Can dietary fiber improve the technological characteristics and sensory acceptance of low-fat Italian type salami?

To meet the needs of new consumers, meat researchers need to develop healthier products. Dietary fibers can be added for structural purposes, to present functional characteristics or to change the composition of the final product. In this study, mixture design was used to investigate the effects of partial substitution of pork fat by inulin, fructooligosaccharides and α-cyclodextrin on the technological and sensory quality characteristics of low-fat Italian type salami. The partial substitution of fat using dietary fibers shows no effect on weight loss, Aw and pH during ripening time. However, the addition of up to 2% α-cyclodextrin increased lightness and reduced redness and yellowness. Up to 2% of inulin or fructooligosaccharides added improved the sensory acceptance, texture parameters and redness. Healthier low-fat Italian type salami can be produced using inulin or fructooligosaccharides as fat substitute for pork fat and still obtain good technological and sensorial results.

Alpha-cyclodextrin as a new functional ingredient in low-fat chicken frankfurter.

1. The current consumer preference for healthier meat products is associated with less additives in manufacturing (so-called 'clean-label') or the addition of non-meat ingredients with functional properties, recognised as improving specific technological properties in meat products.2. This study evaluated the effect of the addition of alpha-cyclodextrin and wheat fibre to low-fat chicken frankfurters containing 35% mechanically deboned chicken meat on the technological and sensorial properties during refrigerated storage.3. The results showed that the addition of dietary fibres (alpha-cyclodextrin and wheat fibre) in low-fat chicken frankfurters improved emulsion stability, hardness, chewiness and reduced cohesiveness.4. Alpha-cyclodextrin helped the retention of fat globules in the microstructure and affected colour in the sensorial evaluation.5. The use of alpha-cyclodextrin, in combination with wheat fibre, as a new ingredient to substitute fat in emulsified meat products containing mechanically deboned chicken, improved emulsion stability and texture.6. Alpha-cyclodextrin and wheat fibre were effective in contributing to fat reduction without affecting the sensory properties of the product.

Effects of diet and exercise training on neurovascular control during mental stress in obese women.

Since neurovascular control is altered in obese subjects, we hypothesized that weight loss by diet (D) or diet plus exercise training (D + ET) would improve neurovascular control during mental stress in obese women. In a study with a dietary reduction of 600 kcal/day with or without exercise training for 4 months, 53 obese women were subdivided in D (N = 22, 33 +/- 1 years, BMI 34 +/- 1 kg/m2), D + ET (N = 22, 33 +/- 1 years, BMI 33 +/- 1 kg/m2), and nonadherent (NA, N = 9, 35 +/- 2 years, BMI 33 +/- 1 kg/m2) groups. Muscle sympathetic nerve activity (MSNA) was measured by microneurography and forearm blood flow by venous occlusion plethysmography. Mental stress was elicited by a 3-min Stroop color word test. Weight loss was similar between D and D + ET groups (87 +/- 2 vs 79 +/- 2 and 85 +/- 2 vs 76 +/- 2 kg, respectively, P < 0.05) with a significant reduction in MSNA during mental stress (58 +/- 2 vs 50 +/- 2, P = 0.0001, and 59 +/- 3 vs 50 +/- 2 bursts/100 beats, P = 0.0001, respectively), although the magnitude of the response was unchanged. Forearm vascular conductance during mental stress was significantly increased only in D + ET (2.74 +/- 0.22 vs 3.52 +/- 0.19 units, P = 0.02). Weight loss reduces MSNA during mental stress in obese women. The increase in forearm vascular conductance after weight loss provides convincing evidence for D + ET interventions as a nonpharmacologic therapy of human obesity.

Acute precipitants of congestive heart failure exacerbations.

BACKGROUND: Few studies have prospectively and systematically explored the factors that acutely precipitate exacerbation of congestive heart failure (CHF) in patients with left ventricular dysfunction. Knowledge of such factors is important in designing measures to prevent deterioration of clinical status. The objective of this study was to prospectively describe the precipitants associated with exacerbation of CHF status in patients enrolled in the Randomized Evaluation of Strategies for Left Ventricular Dysfunction Pilot Study. METHODS: We conducted a 2-stage, multicenter, randomized trial in 768 patients with CHF who had an ejection fraction of less than 40%. Patients were randomly assigned to receive enalapril maleate, candesartan cilexetil, or both for 17 weeks, followed by randomization to receive metoprolol succinate or placebo for 26 weeks. Investigators systematically documented information on clinical presentation, management, and factors associated with the exacerbation for any episode of acute CHF during follow-up. RESULTS: A total of 323 episodes of worsening of CHF occurred in 180 patients during 43 weeks of follow-up; 143 patients required hospitalization, and 5 died. Factors implicated in worsening of CHF status included noncompliance with salt restriction (22%); other noncardiac causes (20%), notably pulmonary infectious processes; study medications (15%); use of antiarrhythmic agents in the past 48 hours (15%); arrhythmias (13%); calcium channel blockers (13%); and inappropriate reductions in CHF therapy (10%). CONCLUSIONS: A variety of factors, many of which are avoidable, are associated with exacerbation of CHF. Attention to these factors and patient education are important in the prevention of CHF deterioration.

