Noteworthy records of the ticks Ornithodoros rostratus and Amblyomma sculptum parasitizing Pteronura brasiliensis in the central-western region of Brazil, with pathogen investigation notes.

A male of Pteronura brasiliensis (Carnivora: Mustelidae) was found dead on the banks of the Rio Negro, in the Pantanal wetlands of Mato Grosso do Sul state, Aquidauana municipality. Two ticks found attached to its skin were morphologically identified as a second-instar nymph of Ornithodoros rostratus (Argasidae) and a male of Amblyomma sculptum (Ixodidae). In order to complement the morphological identification, these tick specimens were subjected to DNA extraction, and tested using PCR assays to confirm the molecular identity the specimens. Also, the tick DNA samples were tested and were negative in the PCR assays for all the pathogens tested. We also examined 30 batches, consisting of 174 individuals of O. rostratus deposited in the Acari Collection of the Butantan Institute, and we found material from four Brazilian states, including one batch containing 2 males and 2 females from Aquidauana, of Mato Grosso do Sul state, collected from the soil. This was therefore the first record of O. rostratus parasitizing P. brasiliensis and the first locality record (Aquidauana). Likewise, A. sculptum is commonly found in the Pantanal and is reported here for the second time parasitizing the giant otter, which is a host little studied regarding the ectoparasites.

Mapping native and non-native vegetation in the Brazilian Cerrado using freely available satellite products.

Native vegetation across the Brazilian Cerrado is highly heterogeneous and biodiverse and provides important ecosystem services, including carbon and water balance regulation, however, land-use changes have been extensive. Conservation and restoration of native vegetation is essential and could be facilitated by detailed landcover maps. Here, across a large case study region in Goiás State, Brazil (1.1 Mha), we produced physiognomy level maps of native vegetation (n = 8) and other landcover types (n = 5). Seven different classification schemes using different combinations of input satellite imagery were used, with a Random Forest classifier and 2-stage approach implemented within Google Earth Engine. Overall classification accuracies ranged from 88.6-92.6% for native and non-native vegetation at the formation level (stage-1), and 70.7-77.9% for native vegetation at the physiognomy level (stage-2), across the seven different classifications schemes. The differences in classification accuracy resulting from varying the input imagery combination and quality control procedures used were small. However, a combination of seasonal Sentinel-1 (C-band synthetic aperture radar) and Sentinel-2 (surface reflectance) imagery resulted in the most accurate classification at a spatial resolution of 20 m. Classification accuracies when using Landsat-8 imagery were marginally lower, but still reasonable. Quality control procedures that account for vegetation burning when selecting vegetation reference data may also improve classification accuracy for some native vegetation types. Detailed landcover maps, produced using freely available satellite imagery and upscalable techniques, will be important tools for understanding vegetation functioning at the landscape scale and for implementing restoration projects.

Transition of care of stable ischaemic heart disease patients from tertiary to primary care with telemedicine support: Randomized noninferiority clinical trial.

INTRODUCTION: Evidence of telehealth for chronic disease management is scarce and contradictory. OBJECTIVES: We aimed to evaluate the safety and efficacy of teleconsultations as support in the care transition of patients with stable coronary artery disease (CAD) from tertiary to primary care. METHODS: A randomized noninferiority clinical trial was undertaken in patients with CAD from a tertiary hospital in a middle-income country. Patients with functional angina class 1 or 2 and meeting discharge criteria were randomized to remain in the cardiology outpatient clinic for 12 months (control group, CG) or continue follow-up in a primary care unit with clinical support via telemedicine (intervention group, IG). The primary outcome was the maintenance of the functional angina class after 12 months. Secondary outcomes included control of risk factors and clinical outcomes. RESULTS: In total 271 patients (mean age, 66 years) were included; 81.1% and 91% of the IG and CG, respectively, maintained stable angina symptoms, thus noninferiority could not be shown between the groups. Regarding emergency room visits at 1 year, the IG (7.6%) was noninferior to the CG (6.0%) (absolute difference, 1.6%; noninferiority margin (NIM), -4.8% to 8.2%). For control of risk factors, 30.7% and 29.6% of the IG and CG, respectively, had blood pressure <130/80 mmHg (absolute difference, 1.1%; NIM, -10.5% to 12.8%), and 48.9% and 33.3% of diabetic patients in the IG and CG, respectively, had glycated haemoglobin <7% (absolute difference, 15.6%; NIM, -6.8% to 36%). CONCLUSIONS: In our study, the difference in the patients' angina functional class did not result in greater seeking of emergency care, supporting that discharge from the outpatient clinic with telemedicine is safe for patients with stable CAD treated at the tertiary level. The control of risk factors in these patients was noninferior to patients followed up in primary care. ClinicalTrials.gov (NCT02489565).

