve developmental progress in children to promote community flourishing and productivity, growth is sometimes used as a surrogate because cognitive skills are more difficult to measure. Our objective was to assess how childhood measures of anthropometry correlate with measures of child development in low-income settings with high prevalence of poor nutrition and enteric disease, to inform studies considering growth outcomes in the absence of direct child developmental skill assessment. Children from the MAL-ED study were followed from birth to 24 months of age in field sites in 8 low- and middle-income countries across 3 continents. Monthly weight, length, and head circumference measurements were performed. At 24 months, the Bayley Scales of Infant and Toddler Development was administered. We correlated cognitive measures at 24 months with anthropometric measurements from birth to 2 years comparing 3 constructs: absolute attained monthly measures, summative difference in measures from the mean growth curve, and rate of change in measures. Growth faltering at multiple time periods is related to Bayley cognitive outcomes at 24 months. Birthweight, overall growth by 18-24 months, and rate of growth in the 6- to 18-month period were most associated with 24-month developmental scores. In this study, head circumference measurements, compared with length, was more closely linked to cognitive scores at 24 months. Notably, all studies between growth and cognitive outcomes exhibited low r2 values (0.001-0.049). Anthropometric measures, particularly head circumference, were related to cognitive development, although explaining a low percent of variance. When feasible, direct measures of child development may be more useful.

Geography, population, demography, socioeconomic, anthropometry, and environmental status in the MAL-ED cohort and case-control study Sites in Fortaleza, Ceará, Brazil.

The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort in the study's Fortaleza, Brazil, catchment area has a population of approximately 82 300 inhabitants. Most of the households (87%) have access to clean water, 98% have electricity, and 69% have access to improved toilet/sanitation. Most childbirths occur at the hospital, and the under-5 mortality rate is 20 per 1000 live births. The MAL-ED case-control study population, identified through the Institute for the Promotion of Nutrition and Human Development (IPREDE), serves 600 000 inhabitants from areas totaling about 42% of the city of Fortaleza. IPREDE receives referrals from throughout the state of Ceará for infant nutrition, and provides services including teaching activities and the training of graduate students and health professionals, while supporting research projects on child nutrition and health. In this article, we describe the geographic, demographic, socioeconomic, anthropometric, and environmental status of the MAL-ED cohort and case-control study populations in Fortaleza, Brazil.

Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review.

INTRODUCTION: Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. OBJECTIVE: To analyze the self-management strategies currently used by older adults with chronic pain. METHOD: An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. RESULTS AND CONCLUSION: Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.

Application of two- and multiway chemometric strategies for describing elementomic changes in pepper plants exposed to cadmium stress by multielement determination.

The objective of this work was to evaluate elemental changes in pepper exposed to Cd stress through different chemometric tools. For this purpose, pepper plants were grown under five different treatments with different Cd concentrations in the nutrient solution. Considering the hypothesis that pepper plants exposed to Cd stress during growth undergo changes in the macro- and microelemental distribution in leaves, stems, and roots, principal component analysis (PCA) and parallel factor (PARAFAC) analysis were applied to compare bidirectional and multivariate chemometric strategies to assess elemental changes in pepper plants. Since the number of variables and the data generated were large and complex, the application of chemometric tools was justified to facilitate the visualization and interpretation of results. The mineral composition, namely the Ca, Cd, Cu, Fe, K, Mg, Mn, N, and P contents, was assessed in 180 samples of leaves, stems, and roots of the cultivated peppers. Then, PCA and PARAFAC analysis were applied to compare bidirectional and multivariate chemometric strategies to assess elemental changes throughout pepper plants. The visualization of the trend on each sample and their intrinsic relationship with the variables were possible with the application of PCA. The use of PARAFAC analysis permitted the simultaneous study of all samples in a straightforward representation of the information that facilitated a quick and comprehensive understanding of the spatial distribution of elements in plants. Thus, macroelements (Ca, K, Mg, N, and P) that were found in higher concentrations in leaves did not present significant differences in the distribution along the plants under different treatment conditions. In contrast, a significant impact on the microelement (Cu, Fe, and Mn) distribution was produced between uncontaminated and contaminated samples. This analysis revealed a significant accumulation of Cd in roots and adverse effects on normal plant growth, demonstrating their level of phytotoxicity to pepper.

Application of multivariate analysis to assess stress by Cd, Pb and Al in basil (Ocimum basilicum L.) using caffeic acid, rosmarinic acid, total phenolics, total flavonoids and total dry mass in response.

