Improved all-cause mortality with left bundle branch area pacing compared to biventricular pacing in cardiac resynchronization therapy: a meta-analysis.

BACKGROUND: Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative pacing strategy to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). We aimed to assess the impact of LBBAP vs. BIVP on all-cause mortality and heart failure (HF)-related hospitalization in patients undergoing CRT. METHODS: Studies comparing LBBAP and BIVP for CRT in patients with HF with reduced left ventricular ejection fraction (LVEF) were included. The coprimary outcomes were all-cause mortality and HF-related hospitalization. Secondary outcomes included procedural and fluoroscopy time, change in QRS duration, and change in LVEF. RESULTS: Thirteen studies (12 observational and 1 RCT, n = 3239; LBBAP = 1338 and BIVP = 1901) with a mean follow-up duration of 25.8 months were included. Compared to BIVP, LBBAP was associated with a significant absolute risk reduction of 3.2% in all-cause mortality (9.3% vs 12.5%, RR 0.7, 95% CI 0.57-0.86, p < 0.001) and an 8.2% reduction in HF-related hospitalization (11.3% vs 19.5%, RR 0.6, 95% CI 0.5-0.71, p < 0.00001). LBBAP also resulted in reductions in procedural time (mean weighted difference- 23.2 min, 95% CI - 42.9 to - 3.6, p = 0.02) and fluoroscopy time (- 8.6 min, 95% CI - 12.5 to - 4.7, p < 0.001) as well as a significant reduction in QRS duration (mean weighted difference:- 25.3 ms, 95% CI - 30.9 to - 19.8, p < 0.00001) and a greater improvement in LVEF of 5.1% (95% CI 4.4-5.8, p < 0.001) compared to BIVP in the studies that reported these outcomes. CONCLUSION: In this meta-analysis, LBBAP was associated with a significant reduction in all-cause mortality as well as HF-related hospitalization when compared to BIVP. Additional data from large RCTs is warranted to corroborate these promising findings.

Intracardiac Echocardiography-guided Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) is a suitable alternative to oral anticoagulant therapy to prevent stroke in patients with AF. Most procedures are performed under transoesophageal echocardiography (TOE) guidance, which facilitates transseptal puncture, reduces the risk of procedurerelated complications and provides an additional method for device selection and real-time monitoring during device deployment. However, TOE has significant shortcomings, including the need for general anaesthesia/deep sedation as well as a significant risk of procedure-related adverse events. More recently, intracardiac echocardiography has been proposed as an alternative to TOE guidance during LAAO procedures. In this review, we summarise the available evidence as well as providing a step-by-step approach for intracardiac echocardiography-guided LAAO.

Impact of intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion procedures: A meta-analysis.

BACKGROUND: Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE). The objective of this study is to evaluate the impact of ICE versus TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. METHODS: All studies comparing ICE-guided versus TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. RESULTS: Twelve studies (n = 5637) were included. There were no differences in procedural success (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p = .27; I2 = 0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p = .25; I2 = 0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-min reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p = 0.64); however, an increased prevalence of residual IASD was observed with ICE-guided versus TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p = 0.04). CONCLUSION: ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.

Left Bundle Branch Pacing vs Left Ventricular Septal Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy.

BACKGROUND: Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined. OBJECTIVES: The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT. METHODS: In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters. RESULTS: A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP. CONCLUSIONS: In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.

Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease.

Background: Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods: This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results: COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion: COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.

Risk Factors for Bisphosphonate-Related Osteonecrosis of the Jaws in Bone Metastatic Breast and Prostate Cancer under Zoledronate Treatment: A Retrospective Analysis from 10 Years of Evaluation.