Perioperative Troponin Screening Identifies Patients at Higher Risk for Major Cardiovascular Events in Noncardiac Surgery.

Myocardial injury after noncardiac surgery (MINS) includes patients with traditional myocardial infarction and those with ischemic myocardial injury after surgery. This study evaluated the prognostic value of MINS on major cardiovascular events and 30-day mortality, and determined independent preoperative predictors of MINS in patients after noncardiac surgery. This multicenter prospective cohort study was part of the VISION Study. The sample consisted of 2504 patients who underwent noncardiac surgery at 2 tertiary hospitals in Brazil between September 2008 and July 2012. Troponin Ts were measured 6-12 hours, and on days 1-3 after surgery. Cox regression analyses were performed to identify independent variables of major outcomes. A total of 314 (13%) patients were diagnosed with MINS, of which 26 (8%) died. Length-of-hospital stay of MINS patients was 3 times higher (18 ± 22 days vs 5.8 ± 11 days). In multivariate analysis, 30-day mortality was significantly higher among patients with MINS (hazard ratio [HR] 3.17 (95% confidence interval [CI] 1.56-6.41)), and major bleeding (HR 5.76 (95% CI 2.75-12.05)), sepsis (HR 5.08 (95% CI 2.25-11.46)), active cancer (HR 4.22 (95% CI 1.98-8.98)), and general surgery (HR 3.11 (95% CI 1.51-6.41)). Multivariable analysis indicated a higher chance of MINS in patients ≥75 years of age, history of diabetes mellitus, hypertension, heart failure, coronary disease, and end-stage renal failure. The incidence of MINS within 30 days after noncardiac surgery is related to higher mortality. Postoperative troponin monitoring in elder patients and with risk factors for atherosclerotic disease may help reduce postoperative cardiovascular events.

Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry. / Revascularização Completa Versus Tratamento da Artéria Culpada no Infarto com Supradesnivelamento do Segmento ST: Registro Multicêntrico.

BACKGROUND: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated. OBJECTIVE: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. METHODS: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. RESULTS: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). CONCLUSION: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237).

FUNDAMENTO: São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. OBJETIVO: Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. MÉTODOS: Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. RESULTADOS: Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). CONCLUSÃO: Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237).

Revascularização Completa Versus Tratamento da Artéria Culpada no Infarto com Supradesnivelamento do Segmento ST: Registro Multicêntrico / Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry

Resumo Fundamento São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237)

Abstract Background Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237)

Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists.

BACKGROUND: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS). METHODS: Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated via SYNTAX website. RESULTS: Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) (p = 0.041). CONCLUSION: Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.

