Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

ENT involvement and orobuccal movements' disorders in Pandas patients: assessment and rehabilitations tools.

OBJECTIVE: PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain. PATIENTS AND METHODS: We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients. RESULTS: The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation. CONCLUSIONS: Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.

Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial.

Endometriosis-associated chronic pelvic pain (EACPP) presents with an intense inflammatory reaction. Melatonin has emerged as an important analgesic, antioxidant, and antiinflammatory agent. This trial investigates the effects of melatonin compared with a placebo on EACPP, brain-derived neurotrophic factor (BDNF) level, and sleep quality. Forty females, aged 18 to 45 years, were randomized into the placebo (n = 20) or melatonin (10 mg) (n = 20) treatment groups for a period of 8 weeks. There was a significant interaction (time vs group) regarding the main outcomes of the pain scores as indexed by the visual analogue scale on daily pain, dysmenorrhea, dysuria, and dyschezia (analysis of variance, P < 0.01 for all analyses). Post hoc analysis showed that compared with placebo, the treatment reduced daily pain scores by 39.80% (95% confidence interval [CI] 12.88-43.01%) and dysmenorrhea by 38.01% (95% CI 15.96-49.15%). Melatonin improved sleep quality, reduced the risk of using an analgesic by 80%, and reduced BNDF levels independently of its effect on pain. This study provides additional evidence regarding the analgesic effects of melatonin on EACPP and melatonin's ability to improve sleep quality. Additionally, the study revealed that melatonin modulates the secretion of BDNF and pain through distinct mechanisms.

Classification of cassava starch films by physicochemical properties and water vapor permeability quantification by FTIR and PLS.

Cassava starches are widely used in the production of biodegradable films, but their resistance to humidity migration is very low. In this work, commercial cassava starch films were studied and classified according to their physicochemical properties. A nondestructive method for water vapor permeability determination, which combines with infrared spectroscopy and multivariate calibration, is also presented. The following commercial cassava starches were studied: pregelatinized (amidomax 3550), carboxymethylated starch (CMA) of low and high viscosities, and esterified starches. To make the films, 2 different starch concentrations were evaluated, consisting of water suspensions with 3% and 5% starch. The filmogenic solutions were dried and characterized for their thickness, grammage, water vapor permeability, water activity, tensile strength (deformation force), water solubility, and puncture strength (deformation). The minimum thicknesses were 0.5 to 0.6 mm in pregelatinized starch films. The results were treated by means of the following chemometric methods: principal component analysis (PCA) and partial least squares (PLS) regression. PCA analysis on the physicochemical properties of the films showed that the differences in concentration of the dried material (3% and 5% starch) and also in the type of starch modification were mainly related to the following properties: permeability, solubility, and thickness. IR spectra collected in the region of 4000 to 600 cm(-1) were used to build a PLS model with good predictive power for water vapor permeability determination, with mean relative errors of 10.0% for cross-validation and 7.8% for the prediction set.

Hepatite C em casais inférteis do setor de Reprodução Humana do Hospital de Clínicas de Porto Alegre / Hepatitis C virus in a population of infertile couples

A possibilidade transmissão do vírus da hepatite C através dos gametas pode acarretar riscos para o pessoal técnico, bem como para os envolvidos no processo e para o próprio feto. Este estudo teve como objetivo determinar a prevalência e os fatores de risco da infecção pelo vírus da hepatite C em um grupo de casais inférteis. Em 409 pacientes atendidas no ambulatório de infertilidade do Hospital de Clínicas de Porto Alegre (HCPA), entre 1997 e 1998, realizou-se triagem sorológica para anti-HCV (ELISA) e HBsAg (ELFA). A infecção pelo vírus da hepatite C (HCV) e a viremia seminal também foram investigadas com detecção de HCV-RNA. A prevalência geral de anti-HCV foi de 3,2 por cento (8/248) entre as mulheres e 3,7 por cento (6/161) entre os homens. Todos os indivíduos eram negativos para o vírus da hepatite B (HBV) e HIV. Das 14 pacientes HCV-positivas, duas foram perdidas, e foi coletado soro das 12 pacientes remanescentes para detecção de HCV-RNS, resultando em cinco casos HCV- positivos (uma mulher e quatro homens). Apenas um dos casos positivos tinha nível de viremia > 500.000 cópias de RNA/ml. Houve uma associação de risco significativa da positividade para HCV nas mulheres com parceiros HCV-positivos (P<0,001). Em pacientes masculinos, a correlação entre uso de drogas endovenosas e positividade para HCV também foi significativa (P<0,001). Pacientes inférteis deveriam ser triados para HCV antes dos procedimentos de tecnologia de reprodução assistida (TRA), uma vez que o risco de infecção vertical e laboratorial pelo HCV não está bem determinado e a prevalência do HCV não é desprezível neste grupo.

