Hazardous Elements in the Edible Portion of Perna perna Mussels: Relation with the COVID-19 Pandemic Period and Assessment of the Risk to Human Health.

In this work, the concentrations of hazardous elements (As, Cd and Pb) in the edible portion of the Perna perna mussel from Southeast Brazil were analyzed to understand the effects of the COVID-19 pandemic on the coastal environment and to evaluate the quality of this fishery resource. Decreases in anthropogenic chemical outputs to the environment were expected to occur during the COVID-19 pandemic, with decreases in element concentrations in mussels. The ranges of median concentrations (µg g-1 dw) in the pre- and pandemic periods were 5.4-16.1 and 2.2-10.6 for As; 0.2-0.6 and 0.1-0.5 for Cd; and 1.2-3.2 and 0.7-1.8 for Pb, respectively. Temporal variations (prepandemic x pandemic) were more significant than spatial variations (five sampling sites). The relationships between the concentrations of hazardous elements and isotopic ratios (δ15N and δ13C) suggested that food sources were more diverse across the sampling sites during the pandemic period, when individuals exhibited less efficient trophic transfer. The concentrations of Cd and Pb were below the tolerable maximum limit, whereas for As, they were above the limit; however, these concentrations are not a risk to human health, as most As was present in the least toxic organic form. The intake estimates were below the tolerable intake limits, and only Pb concentrations are at risk of causing concern if the intake of mussels increases. This is the first study in Brazil that presents a spatial-temporal comparison of hazardous elements in marine fauna considering COVID-19 as a temporal landmark. The results are of interest for both public health and environmental health management in a post-COVID-19 scenario.

Effect of the hydroxamate group in the antitumoral activity and toxicity toward normal cells of new copper(II) complexes.

The synthesis, physico-chemical characterization and cytotoxicity of four copper(II) coordination complexes, i.e. [Cu(HBPA)Cl2] (1), [Cu(BHA)2] (2), [Cu(HBPA)(BHA)Cl] CH3OH (3) and [Cu(HBPA)2]Cl2·4H2O (4), are reported. HBPA is the tridentate ligand N-(2-hydroxybenzyl)-N-(2-pyridylmethyl)amine and HBHA is the benzohydroxamic acid. The reaction between the HBHA and CuCl2.2H2O has resulted in the new complex (2) and the reaction between complex (1) and HBHA has resulted in the new complex (3). X-ray diffraction studies for complex (3) indicated the effective coordination of HBHA as BHA-. Their cytotoxicity was evaluated against three human tumoral cell lines (Colo-205, NCI-H460 and U937) and PBMC (peripheral blood mononuclear cells), using the MTT cytotoxic assay. The results toward PBMC reveal that the new copper(II) complex (2) presents lower toxicity toward normal cells. Furthermore, complex (2) presents IC50 values lower than cisplatin toward NCI-H460 and the best selectivity index obtained towards NCI-H460 (SI = 2.2) and U937 cell lines (SI = 2.0), as a result of the presence of two molecules of HBHA in its structure. Complex (3) presents IC50 values lower than cisplatin toward NCI-H460, Colo-205 and comparable to cisplatin toward U937. The evaluation of the cell death type promoted by complexes (2) and (4) was investigated toward NCI-H460 revealing better results than the standard drug cisplatin, according to the Annexin V and propidium iodide (PI) labeling experiment. Based on the studies here performed, HBHA seems to be related to lower toxicity toward PBMC and HBPA is improving directly the cytotoxity.

Mn2+ concentrations in coastal fish otoliths: understanding environmental and biological influences from EPR.

The Mn2+ concentrations in the sagittae otoliths of 12 fish families (and 19 species) that co-occur in a coastal area of southeastern Brazil (~21°S) were quantified using electron paramagnetic resonance (EPR). Inferences were made about the relationship between fish habitat and trace element incorporation. Inferences were made on the relationship between trace element concentration and otolith shape. The differences in Mn2+ concentrations among the species suggest that habitat (and feeding habits) might drive the incorporation of this trace element into fish otoliths, with higher values in bottom-associated fish species than in surface-associated species. In surface-associated fish species, the correlation between trace element concentrations and otolith shape was stronger than in bottom-associated species. Thus, while the Mn bioavailability in a fish's habitat, especially from feeding resources, is a local driving influence of trace element incorporation in sagittae otoliths, species-specific requirements also have an influence. Quantitative EPR is a non-destructive technique that is very useful when the available samples cannot be damaged, like with otolith collections.

