Association among cardiopulmonary and metabolic rehabilitation, arrhythmias, and myocardial ischemia responses of patients with HFpEF or HFmrEF.

There's limited evidence of the potential benefits of cardiopulmonary and metabolic rehabilitation (CPMR) in patients with heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF) and coronary artery disease (CAD). The aim of this study was to investigate the impact of CPMR on the myocardial ischemia response (MIR), exercise-induced arrhythmias (EIA), New York Heart Association (NYHA) functional class, heart rate recovery (HRR), Borg CR10 perceived symptoms, and the SF-36 physical and mental health summary scores. A prospective cohort study was conducted with 106 patients undergoing 12 weeks of CPMR who completed two exercise tests pre- and post-CPMR: 1) maximum incremental test (CPX) and 2) submaximal constant load test (SUB). After CPMR, the effects on MIR, EIA, NYHA functional class, and HRR during both tests were analyzed. There was a significant change in NYHA functional classes after CPMR, with 96% of the patients in class I (vs 62% pre-CPMR, P<0.0001), 4% in class II (vs 32%), and none in class III (vs 6%). There was a significant reduction in the frequency of EIA (P<0.05) and MIR (P<0.001) and a significantly improved performance on both CPX and SUB tests (P<0.0001). Lastly, there was significant progress in the recovery metrics like HRR (P<0.0001), the Borg CR10 (P<0.0001), and the SF-36 summary scores (P<0.0001). The CPMR resulted in a significant decrease in EIA, delayed ischemia threshold in CPX and SUB tests, increased functional capacity, and improved quality of life.

Post-COVID-19 tomographic abnormalities.

BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchymal bands (65%) were the predominant abnormalities. Both chest HRCT technical assessments presented high sensitivity (95.9%) and positive predictive value (92%), with a statistically significant correlation at baseline (R = 0.80) and after 90 days (R = 0.36).CONCLUSION: The prevalence of pulmonary abnormalities on chest HRCT 90 days after symptom onset due to COVID-19 was high; both technical assessments can be used to analyse the images.

Benthic macroinvertebrates of a tropical lake: Lake Caçó, MA, Brazil.

Benthic communities are highly relevant in the study of aquatic ecosystems, both for their role in the functioning of the ecosystem and also as markers or indicators of paleo-conditions. Their distribution, as in other communities, is conditioned by abiotic and biotic factors and to their interactions, which determine the structure of the community that is established. The aim of this study was to determine the taxonomic composition, abundance and spatial distribution of the benthic community, by collecting at 20 sampling sites in Caçó Lake (State of Maranhão, Brazil). Seasonal variation in these community parameters was analysed and related to the seasonal displacement of the Intertropical Convergence Zone. The results indicated that changes occur in the taxa richness, diversity and density of the benthic species of this lake that are mainly related to seasonality. All those parameters were higher in the dry than in the rainy period. The family Chironomidae (Diptera, Insecta) was the most important component of the community, representing approximately 50% of the total benthic fauna of the lake. The identification of the Chironomidae currently occurring in Lake Caçó is relevant, even at the genus level, considering the fact that this group produces fossilizing remains and could perhaps be good paleolimnological and paleoclimatic tracers that could be used to make inferences on past lake and climate conditions.

Benthic macroinvertebrates of a tropical lake: lake Caçó, MA, Brazil / Macroinvertebrados bentônicos de um lago tropical: lago Caço, MA, Brasil

Benthic communities are highly relevant in the study of aquatic ecosystems, both for their role in the functioning of the ecosystem and also as markers or indicators of paleo-conditions. Their distribution, as in other communities, is conditioned by abiotic and biotic factors and to their interactions, which determine the structure of the community that is established. The aim of this study was to determine the taxonomic composition, abundance and spatial distribution of the benthic community, by collecting at 20 sampling sites in Caçó Lake (State of Maranhão, Brazil). Seasonal variation in these community parameters was analysed and related to the seasonal displacement of the Intertropical Convergence Zone. The results indicated that changes occur in the taxa richness, diversity and density of the benthic species of this lake that are mainly related to seasonality. All those parameters were higher in the dry than in the rainy period. The family Chironomidae (Diptera, Insecta) was the most important component of the community, representing approximately 50 percent of the total benthic fauna of the lake. The identification of the Chironomidae currently occurring in Lake Caçó is relevant, even at the genus level, considering the fact that this group produces fossilizing remains and could perhaps be good paleolimnological and paleoclimatic tracers that could be used to make inferences on past lake and climate conditions.

