Publications by authors named "Felipe Ferreira"

53 Publications

The interplay between heated environment and active standing test on cardiovascular autonomic control in healthy individuals.

Physiol Meas 2021 Aug 27;42(8). Epub 2021 Aug 27.

Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil.

To investigate the interplay between active standing and heat stress on cardiovascular autonomic modulation in healthy individuals.Blood pressure (BP) and ECG were continuously recorded during 30 min in supine (SUP) and 6 min in orthostatic position (ORT) under thermal reference (TC; ∼24 °C) or heated environment (HOT; ∼36 °C) conditions, in a randomized order. All data collection was performed during the winter and spring seasons when typical outdoor temperatures are ∼23 °C. Spectral analysis was employed by the autoregressive model of R-R and systolic blood pressure (SBP) time series and defined, within each band, in low (LF, 0.04 to 0.15 Hz) and high (0.15-0.40 Hz) frequencies. The indices of cardiac sympathetic (LF) and cardiac parasympathetic (HF) were normalized (nu) dividing each band power by the total power subtracted the very-low component (<0.04 Hz), obtaining the cardiac autonomic balance (LF/HF) modulation. The gain of the relationship between SBP and R-R variabilities within the LF band was utilized for analysis of spontaneous baroreflex sensitivity (alpha index;LF). Nonlinear analysis was employed through symbolic dynamics of R-R, which provided the percentage of sequences of three heart periods without changes in R-R interval (0V%; cardiac sympathetic modulation) and two significant variations (2UV% and 2LV%; cardiac vagal modulation).HOT increased 0V% and HR, and decreasedLF and 2UV% during SUP compared to TC. During ORT, HOT provokes a greater increment on HR, LF/HF and 0V%, indexes compared to ORT under TC.At rest, heat stress influences both autonomic branches, increasing sympathetic and decreasing vagal modulation and spontaneous baroreflex sensitivity. The augmented HR during active standing under heat stress seems to be mediated by a greater increment in cardiac sympathetic modulation, showing an interplay between gravitational and thermal stimulus.
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http://dx.doi.org/10.1088/1361-6579/ac1497DOI Listing
August 2021

Experimental ethology of intensively reared lowland pacas (Cuniculus paca).

Trop Anim Health Prod 2021 Jun 22;53(3):367. Epub 2021 Jun 22.

Department of Animal Science, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

The objective of this study was to evaluate and to describe the main behaviors of family groups of lowland pacas (Cuniculus paca) raised in a commercial breeding facility. We used 24 adult pacas, 16 females and 8 males, with a mean live weight of 8.2 kg and age ranging from 2 to 4 years. The animals were kept in groups of two females and one male per enclosure. Cameras were used to monitor the animals. The behaviors identified were divided into five categories (maintenance, exploratory, social interaction, reproductive, and environmental interaction). A completely randomized design in a split-split plot arrangement with three treatment factors was used: sex, period of the day, and season. The frequencies of the maintenance and environmental interaction behavioral categories were significantly higher during the day compared to the nocturnal period (P < 0.05). The duration of each behavioral category differed significantly (P < 0.05) between day and night. The frequencies of the maintenance and reproductive behavioral categories were significantly higher during the dry season compared to the rainy season (P < 0.05) and the relative duration of behaviors of the environmental interaction category was shorter during the dry season (P < 0.05). Females exhibited a significantly higher frequency of maintenance and environmental interaction than males (P < 0.05) and the duration of environmental interaction was shorter (P < 0.05) in females. The present results add to the existing knowledge on the behavior of lowland pacas raised in captivity for production of this wild species which is in the stage of domestication.
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http://dx.doi.org/10.1007/s11250-021-02801-4DOI Listing
June 2021

Factors affecting performance response of pigs exposed to different challenge models: a multivariate approach.

J Anim Sci 2021 Jun;99(6)

Prairie Swine Centre, Inc., Saskatoon, SK S7H 5N9, Canada.

Factors associated with the severity with which different challenge models (CMs) compromise growth performance in pigs were investigated using hierarchical clustering on principal components (HCPC) analysis. One hundred seventy-eight studies reporting growth performance variables (average daily gain [ADG], average daily feed intake [ADFI], gain:feed [GF], and final body weight [FBW]) of a Control (Ct) vs. a Challenged (Ch) group of pigs using different CMs (enteric [ENT], environmental [ENV], lipopolysaccharide [LPS], respiratory [RES], or sanitary condition [SAN] challenges) were included. Studies were grouped by similarity in performance in three clusters (C1, C2, and C3) by HCPC. The effects of CM, cluster, and sex (males [M], females [F], mixed [Mi]) were investigated. Linear (LRP) and quadratic (QRP) response plateau models were fitted to assess the interrelationships between the change in ADG (∆ADG) and ADFI (∆ADFI) and the duration of challenge. All variables increased from C1 through C3, except for GF, which decreased (P < 0.05). LPS was more detrimental to ADG than ENV, RES, and SAN models (P < 0.05). Furthermore, LPS also lowered GF more than all the other CMs (P < 0.05). The ∆ADG independent of ∆ADFI was significant in LPS and SAN (P < 0.05), showed a trend toward the significance in ENT and RES (P < 0.10), and was not significant in ENV (P > 0.10), while the ∆ADG dependent on ∆ADFI was significant in ENT, ENV, and LPS only (P < 0.05). The critical value of ∆ADFI influencing the ∆ADG was significant in pigs belonging to C1 (P < 0.05) but not C2 or C3 (P > 0.10). The ∆ADG independent of duration post-Ch (irreparable portion of growth) was significant in C1 and C2 pigs, whereas the ∆ADFI independent of duration post-Ch (irreparable portion of feed intake) was significant in C1 pigs only (P < 0.05). Moreover, the time for recovery of ADG and ADFI after Ch was significant in pigs belonging to C1 and C2 (P < 0.05). Control F showed reduced ADG compared with Ct-M, and Ch-F showed reduced ADFI compared with Ch-M (P < 0.05). Moreover, the irreparable portion of ΔADG was 4.8 higher in F (-187.7; P < 0.05) compared with M (-39.1; P < 0.05). There are significant differences in growth performance response to CM based on cluster and sex. Furthermore, bacterial lipopolysaccharide appears to be an appropriate noninfectious model for immune stimulation and growth impairment in pigs.
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http://dx.doi.org/10.1093/jas/skab035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269967PMC
June 2021

The effects of time and relative humidity on dry-aged beef: Traditional versus special bag.

