Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial.

INTRODUCTION: Chagas disease is one of the most relevant endemic parasitic diseases in Latin America, affecting approximately 6 million people. Overt Chagas heart disease is an ominous condition, occurring in 20-30% of infected individuals, which has besides the persistent myocarditis a peculiar intracardiac ganglionic neuronal depletion and dysautonomy. This study aims to evaluate the safety and feasibility of renal denervation for patients with advanced symptomatic Chagas cardiomyopathy. METHODS: Open-label prospective pilot study that randomized patients with Chagas heart disease to either renal denervation or conservative treatment (2:1 ratio). The primary endpoint was the incidence of major adverse events at 9 months, defined as a composite of all-cause death, myocardial infarction, stroke, need for renal artery invasive treatment, or worsening renal function. RESULTS: A total of 17 patients were allocated for renal denervation (n = 11) or conservative treatment (n = 6). Included patients had severe symptomatic heart disease, with markedly depressed left ventricular function (average ejection fraction 26.7 ± 4.9%). For patients randomized to renal denervation, the procedure was performed successfully and uneventfully. After 9 months, the primary endpoint occurred in 36.4% of patients in the renal denervation group and 50.0% in the control arm (p = .6). After 9 months, clinical, laboratory, functional, echocardiographic, and quality of life parameters were similar between groups. CONCLUSIONS: This pilot study suggests that renal denervation is safe and feasible in patients with Chagas cardiomyopathy, warranting future studies to better evaluate the clinical efficacy of the interventional strategy in improving the prognosis of this high-risk population.

Intake and ingestive behavior in lambs fed low-digestibility forages.

Ingestive behavior of lambs fed diets consisting of fresh sugarcane with urea, bagasse treated with calcium oxide, and urea ammoniated sugarcane bagasse supplemented with concentrate mixture in 50:50 ratio were evaluated. For this, 34 wethers Santa Inês in their growing phase, with an average age of 3.0 ± 0.6 months and a mean initial live weight of 17.8± 5.2 kg were used. The animals were distributed in a completely randomized design and subjected to visual observation periods of 5 days, for 24 h a day, during the experimental period. Dry matter (DM) intake and intake efficiency of DM were higher (P < 0.05) for animals receiving fresh sugarcane with urea. The animals which were fed with bagasse treated with calcium oxide had higher (P < 0.05) consumption of neutral detergent fiber, longer feeding and chewing time (P < 0.05), and shorter (P < 0.05) idling time. The time spent on chewing the ruminal bolus did not differ from one diet to the other (P > 0.05). Grams of dry matter per ruminated bolus were similar among animals fed with fresh sugarcane and ammoniated bagasse (P > 0.05) but lower (P < 0.05) in animals fed with bagasse treated with calcium oxide. Rumination efficiency values, in grams of dry matter per hour, and grams of neutral detergent fiber per hour for all three diets were similar (P > 0.05) to those found for feeding efficiency. The number of feeding and rumination periods was not affected (P > 0.05) by diet. Based on the intake and ingestive behavior responses, the fresh sugarcane with urea compared to bagasse treated with calcium oxide and ammoniated bagasse was found to be the better alternative feed for use in lamb diets.

Myasthenia Gravis and COVID-19: Clinical Characteristics and Outcomes.

Myasthenia gravis (MG), an autoimmune neuromuscular disorder, may be a risk factor for severe COVID-19. We conducted an observational retrospective study with 15 consecutive adult MG patients admitted with COVID-19 at four hospitals in São Paulo, Brazil. Most patients with MG hospitalized for COVID-19 had severe courses of the disease: 87% were admitted in the intensive care unit, 73% needed mechanical ventilation, and 30% died. Immunoglobulin use and the plasma exchange procedure were safe. Immunosuppressive therapy seems to be associated with better outcomes, as it might play a protective role.