OBJECTIVE: This study aims to analyze the risk factors for BRONJ in patients taking zoledronic acid (ZA) for metastatic breast and prostate cancer. METHODS: For this, a retrospective, quantitative, observational cohort study was conducted using data on adverse effects in the oral cavity in patients during chemotherapy for treatment of solid tumors available in the electronic patient record system of the Haroldo Juaçaba Hospital/Ceará Cancer Institute in the period from 2010, to 2019. Data were tabulated in Excel and exported to SPSS v20.0 software for statistical analysis, with 95% confidence. RESULTS: Thus, it can be observed that the prevalence of BRONJ in patients under treatment for breast cancer and prostate cancer was <7%, with age <50 years of age (p=0.009), cytotoxic chemotherapy such as methotrexate (p=0.023), paclitaxel (p=0.005), capecitabine (p<0.001), gemcitabine (p=0.007) and bicalutamide (p=0.016), amount of ZA infusions (p<0.001) and hormone therapy (p=0.007), in addition, a slight reduction in survival and increased use of antidepressants (p=0.014) were observed. The reduced overall survival and increased use of antidepressants in patients who developed BRONJ, reinforcing the need for further research to study the mechanisms involved in the unconventional risk factors for BRONJ. CONCLUSION: Thus, increasing the attention to these patients to prevent this condition from compromising the prognosis of these individuals.

Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization.

BACKGROUND: Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES: The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS: In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS: A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS: LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.

Contamination and mortality of leaf-cutting ant workers by the quinone inside inhibitor fungicide after social interactions.

Leaf-cutting ants of the genera Atta and Acromyrmex (Hymenoptera: Formicidae) are the most important pests in forest and agricultural plantations and livestock. Toxic baits are the main method to manage these insects. The objective was to determine whether the behavior of allogrooming, touch, and self-grooming among Atta sexdens rubropilosa Forel, 1908 (Hymenoptera: Formicidae) workers disperse the fungicide quinone inside inhibitor and whether this product is toxic to them. This fungicide was applied, topically, in groups of workers and the social interactions between them and their mortality with and without the fungicide were evaluated. The interactions and the quinone inside inhibitor fungicide contamination increased with the number of leaf-cutting ant workers per group. Excessive touches, with subsequent allogrooming, and self-grooming among the ant workers dispersed the quinone inside the inhibitor fungicide causing 100% mortality and indicating its toxicity to this insect. The hypothesis that social interactions contaminated ant colony mates and the toxicity of the fungicide quinone inside inhibitor to workers of the leaf-cutting ant A. sexdens rubropilosa was proven.

Outcomes of chlorhexidine lavage without capsulectomy versus complete capsulectomy after lead extraction for the treatment of cardiac implantable electronic device infection.

INTRODUCTION: Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time-consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) lavage in lieu of capsulectomy for the treatment of CIED infections. METHODS: This retrospective study included patients who underwent TLE for CIED-related infections in two institutions in Colombia. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, exhaustive lavage of the generator pocket with 20 cc of CHG at 2% followed by irrigation with approximately 500 cc of normal saline (0.9% sodium chloride) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included the occurrence of any adverse reaction to chlorhexidine, the need for reintervention, infection-related mortality, and total procedural time. RESULTS: A total of 102 patients (mean age 67.2 ± 13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n = 54) or CHG (n = 48) lavage. Hematoma formation was significantly higher in the capsulectomy group versus the CHG group (13% vs. 0%, p = .014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7 ± 78.5 vs. 89.9 ± 51.8 min, p = .002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: three in the capsulectomy group and one in the CHG group (p = .346). CONCLUSIONS: In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.

Assisted reality device to guide cardiac implantable device programming in distant rural areas.