Food Sci Technol Int 2020 Dec 15:1082013220976487. Epub 2020 Dec 15.

Department of Food Technology, School of Food Engineering, University of Campinas - Unicamp, Campinas, Brazil.

The objective of this study was to evaluate the effects of relative humidity (RH) and different dry aging methods on the quality of beef. Sixteen loins, from eight carcasses, were used in this experiment. Each pair of loin was cut into eight sections with equal size, which were evenly assigned to eight treatments, by the combination of two dry aging methods (traditional and highly moisture-permeable special bag), two relative humidity (65 and 85% RH) and two aging times (21 and 42 days). At 85% RH, neither special bag nor the traditional dry aging methods were viable, since samples presented high microbiological counts, mucus and bad odor. At 65% RH, and lactic acid bacteria were not detected in any treatment. The highest aerobic plate count and psychrotrophic count were observed in the samples of the traditional dry-aged process whereas the special bag showed the greatest mold and yeast count. Regarding dry aging in special bag, there was a reduction in the weight loss ( < 0.05) and no change in the physical-chemical characteristics ( > 0.05) compared to traditional dry aging. The values of pH, moisture and Warner-Bratzler shear force were not affected ( > 0.05) by aging method and relative humidity. Thus, the results indicate that high RH should be avoided for both dry aging methods. Furthermore, the special bag dry aging can be considered an alternative to produce dry-aged beef, as it reduces weight losses even at conditions of lower relative humidity.
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http://dx.doi.org/10.1177/1082013220976487DOI Listing
December 2020

Relative bioavailability of manganese in relation to proteinate and sulfate sources for broiler chickens from one to 20 d of age.

Poult Sci 2020 Nov 26;99(11):5647-5652. Epub 2020 Aug 26.

Universidade Federal de Minas Gerais, Department of Animal Science, Belo Horizonte, MG 31270-901. Electronic address:

The objective of this study was to evaluate the relative bioavailability (RB) of manganese (Mn) proteinate compared to Mn sulfate for broilers fed a diet based on corn and soybean meal for 20 d. The diets of 1,350 male Cobb broilers were supplemented with 0, 35, 70, 105, or 140 mg of Mn/kg of feed in the form of Mn sulfate or Mn proteinate. Weight gain, feed intake, feed conversion, bone strength, and Mn concentration in the tibia and liver, as well as the concentration of type I collagen in the tibia, were evaluated. No differences were observed for performance variables (P > 0.05) or for type I collage concentration in broiler tibia (P > 0.05), regardless of the source and level of supplementation used. Relative bioavailability was determined using bone strength values and Mn concentration in the tibia and liver, assuming Mn sulfate as the standard source (100%) by the slope-ratio method. The RB of Mn proteinate based on bone strength was 111%, based on liver Mn concentration was 128%, and based on tibia Mn concentration was 105%. Manganese proteinate was more bioavailable than Mn sulfate; it can be an important source of supplementation to improve bone quality in broilers.
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http://dx.doi.org/10.1016/j.psj.2020.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647700PMC
November 2020

Prognostic Contrast between Anatomical and Clinical Models Regarding Fatal and Non-Fatal Outcomes in Acute Coronary Syndromes.

Arq Bras Cardiol 2020 08;115(2):219-225

Escola Bahiana de Medicina e Saúde Pública,Salvador, BA - Brasil.

Background: Recurrent ischemic events are mediated by atherosclerotic plaque instability, whereas death after an ischemic event results from gravity of insult and ability of the organism to adapt. The distinct nature of those types of events may respond for different prediction properties of clinical and anatomical information regarding type of outcome.

Objective: To identify prognostic properties of clinical and anatomical data in respect of fatal and non-fatal outcomes of patients hospitalized with acute coronary syndromes (ACS).

Methods: Patients consecutively admitted with ACS who underwent coronary angiography were recruited. The SYNTAX score was utilized as an anatomic model and the GRACE score as a clinical model. The predictive capacity of those scores was separately evaluated for prediction of non-fatal ischemic outcomes (infarction and refractory angina) and cardiovascular death during hospitalization. It was considered as significant a p-value <0,05.

Results: EAmong 365 people, cardiovascular death was observed in 4,4% and incidence of non-fatal ischemic outcomes in 11%. For cardiovascular death, SYNTAX and GRACE score presented similar C-statistic of 0,80 (95% IC: 0,70 - 0,92) and 0,89 (95% IC 0,81 - 0,96), respectively - p = 0,19. As for non-fatal ischemic outcomes, the SYNTAX score presented a moderate predictive value (C-statistic = 0,64; 95%IC 0,55 - 0,73), whereas the GRACE score did not presented association with this type of outcome (C-statistic = 0,50; 95%IC 0,40-0,61) - p = 0,027.

Conclusion: Clinical and anatomic models similarly predict cardiovascular death in ACS. However, recurrence of coronary instability is better predicted by anatomic variables than clinical data. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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http://dx.doi.org/10.36660/abc.20190062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384280PMC
August 2020

Predictors of gaming disorder in children and adolescents: a school-based study.

Braz J Psychiatry 2021 May-Jun;43(3):289-292

Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample.

Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses.

Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder.

Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.
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http://dx.doi.org/10.1590/1516-4446-2020-0964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136393PMC
June 2021

Diagnostic accuracy of FDG-PET/MRI versus pelvic MRI and thoracic and abdominal CT for detecting synchronous distant metastases in rectal cancer patients.

Eur J Nucl Med Mol Imaging 2021 01 20;48(1):186-195. Epub 2020 Jun 20.