Left ventricular function after a single large dose of verapamil.

The effects of a single large dose of verapamil on left ventricular (LV) function were evaluated noninvasively in 18 chronically hypertensive patients. Each patient was given a single oral dose of verapamil, 240 mg, before and after which arterial blood pressure was measured and an echocardiogram and a phonomechanocardiogram were obtained. Reactional symmetrical myocardial hypertrophy was seen in all patients on the first echocardiogram. Results showed that heart rate was not significantly altered, but there were significant decreases (p less than 0.01) in systolic blood pressure (183.89 to 127.56 mm Hg) and diastolic blood pressure (101.11 to 77.67 mm Hg). The following parameters were also significantly decreased (p less than 0.01): LV ejection time (294.56 to 274.22 ms), LV diastolic diameter (45.78 to 43.99 mm), percentage change in LV diameter (33 to 27.83%), mean velocity of circumferential fiber shortening (1.12 to 1.02 cir/s), posterior wall contraction velocity (40.83 to 36.28 mm/s), LV end-diastolic volume (97.78 to 86.89 cm3), ejection fraction (0.70 to 0.62), stroke volume (70 to 55 cm3) and cardiac output (4.7 to 4 liters/m). Three parameters were significantly increased (p less than 0.01): preejection period (104.06 to 112.06 ms), preejection period: LV ejection time ratio (0.35 to 0.41) and end-systolic volume (29.28 to 32.33 cm3). It is concluded that a single oral dose of verapamil, 240 mg, is highly efficient in lowering arterial blood pressure in chronically hypertensive patients and in reducing the peripheral resistance and LV performance indexes.

Acute myocardial infarction with diffuse endarteritis, contraction bands, and distal thrombosis of the coronary arteries in a heart transplant patient.

The case history of a heart transplant patient who died of an acute myocardial infarction 6 months after the procedure is described. The finding of contraction bands and thrombosis associated with endarteritis suggests that coronary vasospasm may have contributed to the acute myocardial infarction during an episode of vascular rejection.

Further trials of nifurtimox in mucocutaneous leishmaniasis.

At a dosage level of 8 to 10 mg/kg body-weight daily for 120 days nifurtimox was associated with clinical healing of cutaneous leishmaniasis in five of eight patients. At a dosage level of 20 mg/kg body-weight daily for 10 days in six of 10 patients the skin ulcer healed. Results and the reasons why both schemes are impracticable are briefly discussed.

Atrial fibrillation in endomyocardial fibrosis is a marker of worse prognosis.

We studied the incidence of AF in patients with endomyocardial fibrosis (EMF) and its influence on prognosis and associated clinical events. One hundred and sixty consecutive patients with EMF were followed for a mean period of 4 years. Their mean age was 39.7 years. There were 114 women. During follow-up there were 56 deaths. Eighty-eight patients (55%) were submitted to surgical intervention. AF was observed in 58 cases (36.2%). The presence of AF was associated with a greater prevalence of dyspnea, peripheral edema, hepatomegaly, lower left ventricular ejection fraction, lower right ventricular systolic pressure (37.8 vs 45.6 mmHg, P=0.0392), and greater incidence of tricuspid regurgitation (86.0 vs 63.2%, P=0.004). AF was more frequent among patients in whom the disease involved the right ventricle, particularly those with intense fibrosis. Overall, patients with AF had a higher mortality rate than those who did not have AF (43.1 vs 30.3%, P=0.0195), but among those submitted to surgery, AF did not have an impact on survival. In conclusion, AF is frequent among patients with EMF. It is more prevalent among patients with right ventricular involvement and its presence is associated with a greater incidence of heart failure. AF is associated with worse prognosis, but surgery potentially reverses this bad evolution.