As comunidades bentônicas são relevantes nos ecossistemas aquáticos devido ao seu papel no seu funcionamento e também como marcadores ou indicadores de paleocondições. Sua distribuição, similarmente à de outras comunidades, é condicionada por fatores abióticos e bióticos e pela interação entre eles, determinando a estrutura da comunidade que se estabelecerá. O objetivo do presente trabalho foi determinar a composição taxonômica, a abundância e a distribuição espacial da comunidade bentônica, amostrando-se em 20 pontos na lagoa do Caçó (Estado do Maranhão, Brasil). As variações sazonais nas características desta comunidade foram analisadas e relacionadas ao deslocamento sazonal da Zona de Convergência Intertropical. Os resultados indicaram que ocorrem mudanças na riqueza de taxons, diversidade e densidade da comunidade bentônica deste lago que são principalmente relacionadas à sazonalidade. Todas as variáveis analisadas foram maiores no período seco do que no chuvoso. Os organismos pertencentes à família Chironomidae (Diptera, Insecta) foram os mais importantes componentes da comunidade, representando aproximadamente 50 por cento do total da fauna. A identificação dos Chironomidae atualmente presentes no Lago Caçó, mesmo em nível de gênero, é relevante, considerando-se o fato de que as larvas deste grupo produzem remanescentes fósseis que podem ser bons traçadores paleolimnológicos e paleoclimáticos, podendo ser utilizados para fazer inferências sobre as condições passadas neste lago e no clima regional.

Paradoxical movement of the lower ribcage at rest and during exercise in COPD patients.

Paradoxical inward displacement of the costal margin during inspiration is observed in many chronic obstructive pulmonary disease patients at rest but its importance is unclear. The current authors studied 20 patients (forced expiratory volume in one second 32.6+/-11.7, functional residual capacity 186+/-32% predicted) and 10 healthy controls at rest and during symptom-limited incremental exercise. With optoelectronic plethysmography, the phase shift between pulmonary and abdominal ribcage volumes and the percentage of inspiratory time the ribcage compartments moved in opposite directions were quantified, using control data to define the normal range of movement. Eight patients showed lower ribcage inspiratory paradox at rest (P+), while 12 patients did not (P-). This was unrelated to resting lung function or exercise tolerance. Total end-expiratory chest wall volume (EEV(cw)) increased immediately when exercise began in P+ patients, but later in exercise in P- patients. This difference in EEV(cw) was mainly due to a greater increase of end-expiratory pulmonary ribcage volume in P+ patients. During exercise, dyspnoea increased similarly in the two groups, while leg effort increased more markedly in the patients without paradox. In conclusion, lower ribcage paradox at rest is reproducible and associated with early-onset hyperinflation of the chest wall and predominant dyspnoea at end-exercise. When paradox is absent, the sense of leg effort becomes a more important symptom limiting exercise.

Inspiratory fraction and exercise impairment in COPD patients GOLD stages II-III.

The inspiratory-to-total lung capacity ratio or "inspiratory fraction" (inspiratory capacity(IC)/total lung capacity (TLC)) may be functionally more representative than traditional indices of resting airflow limitation and lung hyperinflation in patients with chronic obstructive pulmonary disease (COPD). In the present retrospective study, a comparison was made of the individual performance of post-bronchodilator IC, IC/TLC and forced expiratory volume in one second (FEV(1)) in predicting a severely reduced peak oxygen uptake (V'(O(2)); <60% predicted) in 44 COPD patients Global Initiative for Chronic Obstructive Lung Disease stages II-III (post-bronchodilator FEV(1) ranging from 31-79% pred). Patients with lower IC/TLC values (

ßS-Haplotypes in sickle cell anemia patients from Salvador, Bahia, Northeastern Brazil

ßS-Globin haplotypes were studied in 80 (160 ßS chromosomes) sickle cell disease patients from Salvador, Brazil, a city with a large population of African origin resulting from the slave trade from Western Africa, mainly from the Bay of Benin. Hematological and hemoglobin analyses were carried out by standard methods. The ßS-haplotypes were determined by PCR and dot-blot techniques. A total of 77 (48.1 percent) chromosomes were characterized as Central African Republic (CAR) haplotype, 73 (45.6 percent) as Benin (BEN), 1 (0.63 percent) as Senegal (SEN), and 9 (5.63 percent) as atypical (Atp). Genotype was CAR/CAR in 17 (21.3 percent) patients, BEN/BEN in 17 (21.3 percent), CAR/BEN in 37 (46.3 percent), BEN/SEN in 1 (1.25 percent), BEN/Atp in 1 (1.25 percent), CAR/Atp in 6 (7.5 percent), and Atp/Atp in 1 (1.25 percent). Hemoglobin concentrations and hematocrit values did not differ among genotype groups but were significantly higher in 25 patients presenting percent fetal hemoglobin ( percentHbF) > or = 10 percent (P = 0.002 and 0.003, respectively). The median HbF concentration was 7.54 ± 4.342 percent for the CAR/CAR genotype, 9.88 ± 3.558 percent for the BEN/BEN genotype, 8.146 ± 4.631 percent for the CAR/BEN genotype, and 4.180 ± 2.250 percent for the CAR/Atp genotype (P = 0.02), although 1 CAR/CAR individual presented an HbF concentration as high as 15 percent. In view of the ethnic and geographical origin of this population, we did not expect a Hardy-Weinberg equilibrium for CAR/CAR and BEN/BEN homozygous haplotypes and a high proportion of heterozygous CAR/BEN haplotypes since the State of Bahia historically received more slaves from Western Africa than from Central Africa

BetaS-haplotypes in sickle cell anemia patients from Salvador, Bahia, Northeastern Brazil.