Basil is an edible, aromatic plant, which makes the study of the ecotoxicity of metals in plant metabolism relevant. Given the above, the objective of this study was to evaluate the effects of metals, aluminum, lead, and cadmium, in the synthesis of phenolic compounds and in the dry mass of basil plants (O. basilicum L.) grown in a hydroponic system. The plants were subjected to four different concentrations of cadmium (0.2, 0.6, 1.2, and 1.8 mmol L-1), lead and aluminum (0.04, 0.08, 0.12, and 0.16 mmol L-1), and compared with the control. After desiccation of the plant material, the total dry mass was obtained and then, hydroethanolic extracts (43% distilled water and 57% ethanol) were made for biochemical analyzes, which consisted of the determination of caffeic acid (CA) and rosmarinic acid (RA) by high performance liquid chromatography analysis with a diode detector (HPLC-DAD); total phenolics (TP) and total flavonoids (TF) by spectrophotometry. The data were submitted to analysis of variance and multivariate analysis (principal component analysis-PCA and hierarchical cluster analysis-HCA) was applied for data association. The phenolic compounds showed a high positive correlation with each other, and the total dry mass showed low and negative correlations with the analyzed variables. The results showed that the metals aluminum, lead, and cadmium promoted a stress condition in basil plants, which resulted in the reduction of the dry matter mass and an increase in the synthesis of phenolic compounds, according to the type and concentration of the metal.

Effect of pacing-induced ventricular dyssynchrony on right ventricular function.

BACKGROUND: Asynchronous electrical activation induced by right ventricular (RV) pacing can cause several abnormalities in left ventricular (LV) function. However, the effect of ventricular pacing on RV function has not been well established. We evaluated RV function in patients undergoing long-term RV pacing. METHODS: Eighty-five patients and 24 healthy controls were included. After pacemaker implantation, conventional echocardiography and strain imaging were used to analyze RV function. Strain imaging measurements included peak systolic strain and strain rate. LV function and ventricular dyssynchrony by tissue Doppler imaging (TDI) were assessed. Intra- and interobserver variabilities of TDI parameters were tested on 15 randomly selected cases. RESULTS: All patients were in New York Heart Association functional class I or II and percentage of ventricular pacing was 96 ± 4%. RV apical induced interventricular dyssynchrony in 49 patients (60%). LV dyssynchrony was found in 51 patients (60%), when the parameter examined was the standard deviation of the time to peak myocardial systolic velocity of all 12 segments greater than 34 ms. Likewise, septal-to-lateral delay ≥ 65 ms was found in 31 patients (36%). All echocardiographic indexes of RV function were similar between patients and controls (strain: -22.8 ± 5.8% vs -22.1 ± 5.6%, P = 0.630; strain rate: -1.47 ± 0.91 s(-1) vs -1.42 ± 0.39 s(-1) , P = 0.702). Intra- and interobserver variability for RV strain was 3.1% and 5.3%, and strain rate was 1.3% and 2.1%, respectively. CONCLUSIONS: In patients with standard pacing indications, RV apical pacing did not seem to affect RV systolic function, despite induction of electromechanical dyssynchrony.

Exploratory analysis in the evaluation of stress due to aluminum presence in Physalis angulata L. and multielement determination by microwave-induced plasma optical emission spectrometry (MIP OES).

The present work aimed to analyze the mineral nutrition of Physalis angulata L. under stress by aluminum in the nutrient solution. The treatments consisted of five different concentrations of aluminum in the nutrient solution (0, 0.04, 0.08, 0.12, and 0.16 mmol L-1) in the AlCl3 form. The plants were exposed to Al for 30 days. Subsequently, nutritional and aluminum analyses were performed on plant tissue. The data were submitted to analysis of variance (p < 0.05), and, in case of significance, the regression study was performed as well as hierarchical cluster analysis (HCA) and principal component analysis (PCA) were used. The formation of four groups occurred, where we can observe the similarity and differences in the treatments between them. The separation of the treatments into groups reflected the heterogeneity of the treatments about the aluminum levels in the nutrient solution, evidencing its phytotoxicity level in Physalis angulata plants. Among the analyzed variables, P, K, Ca, Mg, Fe, Mo, and Zn were the most influential ones demonstrated by principal component analysis (PCA). The stress of 0.16 mmol L-1 of Al increased the phosphorus contents in the stems and roots and the potassium, copper, and molybdenum contents in all parts of the plants. In contrast, Al reduced the levels of calcium, magnesium, iron, and zinc in P. angulata plants. Iron being the micronutrient that showed the largest reduction, followed by zinc in the leaves. The highest levels of aluminum were found in the roots.