Muscle sympathetic nerve activity and hemodynamic alterations in middle-aged obese women.

To study the relationship between the sympathetic nerve activity and hemodynamic alterations in obesity, we simultaneously measured muscle sympathetic nerve activity (MSNA), blood pressure, and forearm blood flow (FBF) in obese and lean individuals. Fifteen normotensive obese women (BMI = 32.5 +/- 0.5 kg/m2) and 11 age-matched normotensive lean women (BMI = 22.7 +/- 1.0 kg/m2) were studied. MSNA was evaluated directly from the peroneal nerve by microneurography, FBF was measured by venous occlusion plethysmography, and blood pressure was measured noninvasively by an autonomic blood pressure cuff. MSNA was significantly increased in obese women when compared with lean control women. Forearm vascular resistance and blood pressure were significantly higher in obese women than in lean women. FBF was significantly lower in obese women. BMI was directly and significantly correlated with MSNA, blood pressure, and forearm vascular resistance levels, but inversely and significantly correlated with FBF levels. Obesity increases sympathetic nerve activity and muscle vascular resistance, and reduces muscle blood flow. These alterations, taken together, may explain the higher blood pressure levels in obese women when compared with lean age-matched women.

Effects of losartan combined with exercise training in spontaneously hypertensive rats.

We investigate whether combined treatment with losartan, an angiotensin II receptor blocker, and exercise training (ET) in spontaneously hypertensive rats (SHR) would have an additive effect in reducing hypertension and improving baroreflex sensitivity when compared with losartan alone. Male SHR (8 weeks old) were assigned to 3 groups: sedentary placebo (SP, N = 16), sedentary under losartan treatment (SL, N = 11; 10 mg kg-1 day-1, by gavage), and ET under losartan treatment (TL, N = 10). ET was performed on a treadmill 5 days/week for 60 min at 50% of peak VO2, for 18 weeks. Blood pressure (BP) was measured with a catheter inserted into the carotid artery, and cardiac output with a microprobe placed around the ascending aorta. The baroreflex control of heart rate was assessed by administering increasing doses of phenylephrine and sodium nitroprusside (iv). Losartan significantly reduced mean BP (178 16 vs 132 12 mmHg) and left ventricular hypertrophy (2.9 0.4 vs 2.5 0.2 mg/g), and significantly increased baroreflex bradycardia and tachycardia sensitivity (1.0 0.3 vs 1.7 0.5 and 2.0 0.7 vs 3.2 1.7 bpm/mmHg, respectively) in SL compared with SP. However, losartan combined with ET had no additional effect on BP, baroreflex sensitivity or left ventricular hypertrophy when compared with losartan alone. In conclusion, losartan attenuates hypertension and improves baroreflex sensitivity in SHR. However, ET has no synergistic effect on BP in established hypertension when combined with losartan, at least at the dosage used in this investigation.

Recovery of Leishmania (Viannia) braziliensis from inoculated hamsters.

Leishmania (Viannia) braziliensis has never been isolated from wild animals although it is apparently capable of inducing infections in man, dogs, and donkeys. An analysis of the standard hamster culture system for analyzing infectivity of Leishmania sp. was undertaken. Results indicate that for L. (V.) braziliensis, routine cultivation of aspirates taken from the inoculation sites of 1-mo-infected hamsters should be undertaken. Moreover, in at least 1 of the 3 strains examined, isolation of the parasite was only achieved after 84 days of cultivation.

Right ventricular endomyocardial biopsy in undetermined form of Chagas' disease.

Right ventricular endomyocardial biopsy was carried out in thirty three patients with undetermined form of Chagas' disease. Fragments obtained by this method were analysed under light microscopy with hematoxilin-eosin, and Masson trichromic stains. Thirteen (39.4%) patients showed normal myocardial fragments and twenty patients (60.6%) had them altered. Alterations included fiber degeneration, volume changes, interstitial edema, inflammatory infiltrates and fibrosis. These data permit to conclude that only part of patients with this form of Chagas' disease have an incipient myocardial attack and that the alterations found in the fragments obtained are mild. The remaining patients would be either individuals with chagasic infection without cardiac disease or have spontaneous healing. This should be considered in the future treatment of the disease.

The undetermined form of Chagas' heart disease: concept and forensic implications.