BetaS-Globin haplotypes were studied in 80 (160 betaS chromosomes) sickle cell disease patients from Salvador, Brazil, a city with a large population of African origin resulting from the slave trade from Western Africa, mainly from the Bay of Benin. Hematological and hemoglobin analyses were carried out by standard methods. The betaS-haplotypes were determined by PCR and dot-blot techniques. A total of 77 (48.1%) chromosomes were characterized as Central African Republic (CAR) haplotype, 73 (45.6%) as Benin (BEN), 1 (0.63%) as Senegal (SEN), and 9 (5.63%) as atypical (Atp). Genotype was CAR/CAR in 17 (21.3%) patients, BEN/BEN in 17 (21.3%), CAR/BEN in 37 (46.3%), BEN/SEN in 1 (1.25%), BEN/Atp in 1 (1.25%), CAR/Atp in 6 (7.5%), and Atp/Atp in 1 (1.25%). Hemoglobin concentrations and hematocrit values did not differ among genotype groups but were significantly higher in 25 patients presenting percent fetal hemoglobin (%HbF) > or = 10% (P = 0.002 and 0.003, respectively). The median HbF concentration was 7.54+/-4.342% for the CAR/CAR genotype, 9.88 3.558% for the BEN/BEN genotype, 8.146 4.631% for the CAR/BEN genotype, and 4.180+/-2.250% for the CAR/Atp genotype (P = 0.02), although 1 CAR/CAR individual presented an HbF concentration as high as 15%. In view of the ethnic and geographical origin of this population, we did not expect a Hardy-Weinberg equilibrium for CAR/CAR and BEN/BEN homozygous haplotypes and a high proportion of heterozygous CAR/BEN haplotypes since the State of Bahia historically received more slaves from Western Africa than from Central Africa.

Assessment of a rapid HIV test strategy during labor: a pilot study from Rio de Janeiro, Brazil.

OBJECTIVES: To use two rapid human immunodeficiency virus (HIV) tests at labor, measure test acceptance and performance, and measure HIV prevalence in these women. METHODS: Between February and October 2000, two rapid tests (Determine; Abbott, Chicago, IL, U.S.A. and Double Check; Orgenics, Yavne, Israel) were used in three public maternities in Rio de Janeiro, Brazil. Enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) analysis confirmed positive and discordant results. RESULTS: Of the 858 patients who were enrolled, the mean gestational age was 36 weeks (median = 39, mode = 40) and 17 (2%) refused testing. Of the 841 patients tested, 13 were positive by both tests, which represents a 1.5% prevalence (95% confidence interval: 0.7%-2.3%); all were confirmed by ELISA and WB analysis. Seven samples gave discordant results by the rapid tests; of these, six were ELISA-negative/WB-negative and one was ELISA-negative/WB-indeterminate. The positive predictive value for samples that were positive by both rapid tests simultaneously was 100%. CONCLUSIONS: Two rapid HIV tests used at labor were well accepted (98%). When the combined results of the two rapid tests (but not a single rapid test) were analyzed, this strategy was as efficient as the standard ELISA and WB HIV strategy for correctly classifying individuals.

Neurofibromatose de von Recklinghausen com lesoes ao nivel do sacro. Relato de um caso. / Von Recklinghausen's neurofibromatosis with sacrum lesions. A case report

Os autores apresentaram um caso de neurofibroma com lesao ossea. Devido a ausencia de complicacoes, nao houve indicacao cirurgica para o caso. Um aspecto importante foi a ausencia de sardas e manchas cafe com leite, presentes em quase todos os pacientes

Raquitismo resistente a vitamina D. / Vitamin D resistant rickets

O presente trabalho consiste na apresentacao de um caso de raquitismo D resistente em um menor de 12 anos de idade, do sexo masculino, com historia de mais ou menos 1 ano de lombalgia e dores articulares. Nao apresentava queixas sistemicas, antecedentes patologicos e familiares valorizados.Ao exame fisico observa-se discreto defeito pondo-estatural, diminuicao da cifose dorsal, retificacao da coluna lombar, geno valgum bilateral, pes cavo e atrofia muscular generalizada. O diagnostico foi realizado atraves de exames laboratoriais radiologicos