Nuclear Medicine Division, Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 872, Sao Paulo, SP, 05403-010, Brazil.

Purpose: We compared the diagnostic accuracy of detecting distant metastases for baseline rectal cancer staging between PET/MRI and conventional staging (CS).

Materials And Methods: This prospective study from November 2016 to April 2018 included 101 rectal adenocarcinoma patients for primary staging. These patients underwent whole-body PET/MRI in addition to CS (pelvic MRI and thoracic and abdominal contrast-enhanced CT). Different readers analyzed CS and PET/MRI findings for primary tumor, nodal, and metastatic staging. The presence, number, and location of metastases were recorded according to the organ involved (non-regional lymph nodes (LNs), liver, lungs, or others). Lesions were defined as positive, negative, or indeterminate. The number of lesions per organ was limited to 10. The McNemar test was used to compare the accuracies.

Results: PET/MRI exhibited a higher accuracy in detecting metastatic disease than CS in all patients (88.4% vs. 82.6%, p = 0.003) and in patients with extramural vascular invasion (EMVI) (88.9% vs. 85.5%, p = 0.013). The detection rate of PET/MRI was superior to that of CS for all lesions [84.1% vs. 68.9%, p = 0.001], as well as those in the liver (89.2% vs. 84.2%), non-regional LNs (90.0% vs. 36.7%), and lungs (76.4% vs. 66.9%). PET/MRI correctly classified 19/33 (57.5%) patients with indeterminate lesions on CS.

Conclusion: PET/MRI yields higher accuracy than CS for detecting distant synchronous metastases in the baseline staging of patients with rectal cancer and EMVI. PET/MRI exhibited a higher detection rate than CS for identifying non-regional LNs, hepatic lesions, and pulmonary lesions as well as correctly classifying patients with indeterminate lesions.

Trial Registration: NCT02537340.
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http://dx.doi.org/10.1007/s00259-020-04911-xDOI Listing
January 2021

In vitro pharmacokinetics/pharmacodynamics modeling and efficacy against systemic candidiasis in Drosophila melanogaster of a bisaryloxypropanamine derivative.

Med Mycol 2021 Jan;59(1):58-66

Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

The number of deaths due to systemic fungal infections is increasing alarmingly, which is aggravated by the limitations of traditional treatments and multidrug resistance. Therefore, the research and development of new therapeutic options against pathogenic fungi is an urgent need. To evaluate the fungicidal activity of a synthetic compound, 1,3-bis-(3,4-dichlorophenoxy)propan-2-aminium chloride (2j), through time-kill studies and pharmacokinetics/pharmacodynamics (PK/PD) modeling. The protective effect of the compound was also evaluated using the Drosophila melanogaster minihost model of candidiasis. Mathematical modeling of time-kill data of compound 2j was performed to obtain PD characteristics. Additionally, Toll-deficient D. melanogaster flies were infected with a Candida albicans strain and treated with 2j. We observed that compound 2j demonstrated a time- and dose-dependent fungicidal effect against Candida spp. and dermatophytes, even at low concentrations, and rapidly achieved kill rates reaching the maximum effect in less than one hour. The efficacy of the compound against systemic candidiasis in D. melanogaster flies was comparable to that achieved by fluconazole. These results support the potential of compound 2j as a systemic antifungal agent candidate and serve as a starting point for further studies involving mammalian animal models.
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http://dx.doi.org/10.1093/mmy/myaa030DOI Listing
January 2021

Inhibition of Lrrk2 reduces ethanol preference in a model of acute exposure in zebrafish.

Prog Neuropsychopharmacol Biol Psychiatry 2020 06 4;100:109885. Epub 2020 Feb 4.

Laboratório de Genética Animal e Humana, Departamento de Genética, Ecologia e Evolução, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil. Electronic address:

Due to its multifactorial and yet to be fully understood origin, ethanol addiction is a field that still requires studies for the elucidation of novel genes and pathways that potentially influence the establishment and maintenance of addiction-like phenotypes. In this context, the present study aimed to evaluate the role of the LRRK2 pathway in the modulation of ethanol preference behavior in Zebrafish (Danio rerio). Using the behavioral Conditioned Place Preference (CPP) paradigm, we accessed the preference of animals for ethanol. Next, we evaluated the transcriptional regulation of the gene lrrk2 and the receptors drd1, drd2, grin1a, gria2a, and gabbr1b in the zebrafish brain. Additionally, we used a selective inhibitor of Lrrk2 (GNE-0877) to assess the role of this gene in the preference behavior. Our results revealed four distinct ethanol preference phenotypes (Light, Heavy, Negative Reinforcement, and Inflexible), each showing different transcriptional regulation patterns of the drd1, drd2, grin1a, gria2a, and gabbr1b receptors. We showed that the lrrk2 gene was hyperregulated only in the brains of the animals with the Inflexible phenotype. Most importantly, we showed, for the first time in the context of preference for ethanol, that treatment with the GNE-0877 inhibitor modulates the transcription of the target receptor genes and reduces the preference for ethanol in the animals of the Inflexible group. This result corroborates the hypothesis that the LRRK2 pathway is involved in the inflexible preference for ethanol behavior. Lastly, we identified a possible pharmacological target for the treatment of abusive preference behavior for ethanol.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109885DOI Listing
June 2020

Costs and benefits of bevacizumab vial sharing for the treatment of retinal diseases.

BMC Public Health 2019 Sep 11;19(1):1252. Epub 2019 Sep 11.

Universidade Estadual De Campinas (UNICAMP), Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brasil.

Background: Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital.

Method: This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA).

Results: In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%).

Conclusion: This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.
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http://dx.doi.org/10.1186/s12889-019-7562-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6740002PMC
September 2019

Imaging Findings in Transgender Patients after Gender-affirming Surgery.