BACKGROUND: Patients with cardiac implantable electronic devices (CIEDs) living in rural areas have difficulty obtaining follow-up visits for device interrogation and programming in specialized healthcare facilities. OBJECTIVE: To describe the use of an assisted reality device designed to provide front-line workers with real-time online support from a remotely located specialist (Realwear HTM-1; Realwear) during CIED assistance in distant rural areas. METHODS: This is a prospective study of patients requiring CIED interrogation using the Realwear HMT-1 in a remote rural population in Colombia between April 2021 and June 2022. CIED interrogation and device programming were performed by a general practitioner and guided by a cardiac electrophysiologist. Non-CIED-related medical interventions were allowed and analyzed. The primary objective was to determine the incidence of clinically significant CIED alerts. Secondary objectives were the changes medical interventions used to treat the events found in the device interrogations regarding non-CIED related conditions. RESULTS: A total of 205 CIED interrogations were performed on 139 patients (age 69 ± 14 years; 54% female). Clinically significant CIED alerts were reported in 42% of CIED interrogations, consisting of the detection of significant arrhythmias (35%), lead malfunction (3%), and device in elective replacement interval (3.9%). Oral anticoagulation was initiated in 8% of patients and general medical/cardiac interventions unrelated to the CIED were performed in 52% of CIED encounters. CONCLUSION: Remote assistance using a commercially available assisted reality device has the potential to provide specialized healthcare to patients in difficult-to-reach areas, overcoming current difficulties associated with RM, including the inability to change device programming. Additionally, these interactions provided care beyond CIED-related interventions, thus delivering significant social and clinical impact to remote rural populations.

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy.

Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.

Analysis of gunshot residues from nontoxic ammunition: a contribution to health and environmental analysis.

This study's aim was to determine the presence, as well as to evaluate the health and environmental impacts, of chemical elements from firearm shots during shooter practice at outdoor shooting ranges, both in the environment and on the shooters' hands. Two high-precision devices were used for measuring suspended particles that are released during discharge of Taurus PT 100 .40 caliber pistols. The analysis of collected data allowed the identification of specific distribution patterns of samples that were adsorbed. Moreover, samples were collected from the opisthenar area of the hand to investigate both the occurrence and deposition of particles and chemical elements through scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS). The results indicate that copper, lead, and zinc concentration profiles will be able to delimit and reveal more precise details regarding shots made with nontoxic ammunition (NTA). In particular, the residual graphic analysis indicated that the majority of metal deposited in the shooter's hand is zinc. Further, the metals barium and lead also were detected. Due to the exposure to these elements, it could be concluded that engineering controls and administrative management should be sought in order to avoid human overexposure and environmental release of these airborne toxic metals.

The ideal habitat for leaf-cutting ant queens to build their nests.

Queens of Atta sexdens Forel (Hymenoptera: Formicidae) face biotic and abiotic environmental factors in the environment while establishing their nests. Biotic factors such as predation, microbial pathogens, successful symbiotic fungus regurgitation, excavation effort and abiotic factors such as radiant sunlight, temperature, density, and soil moisture exert selection pressures on ant queens. Biotic factors such as temperature and solar irradiation affect the survival of the initial colony differently, in different environments in the field. Queens of the leaf-cutting ant A. sexdens, were installed in sunny and shaded conditions to test this hypothesis. Two hundred A. sexdens queens were collected and individualized in two experimental areas (sunny and shaded), each in an experimental area (25 m2) in the center of a square (50 × 50 cm). Temperature, irradiance, nest depth, rainfall and queen mortality were evaluated. Atta sexdens colony development was better in the shaded environment, and the depth and volume of the initial chamber, fungus garden biomass and number of eggs, larvae, pupae and workers were greater. The queen masses were similar in both environments but mortality was higher in the sunny environment. The worse parameter values for A. sexdens nests in the sunny environment are due to the greater solar irradiance, increasing the variation range of the internal temperature of the initial chamber of the nest. On the other hand, the more stable internal temperature of this chamber in the shaded environment, is due to the lower incidence of solar irradiance, which is also more advantageous for queen survival and the formation and development of A. sexdens colonies. Shaded environments are a better micro habitat for nesting A. sexdens than sunny ones.

Allogrooming, Self-grooming, and Touching Behavior as a Mechanism to Disperse Insecticides Inside Colonies of a Leaf-Cutting Ant.