The usefulness of laparoscopic removal of dysgenetic gonads: a case report

Females with XY karyotype and streak gonads are classified as presenting XY gonodal dysgenesis. These patients are at higher risk of developing malignancy in their gonads; in such cases prophylactic surgical removal is indicated. This article reports a case in which a patient with dysgenesis presented 45,X/46,XY karyotype. Laparoscopic prophylactic gonodal resection was performed. Laparoscopy plays an important role in exploring pelvic structures and allows the diagnosis, prognosis and treatment of lesions. In addition, it provides an effective method for gonadectomy. The prophylactic removal of dysgenetic gonads using this surgical technique has been preferred in selected patients lately.

Modelo experimental de induçäo de endometriose em ratas / Experimental model of endometriosis induction in rats

RETROSPECTIVA: A endometriose é uma doença nao completamente entendida, constituindo uma área da ginecologia na qual há grande atividade científica. Seria importante para facilitar o estudo dessa moléstia a existência de um modelo experimental de fácil obtençao e com baixo custo. OBJETIVOS: Descrever um modelo de endometriose induzida experimentalmente em ratas que permite a posterior avaliaçao macroscópica, microscópica e bioquímica da patologia. MATERIAIS E MÉTODOS: Foram utilizadas 30 ratas Wistar divididas em dois grupos: 18 animais foram submetidos à laparotomia na qual uma porçao do corno uterino esquerdo foi aberto longitudinalmente até atingir-se a cavidade endometrial, sendo o endométrio manipulado e implantado no peritônio; 12 ratas-controle sofreram apenas laparotomia sem manipulaçao do útero. Sessenta dias após o procedimento, as ratas foram re-operadas para avaliaçao macroscópica dos focos de endometriose e coleta de material para análise microscópica e citológica.RESULTADOS: Dentre as ratas que sofreram abertura uterina e sobreviveram, 84 por cento apresentavam focos macroscópicos de endometriose à re-intervençao. Nenhuma rata do grupo controle apresentou a doença.

Endotoxin-induced enteric hypomotility in jaundiced loops in vitro.

Biliary obstruction may be accompanied by systemic endotoxemia due to increased growth of enteric microbiota and failure of hepatic clearance mechanisms. This endotoxemia is related to increased postoperative morbidity and mortality. An increased growth of the aerobic flora has been demonstrated experimentally in the presence of biliary obstruction, and in previous studies we observed intestinal hypomotility of jaundiced loops in vitro. To determine the ileal motor response in the presence of jaundice caused by biliary obstruction and in the presence of endotoxemia, an in vitro study was carried out on ileal segments from 10 female Holtzman rats, 2-3 months old, weighing 200 to 300 g, divided into two groups (N = 5); A, washed loops of jaundiced rats, and B, washed loops of jaundiced rats to which endotoxin was added. On the seventh postoperative day, we evaluated the effect of exogenous endotoxin (E. coli 0111:B4, Sigma) on the motor response to acetylcholine of distal ileal segments isolated from both animal groups. A 4-cm ileal segment, located 10 cm from the ileal papilla, was removed and studied in an organ chamber in order to assess dose-response curves to acetylcholine. There was an increase in threshold dose in jaundiced loops with intraluminally injected endotoxin when compared with the loops without intraluminal endotoxin (291 +/- 188 vs 8.5 +/- 6.7 microM, P < 0.05). The maximum contraction was reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (5.3 +/- 1.7 vs 18.7 +/- 4.8 mm, P < 0.05), and pD2 was also reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (2.4 +/- 0.6 vs 3.7 +/- 0.5, P < 0.05). There was no statistical difference between jaundiced loops with and without intraluminal endotoxin when the maximal contraction doses were compared (86 +/- 66 vs 48 +/- 22 mM, P > 0.05). These results demonstrate that intraluminal endotoxin depressed enteric motility in jaundiced rats.

Endotoxin-induced enteric hypomotility in jaundiced loops in vitro

Biliary obstruction may be accompanied by systemic endotoxemia due to increased growth of enteric microbiota and failure of hepatic clearance mechanisms. This endotoxemia is related to increased postoperative morbidity and mortality. An increased growth of the aerobic flora has been demonstrated experimentally in the presence of biliary obstruction, and in previous studies we observed intestinal hypomotility of jaundiced loops in vitro. To determine the ileal motor response in the presence of jaundice caused by biliary obstruction and in the presence of endotoxemia, an in vitro study was carried out on ileal segments from 10 female Holtzman rats, 2-3 months old, weighing 200 to 300 g, divided into two groups (N = 5): A, washed loops of jaundiced rats, and B, washed loops of jaundiced rats to which endotoxin was added. On the seventh postoperative day, we evaluated the effect of exogenous endotoxin (E. coli 0111:B4, Sigma) on the motor response to acetylcholine of distal ileal segments isolated from both animal groups. A 4-cm ileal segment, located 10 cm from the ileal papilla, was removed and studied in an organ chamber in order to assess dose-response curves to acetylcholine. There was an increase in threshold dose in jaundiced loops with intraluminally injected endotoxin when compared with the loops without intraluminal endotoxin (291 + 188 vs 8.5 + 6.7 muM, P<0.05). The maximum contraction was reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (5.3 + 1.7 vs 18.7 + 4.8 mm, P<0.05), and pD2 was also reduced in jaundiced loops with intraluminal endotoxin in relation to control loops (2.4 + 0.6 vs 3.7 + 0.5, P<0.05). There was no statistical difference between jaundiced loops with and without intraluminal endotoxin when the maximal contraction doses were compared (86 + 66 vs 48 + 22 mM, P>0.05). These results demonstrate that intraluminal endotoxin depressed enteric motility in jaundiced rats.