Radiographics 2019 Sep-Oct;39(5):1368-1392

From the Department of Radiology, University of Missouri-Kansas City School of Medicine, 4401 Wornall Rd, Kansas City, MO 64111 (J.T.S.); Department of Radiology (J.T.S., A.K.P., S.A.S., K.J.A.) and the Department of Obstetrics and Gynecology (F.W.G.), University of Missouri-Kansas City School of Medicine, 4401 Wornall Rd, Kansas City, MO 64111; Children's Mercy Hospitals and Clinics, Kansas City, Mo (F.W.G.); Department of Radiology (D.L.K., E.R.B) and Department of Obstetrics and Gynecology (K.A.S.), University of Kansas School of Medicine, Kansas City, Kan; Department of Radiology (D.L.K., E.R.B) and Department of Obstetrics and Gynecology (K.A.S.), University of Kansas Health System, Kansas City, Kan; Brownstein-Crane Surgical Services, Austin, Tex (R.A.S.); Brownstein-Crane Surgical Services, San Francisco, Calif (C.C.); Department of Radiology, Liberty Hospital, Liberty, Mo (A.K.P.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (J.P.); Department of Radiology, Harvard Medical School, Boston, Mass (J.P); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (M.A.F., F.R.F.); Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.H.B., R.H.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (C.C.W.); Department of Radiology, Truman Medical Centers, Kansas City, Mo (S.A.S.); and Department of Radiology, Saint Luke's Hospital of Kansas City, Kansas City, Mo (K.J.A.).

Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other soft-tissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation. RSNA, 2019.
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http://dx.doi.org/10.1148/rg.2019190010DOI Listing
May 2020

Spontaneous Breathing Trial for Prediction of Extubation Success in Pediatric Patients Following Congenital Heart Surgery: A Randomized Controlled Trial.

Pediatr Crit Care Med 2019 10;20(10):940-946

All authors: Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Objectives: To evaluate the usefulness of a spontaneous breathing trial for predicting extubation success in pediatric patients in the postoperative period after cardiac surgery compared with a physician-led weaning.

Study Design: Randomized, controlled trial.

Setting: PICU of a tertiary-care university hospital.

Patients: A population of pediatric patients following cardiac surgery for congenital heart disease.

Interventions: Patients on mechanical ventilation for more than 12 hours after surgery who were considered ready for weaning were randomized to the spontaneous breathing trial group or the control group. The spontaneous breathing trial was performed on continuous positive airway pressure with the pressure support of 10 cmH2O, the positive end-expiratory pressure of 5 cmH2O, and the fraction of inspired oxygen less than or equal to 0.5 for 2 hours. Patients in the control group underwent ventilator weaning according to clinical judgment.

Measurements And Main Results: The primary endpoint was extubation success defined as no need for reintubation within 48 hours after extubation. Secondary outcomes were PICU length of stay, hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality. One hundred and ten patients with the median age of 8 months were included in the study: 56 were assigned to the spontaneous breathing trial group and 54 were assigned to the control group. Demographic and clinical data and Risk Adjustment for Congenital Heart Surgery-1 classification were similar in both groups. Patients undergoing the spontaneous breathing trial had greater extubation success (83% vs 68%, p = 0.02) and shorter PICU length of stay (median 85 vs 367 hr, p < 0.0001) compared with the control group, respectively. There was no significant difference between groups in hospital length of stay, occurrence rate of ventilator-associated pneumonia, and mortality.

Conclusions: Pediatric patients with congenital heart disease undergoing the spontaneous breathing trial postoperatively had greater extubation success and shorter PICU length of stay compared with those weaned according to clinical judgment.
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http://dx.doi.org/10.1097/PCC.0000000000002006DOI Listing
October 2019

Antibacterial and antibiotic modifying activity evaluation of ruminants' body fat used as zootherapeutics in ethnoveterinary practices in Northeast Brazil.

J Ethnopharmacol 2019 Apr 25;233:87-93. Epub 2018 Dec 25.

Universidade Regional do Cariri - URCA, Crato, CE, Brazil.

Ethnopharmacological Relevance: Northeast Brazilian ethnoveterinary studies associated with the medicinal use of zootherapies have shown that ruminants' body fat such as sheep (Ovis aries), goats (Capra hircus) and cows (Bos taurus) are used in diseases affecting domestic animals.

Aim Of The Study: The objective of this study was to evaluate the antibacterial activity of the fixed oils from these ruminants in isolation and in association with antibiotics.

Results: Ovis aries (OFOA), Capra hircus (OFCH) and Bos taurus (OFBT) fixed oils were extracted using a Soxhlet apparatus with hexane as the solvent. Through the use of gas chromatography coupled to mass spectrometry (GC-MS) the methyl esters from the ruminants' fixed oils were obtained and the fatty acids present in these oils were indirectly determined. The OFOA, OFCH and OFBT antibacterial and antibiotic modifying activities against standard and multi-resistant bacterial strains were carried out using the broth microdilution test. The fixed oils from these species did not present antibacterial activity when tested in isolation, obtaining Minimal Inhibitory Concentration (MICs) values ≥ 1024 μg/mL. However, when associated with antibiotics, OFBT and OFCH showed a synergistic activity for the Amicacin, Amoxicillin, Norfloxacin and Oxytetracycline antibiotics.

Conclusion: The OFOA promoted a synergistic action for the same antibiotics with the exception of Norfloxacin.
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http://dx.doi.org/10.1016/j.jep.2018.12.012DOI Listing
April 2019

Body fat modulated activity of Gallus gallus domesticus Linnaeus (1758) and Meleagris gallopavo Linnaeus (1758) in association with antibiotics against bacteria of veterinary interest.

Microb Pathog 2018 Nov 22;124:163-169. Epub 2018 Aug 22.

Universidade Regional do Cariri - URCA, Crato, CE, Brazil.

