El electrocardiograma en el diagnóstico de la hipertrofia ventricular de pacientes con enfermedad renal crónica

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE: To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS: Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 ± 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearson's linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION: ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterización y prevalencia en la enfermedad renal crónica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnóstico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiográficos, correlacionándolos al índice de masa del ventrículo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. MÉTODOS: Estudio transversal que incluyó a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 años) con ERC de todas las etiologías, desde hace al menos 6 meses en hemodiálisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el término de las sesiones de HD. RESULTADOS: La HVI se detectó en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estándar concéntrico y 27 (32,6%) el estándar excéntrico de HVI. Todos los métodos electrocardiográficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnósticas superiores al 50%. Mediante la correlación lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presentó coeficiente > 0,50. Sin embargo, el cálculo de la razón de verosimilitud evidenció que el ECG tiene poder discriminatorio para diagnóstico de HVI en la población estudiada, con énfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlación entre IMVI con el QTc y su dispersión. CONCLUSIÓN: El ECG es un método útil, eficaz y de alta reproductibilidad en el diagnóstico de HVI de los pacientes en HD. En esa población, el criterio de Producto de Cornell fue más fiable para la detección de HVI.FUNDAMENTO: A hipertrofia ventricular esquerda (HVE) é um fator preditor independente de risco cardiovascular e sua caracterização e prevalência na doença renal crônica (DRC) carecem de melhor estudo. OBJETIVO: Estabelecer o diagnóstico de HVE em pacientes com DRC em estágio 5 por seis diferentes critérios eletrocardiográficos, correlacionando-os com o índice de massa do ventrículo esquerdo (IMVE) obtido pelo ecocardiograma. MÉTODOS: Estudo transversal que incluiu 100 pacientes (58 homens e 42 mulheres, idade de 46,2 ± 14,0 anos) com DRC de todas as etiologias, há pelo menos seis meses em hemodiálise (HD). Foram obtidos eletrocardiograma (ECG) e ecocardiograma dos pacientes, sempre até uma hora após o término das sessões de HD. RESULTADOS: A HVE foi detectada em 83 pacientes (83%), dos quais 56 (67,4%) apresentavam o padrão concêntrico e 27 (32,6%) o padrão excêntrico de HVE. Todos os métodos eletrocardiográficos estudados tiveram sensibilidade, especificidade e acurácia diagnósticas acima de 50%. Pela correlação linear de Pearson com o IMVE, apenas o critério de Sokolow-Lyon voltagem não apresentou coeficiente > 0,50. Já o cálculo da razão de verossimilhança mostrou que o ECG possui poder discriminatório para diagnóstico de HVE na população estudada, com ênfase para os critérios de Cornell produto e Romhilt-Estes. Não houve correlação entre IMVE com o QTc e sua dispersão. CONCLUSÃO: O ECG é um método útil, eficaz e de alta reprodutibilidade no diagnóstico de HVE dos pacientes em HD. Nessa população, o critério de Cornell produto mostrou-se o mais fidedigno para a detecção de HVE.Universidade Estadual de Ciências da Saúde de AlagoasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Left ventricular mass and cardiothoracic index in patients with chronic renal disease on hemodialysis

Introduction:Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). Objective:To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. Methods:Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. Results:LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p 0,5 - esteve presente em 61 pacientes (61%). Foram os seguintes os valores de sensibilidade, especificidade e acurácia, respectivamente, para a variável ICT: 66,2%, 70,5% e 68,0%. A correlação de Pearson entre ICT e índice de massa do ventrículo esquerdo (IMVE) foi de 0,552 (p < 0,05) e razão de verossimilhança positivo de 2,2. Conclusão:A radiografia de tórax é um exame seguro e útil como ferramenta diagnóstica de HVE em pacientes com DRC em HD.Universidade Federal de São Paulo (UNIFESP)Universidade Estadual de Ciências da Saúde de AlagoasUniversidade de São PauloUniversidade Federal de AlagoasUniversidade Federal de SergipeUNIFESPSciEL

Task force for the diagnosis of thrombotic microangiopathy / Força-tarefa para o diagnóstico de microangiopatia trombótica

Background: Thrombotic microangiopathy triggers microangiopathic hemolytic anemia, thrombocytopenia, and organic injuries. It is a rare and serious condition that demands specific approaches and strategies to recognize it promptly, especially in critically ill patients. The task force could be an effective model. Methods: An evaluative study of the impact of a task force in establishing a routine for the diagnosis of TMA in ICUs. A standard flowchart was used for 90 consecutive days and a low platelet count was the driver for the collection of epidemiological and laboratory data. Suspicion of typical HUS was proven after analyzing haptoglobin, LDH, creatinine, ADAMTS-13 enzyme, and Shiga toxin levels.  Meetings were also held with ICU personnel and the self-explanatory flowchart was fine tuned. Results: There were 490 patients (55.9% male and 44.1% female) aged 59.5 ± 21.13 years. Forty-two percent of patients in the sample had thrombocytopenia. Out of the 42 patients, five (1.02%) had TTP, three (0.6%) were presumed to have atypical HUS, and none had typical HUS. The task force remained in touch with researchers to assess diagnoses and three other suspected cases of atypical HUS underwent specific treatment.Discussion: Only 1.62% of the sampled patients had TMA. Despite its complexity, the task force model is useful in situations in which higher technology is the norm.  Conclusion: The use of a task force has proven to be effective in establishing a diagnostic practice for a health condition deemed rare or exceedingly rare