A robust finite-time model reference adaptive controller for arbitrary order disturbed LTI systems.

This manuscript deals with the trajectory-tracking problem for linear time-invariant systems with parameter uncertainties and time-dependent external perturbations. A robust finite-time model reference adaptive controller is proposed. In the absence of external perturbations, the proposed controller ensures finite-time convergence to zero of the tracking and parameter identification errors. In presence of time-dependent external perturbations, the tracking and parameter identification errors converge to a region around the origin in a finite time. The convergence proofs are developed based on Lyapunov and input-to-state stability theory. Finally, simulation results in an academic example and a flexible-joint robot manipulator show the feasibility of the proposed approach.

Chemical elements in mussels: Insights into changes in coastal environments due to the COVID-19 pandemic.

The concentrations of macro elements (Ca, K, Mg, and Na), essential trace elements (Cr, Cu, Fe, Li, Mn, Ni, and Zn), and nonessential trace elements (Al, As, Cd, Pb, and Ti) in the shell and soft tissues of Perna perna (L. 1758) mussels from Southeast Brazil are presented as a baseline reference for understanding the effects of the COVID-19 pandemic on the quality of coastal environments. For shells, the macro elements load was greater during the pandemic period at all sampling sites; however, for soft tissues, the opposite trend was recorded. On the contrary, the concentrations of trace elements in the shell were below the limit of quantification in most samples, and they tended to decrease in the soft tissues during the pandemic. Thus, the COVID-19 was a short-term conservation event that positively impacted the mussels. The results are relevant for monitoring the coastal environment in a post-COVID-19 scenario.

The use of pencil ionization chamber with temporal readout capabilities to measure CT beam full width half maximum.

BACKGROUND: Measurement of Computed Tomography (CT) beam width is required by accrediting and regulating bodies for routine physics evaluations due to its direct correlation to patient dose. Current methods for performing CT beam width measurement require special hardware, software, and/or consumable films. Today, most 100-mm pencil chambers with a digital interface used to evaluate Computed Tomography Dose Index (CTDIvol) have a sufficiently high sampling rate to reconstruct a high-resolution dose profile for any acquisition mode. PURPOSE: The goal of this study is to measure the CT beam width from the sampled dose profile under a single helical acquisition with the 100-mm pencil chamber used for CTDIvol measurements. METHODS: The dose profiles for different scanners were measured for helical scans with varying collimation settings using a 100-mm pencil chamber placed at the isocenter and co-moving with the patient table. The measured dose profiles from the 100-mm pencil chamber were corrected for table attenuation by extracting a periodic correction function (PCF) to eliminate table interference. The corrected dose profiles were then deconvolved with the response function of the chamber to compute the beam profile. The beam width was defined by the full width half maximum (FWHM) of the resulting beam profile. Reference dose profiles were also measured using Gafchromic film for comparison. RESULTS: The beam widths, estimated using the innovative deconvolution method from the 100-mm pencil chamber, exhibit an average percentage difference of 1.6 ± 1.8 when compared with measurements obtained through Gafchromic film for beam width assessment. CONCLUSION: The proposed approach to deconvolve the pencil chamber response demonstrates the potential of obtaining the CT beam width at high accuracy without the need of special hardware, software, or consumable films. This technique can improve workflow for routine performance evaluation of CT systems.

Elemental Concentrations in the Shells of the Mussel Perna perna: Discrimination of Origin.

The potential use of elemental concentrations and element:calcium (Ca) ratios as indicators of provenance for bivalve mollusks on the Brazilian coast is evaluated herein for the first time. The approach was applied to shells of the mussel Perna perna (target of extractive fisheries) from geographically close areas but under distinct environmental and anthropogenic influences. Both concentrations of the elements normalized by Ca and the total concentrations can be applied to discriminate the mussels' origin. However, the canonical approach using the total concentrations indicated variations regarding the discriminatory power, and the concentrations of the elements normalized by Ca were more robust in differentiating the provenance of the shells. The origin of mussels was better discriminated by six elementary ratios: Al:Ca, Fe:Ca, K:Ca, Mg:Ca, Mn:Ca and Na:Ca. Thus, monitoring studies aiming to discriminate the origin of P. perna individuals along their distribution based on these elementary ratios of the shell are recommended.