Description of the scientific method for the preparation and validation of educational technologies in digital format: a methodological study

Introduction: the use of digital technologies constitutes a process that allows the dynamization of the care process, based on aspects related to criticality and creativity. It is emphasized that the development of technologies must, therefore, be inserted in a context for changes and innovation in response to the population's health demand, and must follow a precise methodological path that goes from the construction to the validation of the appearance, content and effect . Objective: to describe the scientific method of elaboration and validation of educational technologies in digital format. Methods: methodological study, conducted according to the following steps: development of the research project and submission to the Research Ethics Committee; data collection; elaboration of the content, script, illustrations and layout of the booklet; and validation of educational technology. Results: the process of developing a technology requires methodological rigor, enabling coherence between theory and the purpose of the desired product, guaranteeing the internal quality of the developed technology. The use of educational technologies in health reinforces information, serving as a guide for guidelines regarding care and assisting in decision-making. Technological innovations in health, consists of a socio-technical process , permeated by professional and user reflections and experiences. Final considerations: educational technologies represent a potential resource for the development of health education practices, encouraging greater interaction between professionals and users, and an active attitude regarding self-care actions related to their health condition.

Introdução: o uso de tecnologias digitais constitui como um processo que permite a dinamização no processo de cuidar, pautada nos aspectos relacionados a criticidade e criatividade. Enfatiza-se, que o desenvolvimento de tecnologias deve, portanto, insere-se em um contexto por mudanças e inovação em resposta a demanda de saúde da população devendo seguir um percurso metodológico preciso que vai desde a construção à validação da aparência, conteúdo e efeito. Objetivo: descrever o método científico de elaboração e validação de tecnologias educativas no formato digital. Método: estudo metodológico, conduzido de acordo com as seguintes etapas: elaboração do projeto de pesquisa e submissão ao Comitê de Ética em Pesquisa; levantamento dos dados; elaboração do conteúdo, roteiro, ilustrações e diagramação da cartilha; e validação da tecnologia educacional. Resultados: o processo de elaboração de uma tecnologia requer rigor metodológico, possibilitando coerência entre teoria e finalidade do produto desejado, garantindo qualidade interna da tecnologia elaborada. O uso de tecnologias educativas em saúde reforça informações, servindo como guia para orientações quanto ao cuidado e auxiliando nas tomadas de decisões. Inovações tecnológicas em saúde, consiste em um processo sócio-técnico, permeado por reflexões e experiências profissionais e usuários. Considerações finais: tecnologias educacionais representam um recurso potencializador para o desenvolvimento de práticas de educação em saúde, estimulando maior interação entre profissionais e usuários, e uma postura ativa quanto a ações de autocuidado relacionado a sua condição de saúde.

COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil, the effects of lethality and mortality / COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil, os efeitos da letalidade e mortalidade

Introduction: In 2019, the proliferation of a virus identified as SARS-CoV-2 emerged in the city of Wuhan, a district in China, quickly spread throughout the world, gaining pandemic status and less than 1 year, its repercussions and magnitude caused scientists, governments and society to adopt severe measures to combat this disease. Objective: To analyze mortality, incidence and mortality from COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil. Methods: This is an ecological study with a time series design with secondary data. All registered cases and deaths registered by COVID-19 from April 2020 to August 2021 in the municipalities of Botucatu and Serrana, São Paulo, Brazil were considered. The incidence, mortality and lethality rate were used. The monthly and/or weekly percentage variation and their respective 95% confidence intervals were estimated.Results: It identified that 12.88% of the residents of the city of Botucatu were infected with COVID-19 and 8.61% of the population of the municipality of Serrana was infected. There was a stationary trend of mortality and incidence in the period between April 2020 and May 2021 and decreasing in both sexes in the mortality rate in the municipality of Serrana, in the city of Botucatu there was a trend of increasing mortality and incidence in the same period observed. Conclusion: The mass vaccination strategy of citizens in the cities of Botucatu and Serrana present robust data to consider that immunization has a decreasing effect on the number of cases and deaths from COVID-19, which effectively contributes to fighting the pandemic and reduces the contamination and progression of the disease to more severe cases.