In the Northeast of Brazil, ethnoveterinary studies have shown that the body fat from Gallus gallus domesticus and Meleagris gallopavo are used for diseases that affect domestic animals. The objective of this study was to identify the chemical composition and to evaluate the antibacterial activity of the Gallus gallus domesticus (OFGG) and Meleagris gallopavo (OFMG) fixed oils in isolation and in association with antibiotics. The OFGG and OFMG from the poultry's body fat were extracted using hexane as a solvent in Soxhlet. Their composition was indirectly determined using fatty acid methyl esters. The OFGG and OFMG antibacterial and modulatory activities against standard and multi-resistant bacterial strains were performed through the broth microdilution test. In the OFGG chemical composition, 4 constituents were identified. The saturated fatty acid (AGS) and unsaturated fatty acid (AGI) percentages were 35.1% and 64.91% respectively, with linoleic acid being the major component. In the OFMG, 3 constituents were identified. The AGS percentage was 27.71% and 72.29% for AGI, with oleic acid as the most abundant component. The oils did not present antibacterial activity when tested in isolation, presenting Minimum Inhibitory Concentrations (MICs) > 512 μg/mL. However, when associated with antibiotics the OFGG showed synergistic activity with the antibiotics Amikacin, Amoxicillin, Norfloxacin and Oxytetracycline, while the OFMG promoted a synergistic action with the antibiotics Amikacin, Amoxicillin and Norfloxacin.
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http://dx.doi.org/10.1016/j.micpath.2018.08.029DOI Listing
November 2018

Gallbladder adenocarcinoma diagnosed from cutaneous metastases occurring along the tract of a ventriculoperitoneal shunt.

J Cutan Pathol 2018 Nov 21;45(11):870-873. Epub 2018 Aug 21.

Department of Dermatology, University of São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1111/cup.13330DOI Listing
November 2018

Inconsistency prevents the valuable synergism of explanatory and pragmatic trails.

J Evid Based Med 2018 May;11(2):105-111

Medical and Public Health School of Bahia, Salvador, Brazil.

Objective: To assess review articles on pragmatic trials in order to describe how authors define the aim of this type of study, how comprehensive methodological topics are covered, and which topics are most valued by authors.

Methods: Review articles were selected from Medline Database, based on the expression "pragmatic trial" in the titles. Five trained medical students evaluated the articles, based on a list of 15 self-explanatory methodological topics. Each article was evaluated regarding topics covered. Baseline statements on the aim of pragmatic trials were derived.

Results: Among 22 articles identified, there was general agreement that the aim of a pragmatic trial is to evaluate if the intervention works under real-world conditions. The mean number of methodological topics addressed by each article was 7.6 ± 3.1. Only one article covered all 15 topics, three articles (14%) responded to at least 75% of topics and 13 articles (59%) mentioned at least 50% of the topics. The relative frequency each of the 15 topics was cited by articles had a mean of 50% ± 25%. No topic was addressed by all articles, only three (20%) were addressed by more than 75% of articles.

Conclusions: There is agreement on the different aims of explanatory and pragmatic trials. But there is a large variation on methodological topics used to define a pragmatic trial, which led to inconsistency in defining the typical methodology of a pragmatic trial.
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http://dx.doi.org/10.1111/jebm.12299DOI Listing
May 2018

Association of the Polymorphism (Val16Ala) and SOD Activity with Vaso-occlusive Crisis and Acute Splenic Sequestration in Children with Sickle Cell Anemia.

Mediterr J Hematol Infect Dis 2018 21;10(1):e2018012. Epub 2018 Feb 21.

Biological Science Institute, University of Pernambuco Pernambuco, Brazil.

The SOD2 polymorphism Val16Ala T→C influences the antioxidative response. This study investigated the association of the SOD2 polymorphism and superoxide dismutase (SOD) activity with the vaso-occlusive crisis (VOC) and acute splenic sequestration (ASS) in children with sickle cell anemia (SCA). One hundred ninety-five children with SCA aged 1-9 years old were analyzed. The TC and CC genotypes were associated with lower SOD activity compared with the TT genotype (p=0.0321; p=0.0253, respectively). Furthermore, TC and CC were more frequent in patients with VOC or ASS (p=0.0285; p=0.0090, respectively). These results suggest that the SOD2 polymorphism associated with low SOD activity could be a susceptibility factor for the occurrence of VOC and ASS.
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http://dx.doi.org/10.4084/MJHID.2018.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841937PMC
February 2018

Optimization of rhein-loaded polymeric nanoparticles using a factorial design and evaluation of the cytotoxic and anti-inflammatory effects.

Drug Dev Ind Pharm 2018 Aug 8;44(8):1285-1294. Epub 2018 Mar 8.

a Department of Pharmacy, Faculty of Pharmacy , University of Concepción , Concepción , Chile.

The aim of the work was to develop rhein loaded polymeric nanoparticles (R-PNPs). Nanoparticles were prepared by three methods, solvent emulsion-evaporation, double emulsion, and nanoprecipitation, by means of experimental design. Additionally, the effects of the best formulation on in vitro cytotoxicity and inflammation were evaluated. The solvent emulsion-evaporation method presented the highest encapsulation efficiency of the three techniques (38.41%), as well as had a mean diameter of 189.33 nm and a polydispersity index of less than 0.1. Despite efforts to optimize the encapsulation of rhein, the drug release from nanoparticles was close to 50% during the first 5 min, followed by a continuous release within 60 min. It was observed that macrophages exposed to the highest concentration of R-PNPs showed cell viability about 80% and at the lowest nanoparticle concentrations was closed to 100%. IL-1β in cell culture supernatants was decreased in the presence of R-PNPs and TNFα concentrations were lower than the sensitivity of the assay. ROS production was only inhibited with R-PNPs at concentrations of 2.5 and 5 μM. In conclusion, the solvent emulsion-evaporation was the best method evaluated to obtain nanoparticles with the desired specifications. It was possible to assess R-PNPs with low cytotoxicity and anti-inflammatory properties showed by the inhibition of IL-1β production and a low decrease in ROS production.
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http://dx.doi.org/10.1080/03639045.2018.1445263DOI Listing
August 2018

Prognostic Accuracy of the GRACE Score in Octogenarians and Nonagenarians with Acute Coronary Syndromes.

Arq Bras Cardiol 2018 Jan 1;110(1):24-29. Epub 2018 Feb 1.

Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.

Background: The GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented.

Objective: To test the accuracy of the GRACE score in predicting in-hospital mortality of very elderly individuals with acute coronary syndromes (ACS).

Methods: Prospective observational study conducted in the intensive coronary care unit of a tertiary center from September 2011 to August 2016. Patients consecutively admitted due to ACS were selected, and the very elderly group was defined by age ≥ 80 years. The GRACE Score was based on admission data and its accuracy was tested regarding prediction of in-hospital death. Statistical significance was defined by p value < 0,05.

Results: A total of 994 individuals was studied, 57% male, 77% with non-ST elevation myocardial infarction and 173 (17%) very elderly patients. The mean age of the sample was 65 ± 13 years, and the mean age of very elderly patients subgroup was 85 ± 3.7 years. The C-statistics of the GRACE Score in very elderly patients was 0.86 (95% CI = 0.78 - 0.93), with no difference when compared to the value for younger individuals 0.83 (95% CI = 0.75 - 0.91), with p = 0.69. The calibration of the score in very elderly patients was described by χ2 test of Hosmer-Lemeshow = 2.2 (p = 0.98), while the remaining patients presented χ2 = 9.0 (p = 0.35). Logistic regression analysis for death prediction did not show interaction between GRACE Score and variable of very elderly patients (p = 0.25).

Conclusion: The GRACE Score in very elderly patients is accurate in predicting in-hospital ACS mortality, similarly to younger patients.
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http://dx.doi.org/10.5935/abc.20170175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831298PMC
January 2018

Effects of dietary inclusion of macaúba seed cake meal on performance, caecotrophy traits and in vitro evaluations for growing rabbits.

Arch Anim Nutr 2018 Apr 7;72(2):138-152. Epub 2018 Feb 7.

a Department of Animal Science , Federal University of Minas Gerais , Belo Horizonte , Brazil.

The objective was to evaluate the inclusion of macaúba seed cake (MSC) meal in diets for growing rabbits by assessing their growth and slaughtering performance, haematological traits, nutritional contribution of caecotrophs, in vitro digestibility, degradability and fermentation parameters. A total of 88 rabbits were distributed to four groups with 22 animals each and fed diets containing 0, 50, 100 and 150 g/kg of MSC, respectively. The in vitro assays were conducted employing cecum inoculum on the same dietary treatments. The inclusion of MSC yielded a quadratic effect on in vitro dry matter digestibility (p < 0.001). The maximum amount of produced gas was raised linearly with the inclusion of MSC (p = 0.016). MSC linearly reduced several variables as the nutritional contribution of caecotrophs in dry matter (p = 0.017) and crude protein (p = 0.014), live weight at 51 d (p = 0.024), body weight gain (p = 0.039), average daily feed intake (ADFI) (p = 0.001) and feed conversion ratio (FCR) (p = 0.007) in the first period evaluated (30-50 d); furthermore the ADFI and FCR the second (51-72 d) and whole period (30-72 d) (p < 0.001). MSC addition caused a quadratic effect on white blood cells count (p = 0.026) and a linear decrease of eosinophils (p = 0.045). In conclusion, the inclusion of up to 150 g/kg of MSC improves the in vitro digestibility and fermentation potential of the diets, reflecting on the ADFI and FCR of the animals, although adverse effects are observed on the weight of the commercial carcass and nutritive contribution of the caecotrophs.
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http://dx.doi.org/10.1080/1745039X.2018.1435480DOI Listing
April 2018

Evaluation of the acaricidal activity of thymol incorporated in two formulations for topical use against immature stages of Rhipicephalus sanguineus sensu lato (Latreille, 1806) (Acari: Ixodidae).

Parasitol Res 2017 Nov 5;116(11):2957-2964. Epub 2017 Sep 5.

Programa de Pós Graduação em Ciências Biológicas - Comportamento e Biologia Animal, Universidade Federal de Juiz de Fora UFJF, Juiz de Fora, Minas Gerais, Brazil.

The objective of this study was to assess, for the first time, the in vitro acaricidal activity of two topical formulations containing thymol, on immature stages of Rhipicephalus sanguineus sensu lato. For this purpose, two base formulations were prepared: an oil-in-water (O/W) emulsion and a hydroalcoholic solution, containing different thymol concentrations (0.5 to 20 mg/mL). We used the larval packet test for non-engorged larvae and nymphs, and the immersion test for engorged larvae and nymphs. For emulsion, a mortality rate of 94.2% was achieved at 0.75 mg/mL in non-engorged larvae. For engorged larvae, there was 95.0% mortality at 5.0 mg/mL. Non-engorged nymphs showed 83.3% mortality at 2.5 mg/mL, and for engorged nymphs, 86.0% mortality was verified at 5.0 mg/mL. For the hydroalcoholic solution, the mortality found for non-engorged larvae was 88.1% at 2.5 mg/mL. For engorged larvae, the highest mortality was 25.0% at 20 mg/mL; non-engorged nymphs had 91.0% mortality at 1.0 mg/mL and for engorged nymphs; the maximum value verified was 18.3% mortality at 20 mg/mL. Preliminary stability tests were carried, and the hydroalcoholic solution remained stable under all the conditions analyzed. The O/W emulsion showed signs of early instability at the concentration of 5.0 mg/mL. The results obtained indicate that the acaricidal activity of thymol, when included in the proposed formulations, was enhanced against non-engorged larvae with topical treatment in comparison with data in the literature. Although there were variations in toxicity between the different stages, these formulations are promising for future therapeutic use.
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http://dx.doi.org/10.1007/s00436-017-5604-xDOI Listing
November 2017

Zero Calcium Score as a Filter for Further Testing in Patients Admitted to the Coronary Care Unit with Chest Pain.

Arq Bras Cardiol 2017 Jun 12. Epub 2017 Jun 12.

Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.

Background:: The accuracy of zero coronary calcium score as a filter in patients with chest pain has been demonstrated at the emergency room and outpatient clinics, populations with low prevalence of coronary artery disease (CAD).