Different methods for assessing glomerular filtration rate in the elderly.

OBJECTIVE: The objective of this study was to identify the best method to replace cystatin C in the evaluation of glomerular filtration in the elderly. METHODS: Individuals over 60 years of age from a primary care center were studied. Blood was collected to determine creatinine and cystatin C and 24-h urine. Three methods were compared to determine glomerular filtration: Creatinine clearance, Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine, considering as a reference the determination of glomerular filtration using the cystatin-based Chronic Kidney Disease Epidemiology Collaboration equation. The statistical methods used were linear regression, Bland-Altman curve, and receiver operating characteristic. RESULTS: A total of 180 elderly people were evaluated, but 14 patients were lost from the sample, resulting in a total of 166 patients. The average age of patients was 66.9±6.1 years, and 69.8% were females. Regarding the number of patients eligible for the study, there were 12 black, 108 brown, and 46 white, 42.77% hypertensive, and 38.3% diabetic. Glomerular filtration was less than 60 mL/min in 22.28% of patients. Regarding the evaluation of the different equations, the correlation coefficient was lower for creatinine clearance and progressively higher for Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine. The Bland-Altman diagram and the receiver operating characteristic curve showed similar performance to the correlation coefficient for the different equations evaluated. CONCLUSION: Collaboration Epidemiology of Chronic Kidney Disease based on creatinine presented the best performance. Creatinine debug had the worst performance, which reinforces the idea that 24-h urine collection is unnecessary in these patients.

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters.

INTRODUCTION: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). OBJECTIVES: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. METHODOLOGY: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. RESULTS: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. CONCLUSION: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics.

The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan-Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.

Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?

BACKGROUND: The pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of this study was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and to verify whether these factors might explain the highest mortality among them. METHODS: We conducted a retrospective study of hemodialysis patients who started treatment from August 2001 to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to the results of echocardiography examination, patients were allocated in two groups: those with PH and those without PH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were compared between the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed and hazard risk to death was evaluated by Cox regression analysis. RESULTS: PH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular water was associated with PH (relative risk = 1.194; 95% CI of 1.006 - 1.416; p = 0.042); nevertheless, in a multiple model, only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 - 1.359; p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 - 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age; 95% CI of 1.000 - 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis. However, when albumin was taken in account the only statistically significant association was between albumin level and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 - 0.984; p = 0.047) while the presence of PH lost its statistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had a statistically worse survival after the sixth year of follow up. CONCLUSIONS: PH in hemodialysis patients is associated with parameters of volume overload that sheds light on its pathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain this association.

Reduction of proteinuria in patients with diabetes kidney disease and dysautonomia through measures aimed at controlling supine hypertension.

In diabetes kidney disease (DKD), orthostatic hypotension and supine hypertension often coexist, which, when uncontrolled, contributes to the progression of proteinuria and renal dysfunction. Chronotherapy and elevation of the head of the bed during sleep are feasible clinical measures and could contribute to the control of supine hypertension and proteinuria in this group of patients. This study consists of a series of cases, in which nine consecutive patients with DKD, dysautonomia and supine hypertension (intervention group) were instructed to use chronotherapy and inclination of the head of the bed in six degrees during sleep. These patients were compared with a historical control group. The primary outcome was proteinuria behavior. The intervention group had a significant drop in proteinuria levels, while there was an increase in proteinuria in the control group (variation in the proteinuria/creatininuria index in an isolated sample from the intervention group: -6.60 ± 3.90 g/g; variation in the group control: +1.70 ± 7.10 g/g, p = 0.008). Chronotherapy and six-degree inclination of the head of the bed during sleep were associated with a significant decrease in proteinuria in patients in the intervention group, with conversion of nephrotic into non-nephrotic proteinuria in most of these patients.

Towards the Integration of an Islet-Based Biosensor in Closed-Loop Therapies for Patients With Type 1 Diabetes.