Toxic baits, containing the active ingredients sulfluramid or fipronil, are the main methods to control leaf-cutting ants of the genera Atta Fabricius, 1805, and Acromyrmex Mayr, 1865 (Hymenoptera: Formicidae). However, the insecticide dispersion among members of the colony during the control needs further studies. We studied whether the behaviors of allogrooming, self-grooming, and contact among individuals spread the insecticides among those of the colony. The insecticides sulfluramid and fipronil (0.1% and 1.0% (w/w)) were applied topically in groups of workers of Atta sexdens (Linnaeus, 1758), and the social interactions among them with or without insecticide were studied. In addition, toxic baits (sulfluramid or fipronil) were provided to colonies and their behavioral acts were observed. At the end of the experiment, colony mortality, number and mass of dead workers, and mass of wet waste were compared between ant nests receiving baits and ants with topical application. In the topical application, behavioral analysis showed higher interaction between ants in the colonies and touch and allogrooming behaviors as the most frequent in those that received the concentrations of sulfluramid. In the baits, the behavior of licking the pellet and allogrooming was more frequent. Colony mortality was faster for those that received topical application, especially with the insecticide fipronil (0.1%). However, the number and mass of dead workers was similar between topical application and toxic baits. In the toxic baits, the licking behavior of the bait pellets and subsequent allogrooming probably dispersed the insecticides. In the topical application, the route of the insecticide occurred by excessive touches among workers, with subsequent allogrooming. Thus, allogrooming, self-grooming, and touching among workers increased the dispersion of insecticides among members of the ant colonies.

Carbon dioxide levels in initial nests of the leaf-cutting ant Atta sexdens (Hymenoptera: Formicidae).

Claustral foundation of nests by Atta sexdens Forel (Hymenoptera: Formicidae) involves great effort by its queens, solely responsible for the cultivation of the fungus and care for her offspring at this stage. The minimum workers, after 4 months, open access to the external environment to foraging plants to cultivate the symbiotic fungus, which decomposes the plant fragments and produces gongilidea nodules as food for the individuals in the colony. Colony gas exchange and decomposition of organic matter in underground ant nests generate carbon dioxide (CO2) emitted into the atmosphere. We described the carbon dioxide concentration in colonies in the field. The objective was to evaluate the carbon dioxide concentration in initial A. sexdens colonies, in the field, and their development. The CO2 level was also measured in 4-month-old colonies in the field, using an open respirometric system fitted with an atmospheric air inlet. The CO2 level of the respirometric container was read by introducing a tube into the nest inlet hole and the air sucked by a peristaltic pump into the CO2 meter box. The CO2 concentration in the initial colony was also measured after 4 months of age, when the offspring production (number of eggs, larvae, pupae and adult workers) stabilized. Ten perforations (15 cm deep) was carried out in the adjacent soil, without a nest of ants nearby, to determine the concentration of CO2. The composition of the nests in the field was evaluated after excavating them using a gardening shovel and they were stored in 250 ml pots with 1 cm of moistened plaster at the bottom. The CO2 concentration was higher in field nest than in adjacent soil. The concentration of carbon dioxide in A. sexdens nests in the field is higher than in those in the soil, due to the production of CO2 by the fungus garden and colony.

Contamination routes and mortality of the leaf-cutting ant Atta sexdens (Hymenoptera: Formicidae) by the insecticides fipronil and sulfluramid through social interactions.

BACKGROUND: Leaf-cutting ants (LCAs) of the genera Atta and Acromyrmex (Hymenoptera: Formicidae) are important pests of forest plantations, agriculture and livestock. Toxic baits containing the active ingredients fipronil or sulfluramid are the main method used to control LCAs. Insecticide dispersion among members of an LCA colony during control with toxic bait is not well understood. The objective of the study was to determine whether self-grooming, allogrooming or touching behavior among Atta sexdens (Hymenoptera: Formicidae) workers disperses the insecticides fipronil and sulfluramid among members of the colony. The insecticides were topically applied on groups of A. sexdens workers and social interactions between ants with and without insecticide, and group mortality were evaluated. RESULTS: Behavioral analysis showed an increase in interaction among LCA workers as the numbers of individuals increased, with touches between workers being the most frequent behavior. The frequency of observed behaviors was higher in groups treated with sulfluramid compared with fipronil. The mortality of groups treated with fipronil was almost twice as high compared with ants treated with sulfluramid. The insecticides are probably dispersed by excessive touching among workers and subsequent self-grooming and allogrooming. CONCLUSION: These behaviors were responsible for the rapid dispersion of insecticides among members of the colony. Corroboration of the hypothesis that social interactions contaminate nestmates is a model for future studies on contamination of ant workers with active insecticide ingredients. © 2021 Society of Chemical Industry.