Relationship of Food Intolerance 2 Years After Roux-en-Y Gastric Bypass Surgery for Obesity with Masticatory Efficiency and Protein Consumption.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is among the most performed bariatric surgery techniques. One known complication of RYGB surgery is food intolerance, which may limit the intake of protein. OBJECTIVE: To investigate the relationship of food intolerance after RYGB surgery with masticatory efficiency, chewing time and cycles, and consumption of protein and red meat. METHODS: A case-control study in subjects with and without food intolerance (regurgitation and/or vomiting more than once a week) aged over 18 years old who had undergone RYGB more than 2 years prior, with an absence of no more than 2 dental units and normal oral motor system evaluation. Masticatory efficiency was evaluated by the granulometry of red meat chewed by the study subject according to a predefined protocol using a sieving technique and classified from very poor to excellent. Protein and red meat consumption were evaluated by usual food recall and a 3-day dietary diary. RESULTS: The study population consisted of 24 cases (37.7 ± 7.57 years old, 79.2% females) and 68 controls (38.0 ± 8.75 years old, 61.8% females). There was a statistically significant association (p = 0.001 by the ranksum test) between food intolerance and masticatory efficiency, with 58.3% of cases and 23.5% of controls showing very poor masticatory efficiency. No evidence was found of an association of food intolerance with chewing time, chewing cycles, low protein or red meat consumption. CONCLUSION: Masticatory inefficiency is a contributing factor to food intolerance after RYGB, regardless of time and chewing cycles. No relationship was found between food intolerance and consumption of red meat and protein.

Dietary patterns of patients with chronic coronary heart disease: a cross-sectional study / Modelos dietéticos de pacientes con enfermedad crónica de las arterias coronarias: un estudio transversal

The objective of this study was to identify dietary patterns in an outpatient cohort of coronary heart disease (CHD) patients, to compare these patterns with dietary recommendations of the international cardiology guidelines, and verify associations with cardiovascular risk factors. Dietary intake was assessed through a food frequency questionnaire. Dietary patterns were identified by cluster analysis. The total energy intake, fiber, cholesterol, macro and micronutrients were calculated. Two dietary patterns were identified in 123 patients. Pattern I was characterized by a greater consumption of whole carbohydrates, beans, meats, vegetables, and fruits. Pattern II was rich in refined carbohydrates, fried foods, and sweets. Participants in pattern I had lower values of diastolic blood pressure (DBP) with 77.1 ± 9.9 mmHg (p= 0.002) and glycated hemoglobin (HbA1c) of 7.83 ± 1.76 % (p= 0.029) compared to pattern II with 84.1 ± 14.3 mmHg and 9.02 ± 2.29 %, respectively. Therefore, pattern I had a healthier nutritional composition, however, nutritional adequacy was still lacking. Despite this, participants in pattern I had significantly lower values of DBP and HbA1c, in addition to being associated with a better control of DBP.

El objetivo de este estudio fue identificar los modelos dietéticos de una cohorte de pacientes ambulatorios con enfermedad de las arterias coronarias (EAC) y compararlos con las recomendaciones dietéticas de las directrices internacionales de cardiología y verificar su asociación con el control de los factores de riesgo cardiovascular. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de consumo. El modelo dietético fue identificado por análisis de conglomerados. Se calculó la ingesta energética total, fibras, colesterol, macro y micronutrientes. Se identificaron dos modelos dietéticos en 123 pacientes. El modelo I se caracterizó por un mayor consumo de carbohidratos enteros, frijoles, carnes, verduras y frutas. El modelo II era rico en carbohidratos refinados, alimentos fritos y dulces. Los participantes en el modelo I tuvieron valores más bajos de presión arterial diastólica (PAD) con 77.1 ± 9.9 mmHg (p= 0.002) y hemoglobina glucosilada (HbA1c) de 7.83 ± 1.76 % (p= 0.029) en comparación con el modelo II con 84.1 ± 14.3 mmHg y 9.02 ± 2.29%, respectivamente. Por lo tanto, el modelo I tenía una composición nutricional más saludable, sin embargo, todavía carece de adecuación nutricional. A pesar de esto, los participantes del modelo I tuvieron valores más bajos de PAD y HbA1c.