Introdução: em 2019, surgiu na cidade de Wuhan, um distrito na região da China a proliferação com a infecção de um vírus identificado como SARS-CoV-2, rapidamente espalhou-se pelo mundo ganhando status de pandemia em menos de 1 ano, suas repercussões e magnitude fizeram que os cientistas, governos e sociedade adotarem medidas severas para o combate a esta enfermidade. Objetivo: analisar a mortalidade, incidência e letalidade por COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil. Método: trata-se de um estudo ecológico com delineamento de série temporal com dados secundários. Foram consideradas todos os casos registrados e óbitos registrados por COVID-19 no período de abril de 2020 a agosto de 2021, nos municípios de Botucatu e Serrana, São Paulo, Brasil. Foi utilizado a taxa de incidência, mortalidade e letalidade. Estimou-se a variação percentual mensal e/ou semanal e seus respectivos intervalos de 95% de confiança. Resultados: identificou que e 12,88% dos munícipes da cidade de Botucatu foram infectados com COVID-19 e 8,61% da população do município de Serrana foi infectada. Observou-se uma tendência estacionária de mortalidade e incidência no período entre abril 2020 a maio 2021 e decrescente em ambos os sexos na taxa de letalidade no município de Serrana, na cidade de Botucatu houve tendência de mortalidade e incidência crescentes no mesmo período observado. Conclusão: a estratégia de vacinação em massa dos munícipes das cidades de Botucatu e Serrana apresentam dados robustos para considerar que a imunização tem efeito de queda no número de casos e óbitos por COVID-19, o que contribui efetivamente no combate a pandemia e reduz a contaminação e evolução da doença para casos mais graves.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study.

BACKGROUND: Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. METHODS: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. RESULTS: Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87-100%, whereas measles vaccination rates ranged widely, 73-100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. CONCLUSIONS: Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.

Determinant Variables, Enteric Pathogen Burden, Gut Function and Immune-related Inflammatory Biomarkers Associated With Childhood Malnutrition: A Prospective Case-Control Study in Northeastern Brazil.

Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biologic factors, socioeconomic factors, enteric pathogenic burden and gut function biomarkers in 402 children 6-24 months of age in Northeastern Brazil. In this prospective case-control study, not being fed colostrum [odds ratio (OR): 3.29, 95% confidence interval (CI): 1.73-6.26], maternal age ≥18 years (OR: 1.88, 95% CI: 1.10-3.22) and no electric fan (OR: 2.46, 95% CI: 1.22-4.96) or bicycle (OR: 1.80, 95% CI: 1.10-2.95) in the household were positively associated, and higher birth weight (OR: 0.27, 95% CI: 0.19-0.38), larger head circumference (OR: 0.74, 95% CI: 0.66-0.82) and shortness of breath in the last 2 weeks (OR: 0.49, 95% CI: 0.27-0.90) were negatively associated with malnutrition. Subclinical enteric pathogen infections were common, and enteroaggregative Escherichia coli infections were more prevalent in malnourished children (P = 0.045). Biomarkers such as the lactulose-mannitol test, myeloperoxidase, neopterin and calprotectin were highly elevated in both malnourished and nourished children. Nourished children had a better systemic immune response than the malnourished children, as detected by elevated serum amyloid A-1 and soluble cluster of differentiation protein 14 biomarkers (P < 0.001). Serum amyloid A-1 and soluble cluster of differentiation protein 14 were also associated with better nutritional Z scores. Neonatal, maternal and socioeconomic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with enteroaggregative E. coli, in malnourished children.

[Chronotropic-metabolic index in Chagas' disease]. / Indice cronotrópico-metabólico na doença de Chagas.

Chronotropic incompetence is a common feature in Chagas' disease patients. New methodologies are now available to evaluate the chronotropic response in different subsets. The chronotropic-metabolic index (CMI) is one of these new indexes and quantifies the relationship between the increment of heart rate and the maximal oxygen consumption (VO2 max) during exercise testing. In normal subjects there is linear response and the index is round 1.0. The aim of the study was to evaluate the chronotropic response in healthy controls and Chagas' disease patients with and without left ventricular dysfunction, using CMI. Twenty-four controls and 171 Chagas' disease patients underwent a clinical protocol and maximal exercise testing. Chagas' disease patients were divided into two groups: Ch1= patients with ejection fraction (EF) > 39% and Ch2 = EF < 40%. CMI was analyzed and calculated according to the Wilkoff method. Chagas' disease patients were older than controls and showed higher prevalence of right bundle branch block, as well as lower VO2 max during exercise. Both groups of Chagas' disease patients showed a less steep curve in the chronotropic-metabolic index (Ch1: 0.91+/-0.10, Ch2: 0.89+/-0.08) than controls (1.0+/-0.12, p < 0.001). Chagas' disease patients with and without left ventricular dysfunction chronotropic incompetence may exhibit reduced chronotropic response to exercise, expressed by a less steep chronotropic-metabolic index.