The undetermined form of Chagas' disease is diagnosed in asymptomatic subjects with a positive blood test for Chagas' disease, normal resting electrocardiogram, chest X-ray, barium esophageal and large bowel radiological studies. Other investigation methods are not recommended for identification of other organs damage lesions in this phase of the disease. When other methods of investigation were employed, cardiac and digestive abnormalities of small magnitude were detected without prognostic implications. These findings do not warrant frequent examinations of patients with undetermined form of the disease except for the electrocardiogram or if the patients report other clinical manifestations. The benign course of the disease does not preclude ability to work and the subjects should be considered apt for work in any profession.

Reversibility of ventricular dysfunction. Clinical experience in a medical office.

OBJECTIVE - To describe clinical observations of marked improvement in ventricular dysfunction in a medical office environment under circumstances differing from those in study protocols and multicenter studies performed in hospital or with outpatient cohorts. METHODS - Eleven cardiac failure patients with marked ventricular dysfunction receiving treatment at a doctors office between 1994 and 1999 were studied. Their ages ranged from 20 and 66 years (mean 39.42+/-14.05 years); 7 patients were men, 4 were women. Cardiopathic etiologies were arterial hypertension in 5 patients, peripartum cardiomyopathy in 2, nondefined myocarditis in 2, and alcoholic cardiomyopathy in 4. Initial echocardiograms revealed left ventricular dilatation (average diastolic diameter, 69.45+/-8.15mm), reduced left ventricular ejection fraction (0.38+/-0.08) and left atrial dilatation (43.36+/-5.16mm). The therapeutic approach followed consisted of patient orientation, elimination of etiological or causal factors of cardiac failure, and prescription of digitalis, diuretics, and angiotensinconverting enzyme inhibitors. RESULTS - Following treatment, left ventricular ejection fraction changed to 0.63+/-0.09; left ventricular diameters changed to 57.18+/-8.13mm, and left atrium diameters changed to 37.27+/-8.05mm. Maximum improvement was noted after 16.9+/-8.63 (6 to 36) months. CONCLUSION - Patients with serious cardiac failure and ventricular dysfunction caused by hypertension, alcoholism, or myocarditis can experience marked improvement in ventricular dysfunction after undergoing appropriate therapy within the venue of the doctor's office.

[Tachycardiomyopathy induced by atrial fibrillation]. / Taquicardiomiopatia induzida por fibrilação atrial.

A 56 year old woman with a previously normal heart developed severe left ventricular dilation and hypo-contractility after a few weeks of a refractory, high ventricular rate atrial fibrillation. Reduction of heart rate with verapamil resulted in a rapid normalization of myocardial contractility.

[The effects of aerobic physical training of short duration using upper limbs in paraplegic persons with mild hypertension]. / Efeito do treinamento físico de membros superiores aeróbio de curta duração no deficiente físico com hipertensão leve.

PURPOSE: To study the modifications induced by physical training (PT) using upper limbs in aerobic condition of short duration on cardiovascular and metabolic variables. METHODS: Eleven paraplegic persons, with a mean age of 59 years, 7 men and 4 women with lesions at T9 through T11 and mild hypertension (HAS) were studied. The patients were studied before and after 12 weeks of a supervised program of PT, through exercise tests in a mechanic ergometer (ST) adapted for the arms. We employed an intermittent protocol with stress increments of 125 (20w) and 140 kgm/min (25w) for women and men, respectively every 3 min. The ergometric speed ranged from 83 to 95 rpm. The oxygen consumption (VO2) was estimated according to American College of Sports Medicine equation for arms. The exercise intensity during the TF program was estimated through the Karvonen cardiac frequency reserve, with a variation of 65% to 85% and the Borg stress scale of subjective perception during the stress test. RESULTS: The mean maximal aerobic capacity increased in 22% (930 +/- 349 vs 1138 +/- 290 mL/min; p = 0.003); there was a reduction of systolic and diastolic pressures at rest and after submaximal exercise of 4%, 15% and 5% and 5%, respectively. CONCLUSION: Physical training of mild to moderate intensity using the upper limbs in paraplegic persons, besides inducing functional capacity increment, is an important model of non drug control of the hypertensive response.

[Diuretics improve functional capacity in patients with congestive heart failure]. / Diuréticos melhoram a capacidade funcional em pacientes com insuficiência cardíaca congestiva.

