Distribution and preference for oviposition sites of Aedes albopictus (Skuse) in the metropolitan area of Belém, in the Brazilian Amazon.

The mosquito Aedes albopictus is a vector of several arboviruses transmitted to humans. They have a sylvatic behavior, occurring in rural areas. However, reports of their adaptation to anthropic environments have been increasing. The aim of this study is to investigate the presence and distribution of Ae. albopictus in the Metropolitan Region of Belém in the Brazilian Amazon and evaluate its preference for either natural or artificial breeding sites under the weather conditions of the Amazon. Ovitraps (artificial breeding sites) and bamboo internodes (natural breeding sites) were deployed in neighborhood peridomiciles during the dry and rainy seasons. The results showed that the presence of Ae. albopictus was recorded in 71.4% of the neighborhoods during the dry season and in 69.2% neighborhoods during the rainy season, thus indicating a wide distribution in the region. A significant increase in the frequency of the capture of mosquitoes in areas with higher vegetation cover was observed during the dry season (R2 = 0.2995; p=0.018) but not during the rainy season (R2 = 0.044; p=0.43). Comparing the weekly frequency of Ae. albopictus on positive bamboos and OVT, no significant difference was observed between them (t= 0.559; df= 23; p=0.58). A significant increase in the number of positive breeding sites was observed with increased rainfall for both bamboo (R2 = 0.33; p= 0.002) and OVT (R2 = 0.24; p= 0.013). This is the first report of Ae. albopictus in the metropolitan area of Belém. The findings suggest a wide distribution in the studied area, preferably in areas with more extensive vegetation cover. Additionally, the mosquito population showed the ability to use both natural and artificial habitats.

Artificial Bloodfeeder Glytube: Evaluating Different Types of Membranes and Blood Sources for Feeding Aedes aegypti and Aedes albopictus.

Mosquito colony maintenance in the laboratory is essential for research but presents logistical and ethical problems with the use of live animals for bloodfeeding. The Glytube is an artificial bloodfeeding system for mosquitoes that uses Parafilm-M® membrane and human blood to feed Aedes aegypti. This study evaluated the efficiency of Glytube with different types of membranes and chicken blood to feed Ae. aegypti and Ae. albopictus. We evaluated 2 artificial (thread seal tape [TST], Parafilm-M) and 2 natural membranes (pork, sheep intestine). The results for Ae. aegypti suggest that TST was the best membrane because it presented a high percentage of fed females (63%), a high average number of eggs per female (54.65), and an egg viability rate significantly similar to control (mouse). For Ae. albopictus, there was no significant difference between the membranes and the control; however, the use of TST is suggested due to the low cost and easy manipulation. The treatments that used chicken blood did not present significant differences in the egg viability when compared with the control. The Glytube functionality can be increased by replacing the Parafilm-M membrane by TST and human to chicken blood.

Evaluating the Adaptation Process of Sandfly Fauna to Anthropized Environments in a Leishmaniasis Transmission Area in the Brazilian Amazon.

Phlebotomines (Diptera: Psychodidae) are vectors of several etiological agents of human and animal diseases, including protozoans of the gender Leishmania. Precarious socioeconomic conditions and uncontrolled population growth directly influence the transmission risk of parasites and the urbanization of vector species, previously restricted to wild environments. The Marajó Archipelago is considered a high incidence area of leishmaniasis in the Brazilian Amazon. However, it is poorly studied. The aim of this study was to assess the adaptation processes of phlebotomine species to anthropized environments in this region. For this purpose, the phlebotomine fauna was compared between three municipalities of the Marajó Archipelago: Anajás, Portel, and São Sebastião da Boa Vista. To survey the phlebotomine fauna, CDC (Center for Disease Control) light traps were installed in the wild areas and in the intra and peridomiciliary areas of rural and urban environments. The environments studied presented a diversified phlebotomine fauna, with higher richness in the wild environment (15 species), followed by the rural (seven species), and finally, the urban environment (three species). A migration of wild fauna to the adjacent anthropized areas (rural environment) and to urban areas was observed, evidencing the adaptation process of this vector to anthropized environments in the studied region. Thus, our study evidenced that the disorganized human occupation and utilization of the landscape might cause the invasion of urban areas by wild populations of phlebotomines, in this way enabling the settlement of urban leishmaniasis transmission cycles.

Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.

INTRODUCTION AND AIM: The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. METHODS: We studied 276 consecutive patients (mean age 62 ± 14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤ 3. RESULTS: The median ZRS was 3 (interquartile range [IQR] 1-4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 [IQR 4-7] vs. 7.0 [5-13] days, p<0.001), and lower 30-day mortality (0 vs. 12.4%, p<0.001), yielding a negative predictive value of 100% (95% CI 97.0-100%) for the proposed cutoff. The ZRS showed excellent discriminative power (C-statistic: 0.937, 95% CI 0.906-0.968, p<0.001), and good calibration against the original cohort. CONCLUSIONS: The ZRS appears to perform well in identifying low-risk STEMI patients who could be safely discharged within 72 hours of admission. Using the ZRS in our population could result in a more rational use of in-patient resources.

Intervenção coronária percutânea utilizando Full Metal Jacket com stents farmacológicos: eventos cardíacos adversos maiores em um ano / Percutaneous coronary intervention using a full metal jacket with drug-eluting stents: major adverse cardiac events at one year

FUNDAMENTO: O benefício clínico de intervenção coronária percutânea (ICP) para lesões coronárias longas é incerto; além disso, foram levantadas dúvidas questões sobre a sua segurança. OBJETIVO: Avaliar os preditores de eventos cardíacos adversos maiores (ECAM) associados à ICP utilizando Full Metal Jacket (FMJ), definido como a sobreposição de stents farmacológicos (SF) medindo >60 mm de comprimento, para lesões muito longas. MÉTODOS: Foram incluídos 136 pacientes consecutivos com lesões coronárias longas, requerendo FMJ em nosso cadastro de centro único. O desfecho primário incluiu a ocorrência combinada de todas as causas de morte, infarto do miocárdio (IM) e revascularização do vaso alvo (RVA). Variáveis demográficas, clínicas, angiográficas e de procedimento foram avaliadas por meio de análise de regressão de Cox para determinar os preditores independentes de desfecho. RESULTADOS: O comprimento médio do stent por lesão foi de 73,2 ± 12,3 mm e o diâmetro médio do vaso de referência foi de 2,9 ± 0,6 mm. O sucesso angiográfico foi de 96,3%. A ausência de ECAM foi de 94,9% em 30 dias e 85,3% em um ano. No acompanhamento de um ano, a taxa de mortalidade por todas as causas foi de 3,7% (1,5% por mortes cardíacas), a taxa de IM foi de 3,7%, e a incidência de trombose de stent (TS) definitiva ou provável foi de 2,9%. O gênero feminino [risco relativo (RR), 4,40; intervalo de confiança de 95% (IC), 1,81-10,66, p = 0,001) e ICP de artéria coronária não direita (RR, 3,49; p = 0,006; IC 95%, 1,42-8,59) foram preditores independentes de ECAM em um ano. A ausência de eventos adversos em um ano foi maior em pacientes com angina estável submetidos à ICP (RR, 0,33; IC 95% 0,13-0,80, p = 0,014). CONCLUSÕES: A ICP utilizando FMJ com SF para lesões muito longas foi eficaz, mas associada a uma alta taxa de TS em acompanhamento de um ano. No entanto, a taxa de mortalidade cardíaca, IM não relacionado a procedimento, e ECAM foi relativamente baixa. ICP de vaso coronário alvo, apresentação clínica, e gênero feminino são novos fatores clínicos contemporâneos que parecem apresentar efeitos adversos sobre o resultado da ICP utilizando FMJ para lesões longas.