Procedimento operacional padrão na assistência nutricional ao paciente com covid 19: relato de experiência / Standard operational procedure in nutritional assistance to patients with covid 19: experience report / Procedimiento operativo estándar en asistencia nutricional a pacientes con covid 19: informe de experiência

Introdução:Vivencia-se na atualidade uma pandemia causada pelo novo Coronavírus,o qual é transmitido por meio de gotículas de saliva, espirro e tosse, fazendo-se necessário mudanças na assistência ao paciente. Objetivo:Descrever a experiência com a construção de um Procedimento Operacional Padrão para assistência nutricional em pacientes acometidos pelo Coronavírus. Metodologia:Trata-se de um estudo descritivo, do tipo relato de experiência,vivenciado pela equipe de residentes multiprofissionais em nutrição do Hospital Universitário Onofre Lopes,da Universidade Federal do Rio Grande do Norte. Resultados:Baseado nas recomendações da Organização Mundial de Saúde e do Conselho Federal de Nutrição e, com a participação dos profissionais do serviço, foi construído o referido procedimento que descreve as boas práticas na triagem, avaliação e conduta nutricional. Conclusão:A implantação e implementação do POP oportunizou a interação de conhecimentos e novas condutas assistenciais, mesmo diante das limitações estruturais, de equipamentos de proteção individual e de medidas de contingenciamento implementadas no serviço (AU).

Introduction:We are currently experiencing a pandemic caused by the new Coronavirus, which is transmitted through droplets of saliva, sneezing and coughing, making changes in patient care necessary. Objective:To describe the experience with the construction of a Standard Operating Procedure for nutritional assistance in patients affected by the Coronavirus. Methodology:This is a descriptive study, an experience report, experienced by the team of multiprofessional residents in nutrition at the Hospital Universitário Onofre Lopes, at the Federal University of Rio Grande do Norte. Results:Based on the recommendations of the World Health Organization and the Federal Nutrition Council and, with the participation of service professionals, the referred procedure was developed, which describes good practices in screening, assessment and nutritional conduct. Conclusion: The implementation and implementation of SOP provided an opportunity for the interaction of knowledge and new care behaviors, even in the face of structural limitations, personal protective equipment and contingency measures implemented in the service (AU).

Introducción:Actualmenteestamos experimentando una pandemia causada por el nuevo Coronavirus, que se transmite a través de gotas de saliva, estornudos y tos, lo que hace que sea necesario realizar cambios en la atención del paciente. Objetivo:Describir la experiencia con la construcción de un Procedimiento Operativo Estándar para asistencia nutricional en pacientes afectados por el Coronavirus. Metodología:Este es un estudio descriptivo, un informe de experiencia, experimentado por el equipo de residentes multiprofesionales en nutrición del Hospital Universitário Onofre Lopes, de la Universidad Federal de Río Grande del Norte. Resultados:Basado en las recomendaciones de la Organización Mundial de la Salud y el Consejo Federal de Nutrición y, con la participación de profesionales de servicio, se desarrolló el procedimiento referido, que describe buenas prácticas en la detección, evaluación y conducta nutricional. Conclusión:La implementación e implementación de SOP brindó una oportunidad para la interacción del conocimiento y los nuevos comportamientos de atención, incluso frente a limitaciones estructurales, equipos de protección individual y medidas de contingencia implementadas en el servicio (AU).

Periodontitis and tooth loss have negative impact on dietary intake: A cross-sectional study with stable coronary artery disease patients.

BACKGROUND: Despite the association between cardiovascular diseases and periodontitis, there are scarce data on the impact of oral health in the dietary intake of patients with coronary artery disease (CAD). The aim of this study was to assess the association between dietary intake with periodontitis and present teeth in individuals with stable CAD. METHODS: This cross-sectional study included 115 patients with stable CAD (76 males, aged 61.0 ± 8.3 years) who were under cardiovascular care in an outpatient clinic for at least 3 months. Dietary intake was recorded applying a food frequency questionnaire previously validated. Periodontal examinations were performed by two calibrated examiners in six sites per tooth from all present teeth. Blood samples were collected to determine serum levels of lipids. Multivariable logistic and linear regression models were fitted to evaluate the association between dietary outcomes and oral health variables. RESULTS: Individuals with periodontitis had significantly higher percentage of total energy intake from fried foods, sweets, and beans, and also had lower consumption of fruits than those without periodontitis. Presence of periodontitis was associated with lower percentage of individuals who reached the nutritional recommendation of monounsaturated fatty acids and higher blood concentration of triglycerides. Having a greater number of present teeth (≥20 teeth) was associated with higher intake of fibers and total calories. CONCLUSION: In patients with stable CAD, the presence of periodontitis and tooth loss were associated with a poor dietary intake of nutrients and healthy foods, which are important for cardiovascular prevention.

Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk biomarkers in patients with stable coronary artery disease: Preliminary findings of 3 months.

AIM: To assess the effect of periodontal therapy (PT) on cardiovascular blood biomarkers. MATERIALS AND METHODS: This single-blind, parallel-design, randomized controlled trial included patients with stable coronary artery disease and periodontitis. The test group (TG) received non-surgical PT, whereas the control group (CG) received one session of plaque removal. Plasma levels of C-reactive protein (CRP), glycated haemoglobin, lipids and cytokines (IL-1ß, IL-6, IL-8, IL-10, IFN-γ and TNF-α) were measured at baseline and after 3 months. RESULTS: Eighty-two patients (74.4% women, mean age 59.6 years) were analysed. TG had significantly better periodontal parameters than CG after 3 months, but no significant differences in blood markers were observed between them. In a post hoc subgroup analysis in patients with baseline CRP <3 mg/L, a significant increase in CRP was observed in CG (1.44 ± 0.82 mg/L to 4.35 ± 7.85 mg/L, p = 0.01), whereas CRP remained unchanged in TG (1.40 ± 0.96 mg/L to 1.33 ± 1.26 mg/L, p = 0.85), resulting in a significant difference between groups at 3 months. In patients with CRP ≥3 mg/L, a significant reduction in CRP was observed only in TG (11.3 ± 12.8 mg/L to 5.7 ± 4.1 mg/L, p = 0.04). Levels of IL-6 and IL-8 were significantly lower in TG than CG at 3 months. CONCLUSIONS: PT leads to lower levels of CRP, IL-6 and IL-8 in cardiovascular patients with high CRP levels.

Evaluation of factors that may influence in the insufficient weight loss in patients after two years of Roux-en-Y gastric bypass.

INTRODUCTION: bariatric surgery is a favorable option for the treatment of obesity, resulting in long-term weight loss. OBJECTIVES: to analyze whether feeding behavior, evaluated by caloric intake, dietary preferences and tolerance, can be considered as a determinant factor for weight loss in obese patients submitted to Roux-en-Y gastric bypass (RYGB). METHODS: cross-sectional study of 105 patients with at least two years post-RYGB surgery with a preoperative body mass index (BMI) of ≥ 35 kg/m². Caloric intake was evaluated by 24-hour dietary recall and 3-day dietary intake record; dietary habits, by a qualitative dietary frequency questionnaire; and food tolerance, with a validated questionnaire. Multiple logistic regression was used for statistical analysis. RESULTS: the majority of the 105 participants were female (84%). The mean age was 43.3 ± 11.4 years in the success group (n = 64) and 43.4 ± 10.7 years in the failure group (n = 41). Preoperative BMI was not associated with the outcome. Mean caloric intake did not show significant differences between groups: 24 hours recall, p = 0.27; 3-day record, p = 0.95. The frequency of weekly consumption of desserts was twice as high in the success group. Only two patients in the success group presented daily vomiting. CONCLUSION: the factors that determine the failure of weight loss have not yet been fully elucidated. Caloric intake was not a determining factor of failure, and insufficient weight loss was more prevalent in patients who ceased to lose weight earlier.

Evaluation of factors that may influence in the insufficient weight loss in patients after two years of roux-en-y gastric bypass / Evaluación de factores que pueden influenciar en la pérdida de peso insuficiente en pacientes después de dos años de bypass gástrico en Y de Roux