Força muscular, distância percorrida e capacidade pulmonar na Doença Pulmonar Obstrutiva Crônica / Muscle strength, distance traveled and lung capacity in Chronic Obstructive Pulmonary Disease

Objetivo: Avaliar a força do músculo quadríceps e sua relação com a capacidade pulmonar em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Assim como a capacidade funcional destes pacientes e sua repercussão sobre a funcionalidade desses indivíduos. Métodos: Quarenta voluntários sendo vinte com diagnóstico de DPOC (grupo 1) e vinte saudáveis (grupo 2). Foi mensurado o pico de força (PF) do músculo quadríceps através do dinamômetro portátil MicroFETâ 2 (Hoggan Health Industries, West Jordan, UT, EUA), modo High Threshold. A capacidade pulmonar foi avaliada através do Teste de Caminhada de 6 minutos (TC6m). Resultados: Os pacientes com DPOC classificaram-se em média (61%) como GOLD II de acordo com os valores de VEF1/CVF. A idade média da amostra foi de 61±7 anos e IMC de 25±4 kg.m-2. Apenas 10% do grupo 1 pratica atividade física, e consequentemente obtiveram valores menor de PF (106±33)N comparado com o grupo 2 (163±45)N (p<0,05). O mesmo se repetiu na distância percorrida do TC6m, onde o grupo 1 percorreu uma média de 356±58m e o grupo 2 380±106m (p<0,05). Conclusões: Os pacientes com DPOC apresentam fraqueza muscular do quadríceps desde estágios iniciais da doença (GOLD II). Assim como percorreram uma distância menor do que os participantes saudáveis no TC6m, o que demonstra uma capacidade pulmonar limitada com declínio funcional e baixa tolerância ao exercício.

Effects of Entomopathogenic Fungi on Individuals as Well as Groups of Workers and Immatures of Atta sexdens rubropilosa Leaf-Cutting Ants.

In 2009, sulfluramid, the main ingredient in toxic baits for leaf-cutting ant control, was included in Annex B of the Stockholm Convention on Persistent Organic Pollutants. This resulted in interest in the use of entomopathogenic fungi such as Beauveria bassiana and Trichoderma harzianum for leaf-cutting ant control. The efficiency of these fungi in controlling these insects and the way that ants react individually or in group to the biological risks posed by these fungi is poorly understood. For this reason, we assessed the effects of B. bassiana and T. harzianum on Atta sexdens rubropilosa larvae, pupae and workers. Moreover, we investigated whether the number of contaminated individuals within a group has an influence in controlling the spread of fungi among workers. We found that the fungus T. harzianum showed high pathogenicity against A. sexdens rubropilosa larvae and pupae, leading to faster mortality and a survival rates. On the other hand, the fungus B. bassiana was responsible for causing faster worker mortality and lower survival rates. In addition, we observed that an increase in individuals contaminated with B. bassiana or T. harzianum in the group decreases its survival rate. The results support the hypothesis that entomopathogenic fungi are efficient in controlling leaf-cutting ants when contaminated workers are allocated to groups of healthy workers.

Genetic diversity of Babesia bovis studied longitudinally under natural transmission conditions in calves in the state of Rio de Janeiro, Brazil.

Serum and DNA samples from 15 naturally infected calves in Seropédica, Brazil, were obtained quarterly from birth to 12 months of age, in order to longitudinally evaluate their humoral immune response against Babesia bovis and the merozoite surface antigen diversity of B. bovis. Anti-B. bovis IgG antibodies were detected by an indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA). Using DNA amplification, sequencing and phylogenetic analysis, the genetic diversity of B. bovis was assessed based on the genes that encode merozoite surface antigens (MSA-1, MSA-2b and MSA-2c). The serological results demonstrated that up to six months of age, all the calves developed active immunity against B. bovis. Among the 75 DNA samples evaluated, 0, 3 and 5 sequences of the msa-1, msa-2b and msa-2c genes were obtained, respectively. The present study demonstrated that the msa-2b and msa-2c gene sequences amplified from blood DNA of B. bovis-positive calves were genetically diversified. These data emphasize the importance of conducting deeper studies on the genetic diversity of B. bovis in Brazil, in order to design diagnostic antigens and vaccines in the future.