Objective:: To test the gatekeeping role of zero calcium score in patients with chest pain admitted to the coronary care unit (CCU), where the pretest probability of CAD is higher than that of other populations.

Methods:: Patients underwent computed tomography for calcium scoring, and obstructive CAD was defined by a minimum 70% stenosis on invasive angiography.

Results:: In 146 patients studied, the prevalence of CAD was 41%. A zero calcium score was present in 35% of the patients. The sensitivity and specificity of zero calcium score yielded a negative likelihood ratio of 0.16. After logistic regression adjustment for pretest probability, zero calcium score was independently associated with lower odds of CAD (OR = 0.12, 95%CI = 0.04-0.36), increasing the area under the ROC curve of the clinical model from 0.76 to 0.82 (p = 0.006). Zero calcium score provided a net reclassification improvement of 0.20 (p = 0.0018) over the clinical model when using a pretest probability threshold of 10% for discharging without further testing. In patients with pretest probability < 50%, zero calcium score had a negative predictive value of 95% (95%CI = 83%-99%), with a number needed to test of 2.1 for obtaining one additional discharge.

Conclusion:: Zero calcium score substantially reduces the pretest probability of obstructive CAD in patients admitted to the CCU with acute chest pain. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

Fundamento:: A acurácia do escore de cálcio coronário zero como um filtro nos pacientes com dor torácica aguda tem sido demonstrada na sala de emergência e nos ambulatórios, populações com baixa prevalência de doença arterial coronariana (DAC).

Objetivos:: Testar o papel do escore de cálcio zero como filtro nos pacientes com dor torácica admitidos numa unidade coronariana intensiva (UCI), na qual a probabilidade pré-teste de DAC é maior do que em outras populações.

Métodos:: Pacientes foram submetidos a tomografia computadorizada para quantificar o escore de cálcio, DAC obstrutiva foi definida por uma estenose mínima de 70% na cineangiocoronariografia invasiva. Um escore clínico para estimar a probabilidade pré-teste de DAC obstrutiva foi criado em amostra de 370 pacientes, usado para definir subgrupos na definição de valores preditivos negativos do escore zero.

Resultados:: Em 146 pacientes estudados, a prevalência de DAC foi 41% e o escore de cálcio zero foi demonstrado em 35% deles. A sensibilidade e a especificidade para escore de cálcio zero resultaram numa razão de verossimilhança negativa de 0,16. Após ajuste com um escore clínico com a regressão logística para a probabilidade pré-teste, o escore de cálcio zero foi preditor independente associado a baixa probabilidade de DAC (OR = 0,12, IC95% = 0,04-0,36), aumentando a área abaixo da curva ROC do modelo clínico de 0,76 para 0,82 (p = 0,006). Considerando a probabilidade de DAC < 10% como ponto de corte para alta precoce, o escore de cálcio aumentou a proporção de pacientes para alta precoce de 8,2% para 25% (NRI = 0,20; p = 0,0018). O escore de cálcio zero apresentou valor preditivo negativo de 90%. Em pacientes com probabilidade pré-teste < 50%, o valor preditivo negativo foi 95% (IC95% = 83%-99%).

Conclusão:: O escore de cálcio zero reduz substancialmente a probabilidade pré-teste de DAC obstrutiva em pacientes internados em UCI com dor torácica aguda. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).
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http://dx.doi.org/10.5935/abc.20170076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576112PMC
June 2017

Antibacterial, modulatory activity of antibiotics and toxicity from Rhinella jimi (Stevaux, 2002) (Anura: Bufonidae) glandular secretions.

Biomed Pharmacother 2017 Aug;92:554-561

Universidade Regional do Cariri-URCA, Crato, CE, Brazil.

The increase in microorganisms with resistance to medications has caused a strong preoccupation within the medical and scientific community. Animal toxins studies, such as parotoid glandular secretions from amphibians, possesses a great potential in the development of drugs, such as antimicrobials, as these possess bioactive compounds. It was evaluated Rhinella jimi (Stevaux, 2002) glandular secretions against standard and multi-resistant bacterial strains; the effect of secretions combined with drugs; and determined the toxicity using two biologic in vivo models, and a in vitro model with mice livers. Standard strains were used for the determination of the Minimum Inhibitory Concentration (MIC), while for the modulatory activity of antibiotics, the clinical isolates Escherichia coli 06, Pseudomonas aeruginosa 03 and Staphylococcus aureus 10 were used. Modulatory activity was evaluated by the broth microdilution method with aminoglycosides and β-lactams as target antibiotics. The secretions in association with the antibiotics have a significant reduction in MIC, both the aminoglycosides and β-lactams. The toxicity and cytotoxicity results were lower than the values used in the modulation. R. jimi glandular secretions demonstrated clinically relevant results regarding the modulation of the tested antimicrobials.
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http://dx.doi.org/10.1016/j.biopha.2017.05.098DOI Listing
August 2017

A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation.

Arq Bras Cardiol 2017 Apr;108(4):304-314

Escola Bahiana de Medicina e Saúde Pública; Salvador, BA - Brazil.

Background:: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain.

Objective:: To develop and validate a multivariate model to predict coronary artery disease (CAD) based on variables assessed at admission to the coronary care unit (CCU) due to acute chest pain.

Methods:: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%), while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested.

Results:: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC) of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84) in the derivation sample and 0.86 (95%CI = 0.79 - 0.93) in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively). Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002) and validation (p = 0.039) samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001) and validation (p < 0.0015) samples.

Conclusion:: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain.

Fundamento:: Atualmente, não existe um modelo multivariado validado para predizer a probabilidade de doença coronariana obstrutiva em pacientes com dor torácica aguda.

Objetivo:: Desenvolver e validar um modelo multivariado para predizer doença arterial coronariana (DAC) com base em variáveis avaliadas à admissão na unidade coronariana (UC) devido a dor torácica aguda.