BACKGROUND: The clinical benefit of percutaneous coronary intervention (PCI) for long coronary lesions is unclear; furthermore, concerns have been raised about its safety. OBJECTIVES: To evaluate the predictors of major adverse cardiac events (MACE) associated with PCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents (DES) measuring >60 mm in length, for very long lesions. METHODS: We enrolled 136 consecutive patients with long coronary lesions requiring FMJ in our single-center registry. The primary endpoint included the combined occurrence of all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Demographic, clinical, angiographic, and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of outcome. RESULTS: The mean length of stent per lesion was 73.2 ± 12.3 mm and the mean reference vessel diameter was 2.9 ± 0.6 mm. Angiographic success was 96.3%. Freedom from MACE was 94.9% at 30 days and 85.3% at one year. At the one-year follow-up, the all-cause mortality rate was 3.7% (1.5% cardiac deaths), the MI rate was 3.7%, and the incidence of definite or probable stent thrombosis (ST) was 2.9%. Female gender [hazard ratio (HR), 4.40; 95% confidence interval (CI), 1.81-10.66; p = 0.001) and non-right coronary artery PCI (HR, 3.49; 95%CI, 1.42-8.59; p = 0,006) were independent predictors of MACE at one year. Freedom from adverse events at one year was higher in patients with stable angina who underwent PCI (HR, 0.33; 95%CI, 0.13-0.80; p = 0.014). CONCLUSIONS: PCI using FMJ with DES for very long lesions was efficacious but associated with a high rate of ST at the one-year follow-up. However, the rate of cardiac mortality, nonprocedure-related MI, and MACE was relatively low. Target coronary vessel PCI, clinical presentation, and female gender are new contemporary clinical factors that appear to have adverse effects on the outcome of PCI using FMJ for long lesions.

Percutaneous coronary intervention using a full metal jacket with drug-eluting stents: major adverse cardiac events at one year.

BACKGROUND: The clinical benefit of percutaneous coronary intervention (PCI) for long coronary lesions is unclear; furthermore, concerns have been raised about its safety. OBJECTIVES: To evaluate the predictors of major adverse cardiac events (MACE) associated with PCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents (DES) measuring >60 mm in length, for very long lesions. METHODS: We enrolled 136 consecutive patients with long coronary lesions requiring FMJ in our single-center registry. The primary endpoint included the combined occurrence of all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Demographic, clinical, angiographic, and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of outcome. RESULTS: The mean length of stent per lesion was 73.2 ± 12.3 mm and the mean reference vessel diameter was 2.9 ± 0.6 mm. Angiographic success was 96.3%. Freedom from MACE was 94.9% at 30 days and 85.3% at one year. At the one-year follow-up, the all-cause mortality rate was 3.7% (1.5% cardiac deaths), the MI rate was 3.7%, and the incidence of definite or probable stent thrombosis (ST) was 2.9%. Female gender [hazard ratio (HR), 4.40; 95% confidence interval (CI), 1.81-10.66; p = 0.001) and non-right coronary artery PCI (HR, 3.49; 95%CI, 1.42-8.59; p = 0,006) were independent predictors of MACE at one year. Freedom from adverse events at one year was higher in patients with stable angina who underwent PCI (HR, 0.33; 95%CI, 0.13-0.80; p = 0.014). CONCLUSIONS: PCI using FMJ with DES for very long lesions was efficacious but associated with a high rate of ST at the one-year follow-up. However, the rate of cardiac mortality, nonprocedure-related MI, and MACE was relatively low. Target coronary vessel PCI, clinical presentation, and female gender are new contemporary clinical factors that appear to have adverse effects on the outcome of PCI using FMJ for long lesions.

[NT-proBNP for risk stratification of pulmonary embolism]. / NT-proBNP na estratificação de risco no tromboembolismo pulmonar.

INTRODUCTION: Pulmonary embolism (PE) is an entity with high mortality and morbidity, in which risk stratification for adverse events is essential. N-terminal brain natriuretic peptide (NT-proBNP), a right ventricular dysfunction marker, may be useful in assessing the short-term prognosis of patients with PE. AIMS: To characterize a sample of patients hospitalized with PE according to NT-proBNP level at hospital admission and to assess the impact of this biomarker on short-term evolution. METHODS: We performed a retrospective analysis of consecutive patients admitted with PE over a period of 3.5 years. Based on the median NT-proBNP at hospital admission, patients were divided into two groups (Group 1: NT-proBNP