Força muscular, funcionalidade e distância percorrida em pacientes com doença pulmonar obstrutiva crônica / Muscle strength, functionality and distance traveled in patients with chronic obstructive pulmonary disease

O status funcional do indivíduo com Doença Pulmonar Obstrutiva Crônica (DPOC), considerado um indicador preditivo de agravo do quadro clínico e qualidade de vida dessa população. OBJETIVO: Analisar a força muscular, morbidade, qualidade de vida e distância percorrida em pacientes com DPOC e comparar com o grupo não DPOC. MÉTODOS: Foram avaliados 58 voluntários, 29 do grupo DPOC, classificados em GOLD II e 29 o grupo não DPOC, com os seguintes parâmetros mensurados: função pulmonar; variáveis antropométricas; força muscular; morbidade mediante o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE); qualidade de vida com o questionário do Saint George's Respiratory Questionnaire (SGRQ); capacidade pulmonar através da distância percorrida no teste de caminhada de seis minutos. Para análise estatística, realizado o teste de Shapiro Wilk e os testes de Mann-Whitney ou t de Student, assim como o teste de correlação de Pearson, para valores de p < 0,05. RESULTADOS: A idade média total foi de 61±7 anos, a força de extensores de joelho (p:0,0004), com valores de força menores para o grupo DPOC 110,61±41,69; em comparação com do grupo não DPOC 156,31±44,09, destaca-se ainda a força de flexores de cotovelo (p 0,004), com 96,34±26,15 para grupo DPOC, em comparação ao grupo não DPOC 118,19±34,71. Na distância percorrida do TC6M o grupo DPOC percorreu uma média de 274± 107,86 e o grupo não DPOC 384,98±100,47 (p<0,05). O BODE apresentou correlação de (r = -0,79) com a distância percorrida no TC6M e de (r =0,72) com o Saint George total. CONCLUSÕES: Os pacientes com DPOC apresentaram redução da força muscular de membros superiores, extensores de joelho e da distância percorrida, ao comparar com o grupo não DPOC.

The functional status of individuals with Chronic Obstructive Pulmonary Disease (COPD), considered a predictive indicator of clinical condition and quality of life of this population. OBJECTIVE: To analyze muscle strength, morbidity, quality of life and distance traveled in patients with COPD and compare compare them with the group non-COPD. METHODS: Fifty-eight volunteers were, 29 from the COPD group, classified as GOLD II and 29 in the non-COPD group, with the following parameters measured: pulmonary function; anthropometric variables; muscle strength; morbidity through Body mass index, airway Obstruction, Dyspnea, and Exercise (BODE); quality of life with the Saint George's Respiratory Questionnaire (SGRQ); lung capacity through the distance covered in the six-minute walk test. For statistical analysis, the Shapiro Wilk test and the Mann-Whitney or Student t tests were performed, as well as the Pearson correlation test, for p values < 0,05. RESULTS: The mean total age was 61±7 years, the strength of knee extensors (p 0.0004), with lower strength (N) values for the COPD group 110,61±41,69; compared to the non-COPD group 156,31±44,09, the strength of elbow flexors (p 0,004) stands out, with 96,34±26,15 for the COPD group, compared to the non-COPD group 118,19±34,71. In the distance covered in the 6MWT, the COPD group covered an average of 274± 107,86 and the non-COPD group 384,98±100,47 (p<0,05). The BODE presented a correlation between (r = -0,79) and the distance covered in the 6MWT and (r =0,72) with the total Saint George. CONCLUSIONS: Patients with COPD presented a reduction in muscle strength of the upper limbs, knee extensors and the distance covered, when compared with the non-COPD group