PURPOSE: The 6-9 minute walking test was used in this study to evaluate the impact of these drugs on functional capacity of patients admitted to the Hospital because of Heart Failure (CHF). METHODS: Ten patients (5 males and 5 females) with mean age of 47 years and NYHACHF functional class III or IV underwent a 6-9 minute walking test at admission and on the day of discharge from the Hospital. The following parameters were evaluated both at admission and discharge: body weight, echocardiography-derived LV dimensions and function, plasmatic levels of sodium, potassium, Bun, creatinine, hemoglobin and hematocrit. Treatment consisted of increasing outpatient dose of furosemide (IV and/or PO) plus the association of thiazide if necessary. The previous dose regimen of digitalis, ACE inhibitors or the association nitrate and hydralazine was kept unchanged. RESULTS: Time to compensation of CHF varied from 4 to 30 days (mean 8.7 +/- 7.8 days). LV end diastolic dimension varied from 47 to 81mm. LV EF spanned from 0.26 to 0.74. The 6min walking distance improved from 193.4 +/- 71.5m to 341.8 +/- 67.7m (p < 0.00002) and the 9min walking distance from 268.1 +/- 119.6m to 518.0 +/- 114.8m (p < 0.00005). Hemoglobin, hematocrit, BUN, creatinine and sodium levels were unchanged from admission to discharge, whereas plasma potassium level increased from 4.0 +/- 0.9mEq/l to 4.69 +/- 1.00mEq/l (p = 0.01), and body weight was reduced from 58.9 +/- 6.42kg to 52.9 +/- 5.3lkg (p < 0.0006). CONCLUSION: Compensating CHF with diuretics leads to a significant improvement in physical capacity. This benefit already evident in the in-hospital phase.

[Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm]. / Rotura do seio de Valsalva esquerdo com formação de pseudoaneurisma subepicárdico.

A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.

Chagas' heart disease: evolutive evaluation of electrocardiographic and echocardiographic parameters in patients with the indeterminate form.

OBJECTIVE: To identify and associate potential electrocardiographic and echocardiographic changes in patients with the indeterminate form of Chagas' disease during long-term follow-up. METHODS: One hundred sixty patients underwent standard electrocardiography and two-dimensional guided M-mode echocardiography for left ventricular ejection fraction determination. Patients were followed up for 98.6+/-30.4 months, undergoing repeat electrocardiographic studies at 6-month intervals and echocardiographic studies at 12-month intervals. RESULTS: Based on the electrocardiographic findings, the patients were divided into group I, 125 patients (78.6%) with normal electrocardiograms throughout follow-up, and group II, 34 patients (21.3%) who developed electrocardiographic changes. Group II was further divided into group IIA (9 patients, 5.6%) with permanent electrocardiographic changes, group IIB (14 patients, 8.8%) with transitory electrocardiographic changes, and group IIC (11 patients, 6.9%) with changes appearing only on the final electrocardiogram. Left ventricular ejection fractions remained normal in the entire population studied and did not differ among groups. CONCLUSION: The indeterminate form of Chagas' disease clearly represents a benign condition with a favorable long-term prognosis. Although some patients develop electrocardiographic changes, left ventricular systolic function is well preserved.

[Diet with usual quantity of salt in hospital treatment of congestive heart insufficiency]. / Dieta com quantidades habituais de sal no tratamento hospitalar da insuficiência cardíaca congestiva.

PURPOSE: To study the consequences of a diet with usual salt quantity (non salt-restricted) on hospital treatment of congestive heart failure (CHF), in behalf of a better food intake. METHODS: Thirty-two patients admitted to compensation of class III or IV CHF, randomly allowed to group I (2 g salt per day diet) or II (10 g salt). Hypertensive, renal failure or restrictive syndrome cases were excluded. Oral medication and water intake were standardized; furosemide dosage was adjusted on a daly basis, allowing the study of this drug's requirements in each group. Compensation of CHF was defined as a return to classes I or II without edema. RESULTS: Group I included 14 and group II 18 patients. There was no significant difference between groups respective to the time needed for compensation of CHF (7.5 x 6.6 days, mean) percentual weight loss (12.2 x 10.0%), cumulative furosemide dosage (568 x 599 mg), mean daily furosemide dosage per kilogram of lean weight (1.43 x 1.58 mg/kg/day), and to 24-hour urinary excretion of sodium (241 x 254 mEq) and potassium (38.8 x 53.9 mEq). Small elevations of blood urea and potassium were an uniform trend. There was no significant alteration of plasmatic sodium. Food intake was adequate. There was one death for each group, from causes not directly related to CHF. CONCLUSION: Dietary salt intake did not adversely influence in-hospital compensation of severe CHF in studied group. In selected cases, adoption of a more liberal diet in this aspect may allow the patient a better ingestion of food.