Influência dos sais biliares na resposta motora de alças isoladas a acetilcolina, em ratos / Influence of bile salts on the motor response of isolated ileum to acetylcholine, in rats

A ausência de sais biliares na luz intestinal de pacientes com obstruçao biliar tem sido relacionada ao aumento da flora intestinal e maior produçao de endotoxinas, podendo provocar endotoxemia sistêmica. Entretanto, esses sais têm pequena açao sobre a flora aeróbia e facultativa, que pode estar aumentada por alteraçoes motoras intestinais. Objetivo. Avaliar a resposta motora intestinal na obstruçao biliar em presença de sais biliares. Métodos. Estudaram-se in vitro segmentos ileais de 30 ratos Hotzman do sexo feminino divididos em três grupos (n=10): alça lavada; uso de bile intraluminar e uso de sais biliares exógenos por via oral, durante seis dias. Em cada grupo, cinco animais foram submetidos somente a laparotomia, enquanto cinco outros ratos foram submetidos a ligadura do ducto biliar comum. No sétimo dia pós-operatório, retirou-se um segmento ileal de aproximadamente quatro centrímetros, distantes dez centrímetros da papila ileocecal, e que foi estudado por meio de curva dose-resposta a acetilcolina em banho para órgaos isolados. Resultados. Os resultados obtidos mostraram aumento significativo da afinidade pela acetilcolina no grupo com bile intraluminar. Conclusao. A bile intraluminar, aparentemente, exerce efeito modular positivo sobre a motilidade ileal in vitro.

[Influence of bile salts on the motor response of isolated ileum to acetylcholine, in rats]. / Influência dos sais biliares na resposta motora de alças isoladas à acetilcolina, em ratos.

UNLABELLED: Absence of bile salts in the intestinal lumen of jaundiced patients is associated to bacterial overgrowth and systemic endotoxemia. These bile salts, however, did not show significant influence on aerobic and facultative intestinal bacteria. The increasing bacterial colonization may be due to depressed intestinal motor response. PURPOSE: To evaluate the influence of bile salts on intestinal motor response in presence of obstructive jaundice. METHODS: We studied in vitro the motor response of ileal segments of 30 Holtzman rats divided into three groups (n = 10): washed ileum, intraluminal bile salts and exogenous oral bile salts administred during six days. Five animals of each group were submitted to sham operation and the other five were submitted to ligation and section of the common bile duct. A four centimeter ileal segment was isolated and studied through a dose-response assay with acetylcholine in an organ chamber. RESULTS: The results showed an increased ileal affinity to acetylcholine in presence of intraluminal bile salts. CONCLUSION: The intraluminal bile salts appear to exert in vitro a stimulatory effect on ileal motility.

Incidência de Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres assintomáticas näo promíscuas e com doença inflamatória pélvica aguda / Incidence of Chlamydia trachomatis and Neisseria gonorrhoeae in asynptomatic non-promiscuous women and with acute inflammatory pelvic disease

Levando-se em conta a importância epidemiológica da Chlamydia trachomatis e Neisseria gonorrhoeae e das possíveis complicaçoes provenientes destes patógenos, os autores investigaram l86 mulheres que visitaram o Serviço de Orientaçao e Planejamento Familiar e a Emergência do Hospital de Clínicas de Porto Alegre, no período de fevereiro de 1987 a fevereiro de 1988. As pacientes foram divididas em dois grupos: o primeiro era composto por mulheres assintomáticas nao promíscuas e o segundo por pacientes com doença inflamatória pélvica aguda. Foi coletado material do canal endocervical para cultura de gonococo e para pesquisa de clamidia. O grupo de mulheres assintomáticas mostrou a incidência de 4 por cento para Chlamydia trachomatis e 2 por cento para Neisseria gonorrhoeae, já o grupo de pacientes com doença inflamatória pélvica aguda apresentou clamídia em 27,94 por cento das amostras e gonococo em 21,32 por cento. Os autores concluíram que Chlamydia trachomatis e Neisseria gonorrhoeae podem ser isoladas de mulheres assintomáticas nao promíscuas e estao associadas significativamente com doença inflamatória pélvica aguda.