Introduction: bariatric surgery is a favorable option for the treatment of obesity, resulting in long-term weight loss. Objectives: to analyze whether feeding behavior, evaluated by caloric intake, dietary preferences and tolerance, can be considered as a determinant factor for weight loss in obese patients submitted to Roux-en-Y gastric bypass (RYGB). Methods: cross-sectional study of 105 patients with at least two years post-RYGB surgery with a preoperative body mass index (BMI) of ≥ 35 kg/m². Caloric intake was evaluated by 24-hour dietary recall and 3-day dietary intake record; dietary habits, by a qualitative dietary frequency questionnaire; and food tolerance, with a validated questionnaire. Multiple logistic regression was used for statistical analysis. Results: the majority of the 105 participants were female (84%). The mean age was 43.3 ± 11.4 years in the success group (n = 64) and 43.4 ± 10.7 years in the failure group (n = 41). Preoperative BMI was not associated with the outcome. Mean caloric intake did not show significant differences between groups: 24 hours recall, p = 0.27; 3-day record, p = 0.95. The frequency of weekly consumption of desserts was twice as high in the success group. Only two patients in the success group presented daily vomiting. Conclusion: the factors that determine the failure of weight loss have not yet been fully elucidated. Caloric intake was not a determining factor of failure, and insufficient weight loss was more prevalent in patients who ceased to lose weight earlier

Introducción: la cirugía bariátrica es una opción favorable para el tratamiento de la obesidad, resultando a largo plazo en pérdida de peso. Objetivos: analizar si el comportamiento alimentario, evaluado por la ingesta calórica, las preferencias y las tolerancias alimentarias, puede ser considerado un factor determinante de los resultados de pérdida de peso en pacientes obesos sometidos a bypass gástrico en Y de Roux (BPGYR). Métodos: se realizó un estudio de cohorte retrospectivo con 105 pacientes sometidos a cirugía de BPGYR, con índice de masa corporal (IMC) preoperatorio ≥ 35 kg/m² y, como mínimo, dos años de postoperatorio. La ingesta calórica fue evaluada por el recordatorio alimentario de 24 horas y el registro alimentario de tres días. Para la evaluación de los hábitos alimentarios se empleó un cuestionario cualitativo de frecuencia alimentaria y para la tolerancia alimentaria, un cuestionario validado. Resultados: la mayoría de los participantes eran del sexo femenino (84%). La edad promedio fue de 43,30 ± 11,39 años en el grupo éxito y de 43,39 ± 10,73 años en el grupo sin éxito. El IMC preoperatorio no presentó influencia sobre el resultado final. El promedio de ingesta calórica no mostró diferencia significativa entre los grupos estudiados (R 24 h, p = 0,27; registro del diario alimentario, p = 0,95). La frecuencia del consumo semanal de dulces fue dos veces mayor en el grupo éxito. Apenas dos pacientes del grupo éxito presentaban vómitos diarios. Conclusión: los factores que determinan la falta de éxito en la pérdida de peso aún no están bien esclarecidos. La ingesta calórica no fue un factor determinante para no obtener éxito y la pérdida de peso insuficiente fue más prevalente en los pacientes que dejaron de perder peso más temprano

Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial.

OBJECTIVE: To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS: A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS: The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION: Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.

Food Tolerance and Eating Behavior After Roux-en-Y Gastric Bypass Surgery.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery often leads to food intolerance, especially protein intake. AIM: This is to investigate the association of food intolerance with protein intake and chewing parameters in patients who underwent RYGB surgery 2 years prior. METHODS: An observational study was carried out in 30 patients aged between 18 and 60 years old with at least a 2-year postoperative period since undergoing RYGB surgery. A specific questionnaire was applied to obtain a food tolerance score; a masticatory efficiency, chewing cycles, and time were evaluated with a standard test based on the size of the fragmentation of almonds and of meat after a certain chewing time. Protein intake was evaluated by 24-h dietary recall. RESULTS: Mean age was 42.3 ± 11.2 years; mean body mass index was 33 ± 6 kg/m2; and mean time since surgery was 4.9 years. The food tolerance score was 23.4 ± 3.3 points. There was no evidence of an association between food tolerance and chewing efficiency for meat (p = 0.28) nor between food tolerance and protein intake (Spearman correlation coefficient 0.03, p = 0.86). Regarding chewing efficiency with almonds, tolerance was higher in patients with optimal efficiency than among those with good and acceptable efficiency (p = 0.01). CONCLUSIONS: In the evaluation of mastication using almonds, food tolerance increased with the number of chewing cycles and with greater chewing efficiency; the same association was not found in the evaluation using red meat.