Perfil de sensibilidade de uroculturas realizadas em Maceió – AL / Sensitivity pattern of urine cultures realized in Maceió – AL

O conhecimento do perfil de sensibilidade das uroculturas de uma determinada região facilita o tratamento, reduz custos e pode prevenir o desenvolvimento de patógenos resistentes. O objetivo deste trabalho foi avaliar o perfil de prevalência, sensibilidade e resistência dos microrganismos em uroculturas. Foram analisadas 2949 uroculturas de dois laboratórios diferentes na cidade de Maceió – AL, com perfil de pacientes ambulatoriais, no período de janeiro de 2017 a dezembro de 2018. Das uroculturas positivas, constatou-se maior prevalência no sexo feminino (86,5%), sendo a Escherichia coli o patógeno mais frequente (61,5%). O antibiótico de menor percentual de resistência nas culturas que isolaram E. coli foi a Amoxicilina com Clavulanato (95,1%). O agente mais prevalente na infância em comparação às outras faixas etárias foi o Proteus mirabilis ao passo que, nos idosos, foi a Klebsiella pneumoniae. Do total, 169 amostras apresentaram microrganismos produtores de Beta Lactamase de Espectro Estendido (ESBL), sendo as mulheres e os idosos os pacientes mais acometidos. Dessas bactérias, a E. coli foi a mais frequente, cuja prevalência de maior sensibilidade foi à Amicacina. Neste estudo, concluiu-se que a ITU continua mais prevalente no sexo feminino, sendo a Escherichia coli o patógeno mais frequente; a Amoxicilina com Clavulanato foi o antibiótico de menor resistência e observamos 5,7% de prevalência de microrganismos ESBL, o que merece atenção por se tratar de um estudo onde foram incluídos apenas pacientes ambulatoriais

Evidence for Reductive Genome Evolution and Lateral Acquisition of Virulence Functions in Two Corynebacterium pseudotuberculosis Strains

Ruiz JC, D'Afonseca V, Silva A, et al. Evidence for Reductive Genome Evolution and Lateral Acquisition of Virulence Functions in Two Corynebacterium pseudotuberculosis Strains. PLoS ONE. 2011;6(4): e18551.Background: Corynebacterium pseudotuberculosis, a Gram-positive, facultative intracellular pathogen, is the etiologic agent of the disease known as caseous lymphadenitis (CL). CL mainly affects small ruminants, such as goats and sheep; it also causes infections in humans, though rarely. This species is distributed worldwide, but it has the most serious economic impact in Oceania, Africa and South America. Although C. pseudotuberculosis causes major health and productivity problems for livestock, little is known about the molecular basis of its pathogenicity. Methodology and Findings: We characterized two C. pseudotuberculosis genomes (Cp1002, isolated from goats; and CpC231, isolated from sheep). Analysis of the predicted genomes showed high similarity in genomic architecture, gene content and genetic order. When C. pseudotuberculosis was compared with other Corynebacterium species, it became evident that this pathogenic species has lost numerous genes, resulting in one of the smallest genomes in the genus. Other differences that could be part of the adaptation to pathogenicity include a lower GC content, of about 52%, and a reduced gene repertoire. The C. pseudotuberculosis genome also includes seven putative pathogenicity islands, which contain several classical virulence factors, including genes for fimbrial subunits, adhesion factors, iron uptake and secreted toxins. Additionally, all of the virulence factors in the islands have characteristics that indicate horizontal transfer. Conclusions: These particular genome characteristics of C. pseudotuberculosis, as well as its acquired virulence factors in pathogenicity islands, provide evidence of its lifestyle and of the pathogenicity pathways used by this pathogen in the infection process. All genomes cited in this study are available in the NCBI Genbank database (http://www.ncbi.nlm.nih.gov/genbank/) under accession numbers CP001809 and CP001829

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Associação de PTH e espessura carotídea em pacientes com falência renal crônica e hiperparatireoidismo secundário

Introdução: Doenças cardiovasculares (DCVs) são as principais causas de mortalidade em pacientes portadores de falência renal crônica (FRC). Diversos fatores de risco estão envolvidos na patogênese e são classificados em tradicionais - que afetam a população em geral; e não tradicionais - que são peculiares aos pacientes renais crônicos. Hiperparatireoidismo secundário, um fator não tradicional e comum na FRC, causa aumento da taxa de reabsorção óssea e mobilização do cálcio e do fósforo. À medida que o produto cálcio x fósforo aumenta, a solubilidade desse par iônico pode ser excedida e ocorrer deposição de fosfato de cálcio nos tecidos cardiovasculares (denominada calcificação metastática). Objetivo: Verificar possível relação entre a espessura da artéria carótida primitiva e os níveis de PTH em pacientes com FRC. Métodos: Foram realizados exames ultrassonográficos com Doppler para medir a espessura da artéria carótida e avaliar possíveis correlações entre diferentes elevações nos níveis séricos do PTH, distúrbios minerais e fatores de risco tradicionais e as alterações encontradas na carótida de portadores de FRC dialítica e hiperparatireoidismo secundário. Resultados: Foi observada diferença no nível de colesterol e na idade dos pacientes que apresentavam sinais de calcificação arterial. Também foi detectada relação significativa entre os níveis de PTH e a espessura da parede da carótida (r = 0,31; p = 0,03). Conclusão: Dados desse estudo mostram a possível concomitância de fatores tradicionais e os relacionados com a FRC na gênese das DCVs na uremia