Educação Permanente em Saúde e atenção psicossocial: a experiência do Projeto Rede Sampa / Permanent Health Education and psychosocial care: the experience of the Projeto Rede Sampa

RESUMO Este artigo relata uma experiência de formação em saúde mental desenvolvida no município de São Paulo entre os anos de 2013 e 2016. Denominado Projeto Rede Sampa - Saúde Mental Paulistana, direcionou-se a trabalhadores de diversas categorias profissionais e diferentes pontos da Rede de Atenção Psicossocial, tendo sido elaborado e executado utilizando estratégias que garantiram a participação dos distintos atores na construção de conteúdos de aprendizagem, a abordagem da singularidade das redes territoriais e o registro do percurso formativo das turmas. A partir da metodologia construcionista social, procurou-se discutir a relevância das interações dialógicas para o fortalecimento do trabalho em rede e a importância do alinhamento com a atenção psicossocial como modelo ético de cuidado.

ABSTRACT This article reports on a training experience in mental health developed in the city of São Paulo between 2013 and 2016. Named Projeto Rede Sampa - Saúde Mental Paulistana, it was aimed at workers from different professional categories and different points of the Psychosocial Care Network, having been elaborated and executed using strategies that ensured the participation of the different actors in the construction of learning contents, the approach to the singularity of territorial networks and the registration of the training path of the classes. Based on the social constructionist methodology, we sought to discuss the relevance of dialogical interactions for the strengthening of networking and the importance of alignment with psychosocial care as an ethical model of care.

Stable phenotype and function of immortalized Lin-Sca-1+ cardiac progenitor cells in long-term culture: a step closer to standardization.

Putative cardiac progenitor cells (CPCs) have been identified in the myocardium and are regarded as promising candidates for cardiac cell-based therapies. Although two distinct populations of CPCs reached the clinical setting, more detailed studies are required to portray the optimal cell type and therapeutic setting to drive robust cell engraftment and cardiomyogenesis after injury. Owing to the scarcity of the CPCs and the need for reproducibility, the generation of faithful cellular models would facilitate this scrutiny. Here, we evaluate whether immortalized Lin(-)Sca-1(+) CPCs (iCPC(Sca-1)) represent their native-cell counterpart, thereby constituting a robust in vitro model system for standardized investigation in the cardiac field. iCPC(Sca-1) were established in vitro as plastic adherent cells endowed with robust self-renewal capacity while preserving a stable phenotype in long-term culture. iCPC(Sca-1) differentiated into cardiomyocytic-, endothelial-, and smooth muscle-like cells when subjected to appropriate stimuli. The cell line consistently displayed features of Lin(-)Sca-1(+) CPCs in vitro, as well as in vivo after intramyocardial delivery in the onset of myocardial infarction (MI). Transplanted iCPC(Sca-1) significantly attenuated the functional and anatomical alterations caused by MI while promoting neovascularization. iCPC(Sca-1) are further shown to engraft, establish functional connections, and differentiate in loco into cardiomyocyte- and vasculature-like cells. These data validate iCPC(Sca-1) as an in vitro model system for Lin(-)Sca-1(+) progenitors and for systematic dissection of mechanisms underlying CPC subsets engraftment/differentiation in vivo. Moreover, iCPC(Sca-1) can be regarded as a ready-to-use CPCs source for pre-clinical bioengineering studies toward the development of novel strategies for restoration of the damaged myocardium.

Ventricular dyssynchrony and increased BNP levels in right ventricular apical pacing.

BACKGROUND: Long-term right ventricular apical pacing can cause ventricular dyssynchrony and, secondarily, neurohumoral alterations and increase in cardiac morbimortality. OBJECTIVE: To analyze ventricular dyssynchrony and its effects on BNP levels in patients with pacemakers and long-term right ventricular (RV) apex pacing. METHODS: Cross-sectional study of 85 patients with single or dual chamber pacemaker, NYHA functional class I or II and left ventricular ejection fraction (LVEF) ≥ 35%. The dyssynchrony assessment was carried out using several echocardiographic techniques, including Tissue Synchronization Imaging (TSI), with the analysis of the 12 segments. BNP was measured at the same time when the echocardiogram was performed, but the examiner was blinded to the results. RESULTS: Forty-six women and 39 men, aged 58 ± 12 years, with Chagas' disease (56%) and controlled hypertensive individuals (62%), were included in the study. LVEF was 52 ± 8% and the mean QRS duration was 139 ms (120-180 ms). BNP levels were altered in 36.5% of the sample (cutoff = 60 pg/ml). At the multivariate linear regression analysis, BNP was correlated with age (p = 0.024), LVEF (p < 0.0001) and left ventricular (LV) pre-ejection time (p = 0.009), which is an intraventricular dyssynchrony index. CONCLUSION: In clinically stable patients receiving conventional cardiac pacing, the intraventricular dyssynchrony was an independent predictor of BNP level increase after adjusted for age and LVEF.