First detection of feline hemoplasmas in free-ranging jaguars (Panthera onca).

Species of hemoplasmas have been described worldwide, but little information is available for wild felids. Between February 2000 and January 2010, blood samples were collected from 30 jaguars (Panthera onca) and 22 domestic cats (Felis catus) from the Cerrado, Pantanal and Amazon biomes of Brazil. In all samples molecular tests were performed for Mycoplasma haemofelis/Mycoplasma haemocanis (Mhf/Mhc), 'Candidatus Mycoplasma haemominutum' (CMhm) and 'Candidatus Mycoplasma turicensis' (CMt). Twenty-two (73.4%) jaguars and four domestic cats (18.2%) tested positive for infection with at least one feline hemoplasma: 73.4% jaguars from the three areas were positive for CMhm, 13.6% jaguars from the Pantanal and 50.0% from the Amazon were positive for Mhf/Mhc, and 9.1% of individuals from the Pantanal tested positive for CMt. Domestic cats from the Cerrado (28.6%) and the Pantanal (30.0%) were positive for feline hemoplasma. All but one jaguar from the three sites are healthy. One female adult jaguar showed low body weight and dehydration. This is the first record of feline hemoplasmas in free-ranging jaguars. The high prevalence of CMhm suggest the participation of jaguars in the maintenance of this hemoplasma in nature. Although susceptible to Mhf/Mhc and CMt, jaguars did not appear to participate in the maintenance of these agents in the environment. The involvement of domestic cats in the transmission of any of these hemoplasmas cannot be excluded.

Efetividade da Terapia Medicamentosa e dos Procedimentos de Revascularização como Estratégia Inicial na Doença Arterial Coronariana Estável: Estudo de Coorte / Effectiveness of Medical and Revascularization Procedures as the Initial Strategy in Stable Coronary Artery Disease: A Cohort Study

Fundamento: A cirurgia de revascularização miocárdica (CRM) e a intervenção coronária percutânea (ICP) são estratégias amplamente utilizadas no manejo da doença arterial coronariana (DAC) estável. Objetivo: Avaliar o prognóstico de pacientes com DAC estável inicialmente tratada com terapia médica (TM), em comparação com os pacientes submetidos a procedimentos de revascularização. Métodos: Estudo prospectivo de coorte com 560 pacientes ambulatoriais de um hospital terciário com seguimento médio de 5 anos. Os pacientes foram classificados nos grupos TM (n = 288), ICP (n = 159) e CRM (n = 113) de acordo com sua estratégia inicial de tratamento. Os desfechos primários foram mortalidade global e eventos combinados de morte, síndrome coronária aguda e AVC. Resultados: Durante o seguimento, as taxas de mortalidade foram de 11,1% em TM, 11,9% em ICP e 15,9% em pacientes submetidos à CRM, sem diferença estatística (Hazard Ratio [HR] para ICP, 1,05; Intervalo de Confiança de 95% [IC95%], 0,59 a 1,84; e HR para CRM, 1,20; IC95%, 0,68 a 2,15). Os desfechos combinados ocorreram com maior frequência entre os pacientes inicialmente submetidos à ICP em relação à TM (HR 1,50, IC 95% 1,05 a 2,14) e não diferiram entre TM e CRM (HR 1,24, IC95% 0,84 a 1,83). Entre os pacientes com diabetes (n = 198), a ICP foi a única estratégia terapêutica preditiva de desfechos combinados (HR 2,14; IC 95%: 1,25 a 3,63). Conclusão: Neste estudo observacional de doença arterial coronariana estável, não houve diferença na mortalidade global entre as estratégias iniciais de terapia médico ou de cirurgia de revascularização. Os pacientes inicialmente tratados com ICP tiveram maior chance de desenvolver eventos cardiovasculares maiores combinados