Métodos:: Foram estudados um total de 470 pacientes, 370 utilizados como amostra de derivação e os subsequentes 100 pacientes como amostra de validação. Como padrão de referência, a angiografia foi necessária para descartar DAC (estenose ≥ 70%), enquanto a angiografia ou um teste não invasivo negativo foi utilizado para confirmar a doença. Foram testadas como preditoras 13 variáveis basais relacionadas à história médica, 14 características de desconforto torácico e oito variáveis relacionadas ao exame físico ou testes laboratoriais.

Resultados:: A prevalência de DAC foi de 48%. Por regressão logística, seis variáveis permaneceram como preditoras independentes de DAC: idade, gênero masculino, alívio com nitrato, sinais de insuficiência cardíaca, e eletrocardiograma e troponina positivos. A área sob a curva (area under the curve, AUC) deste modelo final foi de 0,80 (intervalo de confiança de 95% [IC95%] = 0,75 - 0,84) na amostra de derivação e 0,86 (IC95% = 0,79 - 0,93) na amostra de validação. O teste de Hosmer-Lemeshow indicou uma boa calibração em ambas as amostras (p = 0,98 e p = 0,23, respectivamente). Em comparação com o modelo básico contendo eletrocardiograma e troponina, o modelo completo ofereceu um incremento na AUC de 0,07 tanto na amostra de derivação (p = 0,0002) quanto na de validação (p = 0,039). A melhoria na discriminação integrada foi de 0,09 nas amostras de derivação (p < 0,001) e validação (p < 0,0015).

Conclusão:: Um modelo multivariado foi derivado e validado como uma ferramenta acurada para estimar a probabilidade pré-teste de DAC em pacientes com dor torácica aguda.
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http://dx.doi.org/10.5935/abc.20170037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421469PMC
April 2017

Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease.

World J Cardiol 2017 Mar;9(3):241-247

Cláudio Marcelo Bittencourt das Virgens, Márcia Noya-Rabelo, Luís Cláudio Lemos Correia, Department of Cardiology, Hospital São Rafael, Salvador, Bahia 41253-190, Brazil.

Aim: To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain.

Methods: We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure.

Results: In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt's numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37).

Conclusion: Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.
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http://dx.doi.org/10.4330/wjc.v9.i3.241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368673PMC
March 2017

Probing -violating Higgs and gauge-boson couplings in the Standard Model effective field theory.

Eur Phys J C Part Fields 2017 12;77(10):675. Epub 2017 Oct 12.

Laboratoire de Physique Subatomique et de Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3, Avenue des Martyrs 53, 38026 Grenoble, France.

We study the phenomenological consequences of several -violating structures that could arise in the Standard Model effective field theory framework. Focusing on operators involving electroweak gauge and/or Higgs bosons, we derive constraints originating from Run I LHC data. We then study the capabilities of the present and future LHC runs at higher energies to further probe associated -violating phenomena and we demonstrate how differential information can play a key role. We consider both traditional four-lepton probes of -violation in the Higgs sector and novel new physics handles based on varied angular and non-angular observables.
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http://dx.doi.org/10.1140/epjc/s10052-017-5226-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956952PMC
October 2017

Evaluation of antimicrobial, cytotoxic, and hemolytic activities from venom of the spider Lasiodora sp.

Toxicon 2016 Nov 29;122:119-126. Epub 2016 Sep 29.

Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, PE, Brazil. Electronic address:

This study characterized the protein/peptide profile of venom isolated from the spider Lasiodora sp. (Mygalomorphae, Theraphosidae) found in northeastern Brazil and determined its antimicrobial activity, toxicity against human cells, and hemolytic activity. Protein concentration of the Lasiodora sp. venom was 4.53 ± 0.38 mg/mL. SDS-PAGE showed proteins with molecular masses up to 75 kDa, some of which contained disulfide bridges. RP-HPLC analysis separate at least 12 peaks that were identified by mass spectrometry as peptides U-theraphotoxin-Lp1a (lasiotoxin-1), U-theraphotoxin-Lp1c (lasiotoxin-3), U-theraphotoxin-Lsp1a (LTx5), and ω-theraphotoxin-Asp3a as well as the proteins phospholipase A (PLA) and hyaluronidase. The crude venom exhibited bactericidal effect against Aeromonas sp., Bacillus subtilis, and Micrococcus luteus and fungicidal effect against Candida parapsilosis and Candida albicans. In addition, the venom exerted bacteriostatic effect against Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus and fungistatic effect against Candida tropicalis and Candida krusei. The minimum inhibitory (MIC), minimum bactericidal (MBC), and minimum fungicidal (MFC) concentrations ranged from 3.9 to 500 μg/mL. The Lasiodora sp. venom decreased the viability of human peripheral blood mononuclear cells (PBMCs) by 50%-90% at concentrations of 0.1, 1, 10, and 100 μg/mL, promoting apoptosis of these cells. On the other hand, the venom showed weak hemolytic activity against Mus musculus erythrocytes (EC: 757 μg/mL). In conclusion, the Lasiodora sp. spider venom is a rich source of antimicrobial agents. Future studies will focus on identifying antimicrobial agents present in this venom and evaluating whether these agents contribute to its cytotoxic effects against PBMCs.
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http://dx.doi.org/10.1016/j.toxicon.2016.09.019DOI Listing
November 2016

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology.

Rev Assoc Med Bras (1992) 2016 Sep-Oct;62(5):421-7

Specialist in General and Breast Radiology - Assistant Physician of the Diagnostic Imaging Service at Santa Casa de São Paulo and the FEMME, Laboratório da Mulher, São Paulo, SP, Brazil.

Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS.

Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI.

Results: The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases.

Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.
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http://dx.doi.org/10.1590/1806-9282.62.05.421DOI Listing
April 2017

Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution.

Radiol Bras 2016 Jan-Feb;49(1):6-11

Imaging Diagnosis Specialist, MD, Resident in General Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy.

Materials And Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations.

Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%.

Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.
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http://dx.doi.org/10.1590/0100-3984.2014.0110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770389PMC
March 2016
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