In diabetes mellitus (DM) treatment, Continuous Glucose Monitoring (CGM) linked with insulin delivery becomes the main strategy to improve therapeutic outcomes and quality of patients' lives. However, Blood Glucose (BG) regulation with CGM is still hampered by limitations of algorithms and glucose sensors. Regarding sensor technology, current electrochemical glucose sensors do not capture the full spectrum of other physiological signals, i.e., lipids, amino acids or hormones, relaying the general body status. Regarding algorithms, variability between and within patients remains the main challenge for optimal BG regulation in closed-loop therapies. This work highlights the simulation benefits to test new sensing and control paradigms which address the previous shortcomings for Type 1 Diabetes (T1D) closed-loop therapies. The UVA/Padova T1DM Simulator is the core element here, which is a computer model of the human metabolic system based on glucose-insulin dynamics in T1D patients. That simulator is approved by the US Food and Drug Administration (FDA) as an alternative for pre-clinical testing of new devices and closed-loop algorithms. To overcome the limitation of standard glucose sensors, the concept of an islet-based biosensor, which could integrate multiple physiological signals through electrical activity measurement, is assessed here in a closed-loop insulin therapy. This investigation has been addressed by an interdisciplinary consortium, from endocrinology to biology, electrophysiology, bio-electronics and control theory. In parallel to the development of an islet-based closed-loop, it also investigates the benefits of robust control theory against the natural variability within a patient population. Using 4 meal scenarios, numerous simulation campaigns were conducted. The analysis of their results then introduces a discussion on the potential benefits of an Artificial Pancreas (AP) system associating the islet-based biosensor with robust algorithms.

Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial.

AIMS: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of JNC 7 Stage I hypertension in patients with type 2 diabetes mellitus. METHODS: In an a priori subgroup analysis of a randomized, double-blind, controlled trial, volunteers aged 30-70 years, with stage I hypertension and diabetes mellitus, were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 47) or 50 mg of losartan (N = 50), and followed for 18 months in 21 clinical centers. If BP remained uncontrolled after three months, study medication dose was doubled, and if uncontrolled after six months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg BID) were added as open label drugs in a progressive fashion. RESULTS: Systolic BP decreased to a greater extent in participants allocated to diuretics compared to losartan (P < 0.001). After 18 months of follow-up, systolic BP was 128.4 ± 10.3 mmHg in the diuretic group versus 133.5 ± 8.0 in the losartan group (P < 0.01). In the diuretic group, 36 out of 43 participants (83.7%) had a JNC 7 normal BP, compared to 31/47 (66%) in the losartan group (P = 0.089). Serum cholesterol was higher in the diuretic arm at the end of the trial. Other biochemical parameters and reports of adverse events did not differ by treatment. CONCLUSIONS: Treatment of hypertension based on a combination of chlorthalidone and amiloride is more effective for BP lowering compared to losartan in patients with diabetes mellitus and hypertension. TRIAL REGISTRATION: Clinical trials registration number: NCT00971165.

Association between statin use and mortality risks during the acute phase of ischemic stroke in patients admitted to an intensive care unit.

Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. OBJECTIVE: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. METHODS: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. RESULTS: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. CONCLUSION: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.

Cardiovascular risk factors: differences between ethnic groups.

OBJECTIVES: to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus. METHODS: a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables. RESULTS: indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro). CONCLUSIONS: the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.

[Predictors of chronic renal failure in patients in a hypertension center]. / Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial.

PURPOSE: To verify which clinical variables can predict the evolution to chronic renal insufficiency in routinely evaluated hypertensives. METHODS: 358 patients from the Hypertension Center of the Botucatu School of Medicine (São Paulo State University) were evaluated. Sequential evaluation of glomerular filtration rate was detected in 210 patients, who were analyzed. Logistic regression was applied to identify clinical variables independently associated with the development of chronic renal insufficiency with a final glomerular filtration rate equal to or below 60 ml/min. RESULTS: In routine urinalysis only proteinuria was independently associated with the outcome. Among 175 patients with initial glomerular filtration rate above 60 ml/min, proteinuria, female gender and age of 50 years or more were predictors of the evolution to a final glomerular filtration rate equal to or below 60 ml/min. CONCLUSION: The presence of proteinuria in simple urinalysis was a risk factor and a reliable predictor associated with the development of chronic renal insufficiency among hypertensives.