Background: Coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) are widely-used strategies in the management of stable coronary artery disease (CAD). Objective: To evaluate the prognosis of patients with stable CAD initially treated by medical therapy (MT), compared to the patients who were submitted to revascularization procedures. Methods: We conducted a prospective cohort study of 560 patients from an outpatient clinic in a tertiary hospital, with a mean follow-up of 5 years. Patients were classified into MT (n = 288), PCI (n = 159) and CABG (n=113) groups according to their initial treatment strategy. Primary endpoints were overall mortality and combined events of death, acute coronary syndrome, and stroke. Results: During follow-up, death rates were 11.1% in MT, 11.9% in PCI and 15.9% in CABG patients, with no statistical difference (hazard ratio [HR] for PCI, 1.05; 95% confidence interval [95%CI], 0.59 to 1.84; and HR for CABG, 1.20; 95% CI: 0.68 to 2.15). Combined outcomes occurred more often among patients initially submitted to PCI compared to MT (HR 1.50, 95% CI 1.05 to 2.14), and did not differ between MT and CABG patients (HR 1.24, 95% CI 0.84 to 1.83). Among patients with diabetes (n=198), PCI was the only therapeutic strategy predictive of combined outcomes (HR 2.14; 95% CI 1.25 to 3.63). Conclusion: In this observational study of stable coronary artery disease, there was no difference in overall mortality between initial medical therapy or revascularization surgery strategies. Patients initially treated with PCI had greater chance to develop combined major cardiovascular events

Molecular detection of viral agents in free-ranging and captive neotropical felids in Brazil.

We describe molecular testing for felid alphaherpesvirus 1 (FHV-1), carnivore protoparvovirus 1 (CPPV-1), feline calicivirus (FCV), alphacoronavirus 1 (feline coronavirus [FCoV]), feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), and canine distemper virus (CDV) in whole blood samples of 109 free-ranging and 68 captive neotropical felids from Brazil. Samples from 2 jaguars ( Panthera onca) and 1 oncilla ( Leopardus tigrinus) were positive for FHV-1; 2 jaguars, 1 puma ( Puma concolor), and 1 jaguarundi ( Herpairulus yagouaroundi) tested positive for CPPV-1; and 1 puma was positive for FIV. Based on comparison of 103 nucleotides of the UL24-UL25 gene, the FHV-1 sequences were 99-100% similar to the FHV-1 strain of domestic cats. Nucleotide sequences of CPPV-1 were closely related to sequences detected in other wild carnivores, comparing 294 nucleotides of the VP1 gene. The FIV nucleotide sequence detected in the free-ranging puma, based on comparison of 444 nucleotides of the pol gene, grouped with other lentiviruses described in pumas, and had 82.4% identity with a free-ranging puma from Yellowstone Park and 79.5% with a captive puma from Brazil. Our data document the circulation of FHV-1, CPPV-1, and FIV in neotropical felids in Brazil.

Hepatozoon SPP. Infect Free-Ranging Jaguars (Panthera onca) in Brazil.

This study investigated the presence of Hepatozoon spp. in jaguars ( Panthera onca ) and domestic animals in the Cerrado, Amazon, and Pantanal biomes of Brazil. Between February 2000 and January 2010, blood samples were collected from 30 jaguars, 129 domestic dogs ( Canis lupus familiaris), and 22 domestic cats ( Felis catus ) for molecular tests. All of the jaguars from the Pantanal (n = 22) and Cerrado (n = 4) and 3 of 4 jaguars from the Amazon were positive for Hepatozoon spp. Domestic dogs (62.8%) and cats (31.8%) were also positive for the agent. Hepatozoon nucleotide sequences from jaguars and domestic cats grouped with other Hepatozoon felis, whereas Hepatozoon from domestic dogs showed high similarity to Hepatozoon canis. Different species of Amblyomma were identified as parasitizing the jaguars and may act as vectors for Hepatozoon spp. Jaguars from the 3 sites were healthy and did not seem to be threatened by the hemoparasite within its population or environments. Most likely, jaguars play an important role in the maintenance of Hepatozoon spp. in nature.