Análise da eficácia do uso terapêutico da trimetazidina nas principais síndromes coronarianas agudas

A injúria de reperfusão, ou isquemia, é um mecanismo fisiopatológico que ocorre nas etiopatogenias do miocárdio, como na angina instável. Assim, são utilizados fármacos adjuvantes citoprotetores, como a trimetazidina (TMZ), que visam à diminuição do tempo de hospitalização e melhora na função cardíaca com ação profilática contra essa lesão. No entanto, apesar dos seus potenciais benefícios no tratamento da síndrome coronariana aguda, ainda não está clara a sua eficácia em relação a outras terapias disponíveis. Nesse sentido, o objetivo do estudo é analisar a eficácia do uso terapêutico da trimetazidina nas principais síndromes coronarianas agudas. Foi realizada uma revisão sistemática usando as bases de dados PubMed, Cochrane Library e Embase. Um total de 3 estudos foi incluído na análise. Os resultados mostraram que a terapia com trimetazidina reduziu significativamente a incidência de eventos cardíacos adversos maiores (ECAM) (OR = 0,33, IC 95% 0,15-0,75, p = 0,007), menor dano miocárdico (p < 0,05) e fração de ejeção ventricular esquerda mais elevada e menos eventos adversos em comparação com o grupo placebo (p < 0,05). Não foram observadas diferenças significativas entre os grupos de trimetazidina e controle em termos de mortalidade por todas as causas, mortalidade cardiovascular ou incidência de eventos adversos. Os resultados deste estudo sugerem que a terapia adjuvante com trimetazidina pode melhorar os resultados clínicos e a função cardíaca em pacientes com IAM sem aumentar o risco de eventos adversos. No entanto, são necessários mais ensaios clínicos randomizados em larga escala para confirmar esses resultados e determinar a duração e dose ideais da terapia com trimetazidina nessa população de pacientes

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

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ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Genetic evaluation and the economic values of performance traits in swine

Dados de suínos Large White (LW), Landrace (LD) e Duroc (DU) foram utilizados na estimação dos componentes de variância, dos valores genéticos e das tendências genéticas e na determinação dos valores econômicos para peso ajustado aos 70 dias (PA70), ganho de peso diário (GPD) e espessura de toucinho (ET). Os componentes de (co)variância foram estimados pelo método de máxima verossimilhança restrita (REML). Esses componentes foram utilizados no cálculo das estimativas das herdabilidades; do efeito comum de leitegada; e das correlações genética, de leitegada e residual; bem como na avaliação genética dos animais. As estimativas de tendências genéticas foram obtidas por meio da regressão das médias dos valores genéticos das características, em função do ano de nascimento do animal. Os valores econômicos foram obtidos por meio da derivada parcial da equação de lucro por suíno, em relação a PA70, GPD e ET. As características apresentaram valores de herdabilidades de médio a alto, indicando a possibilidade de ganhos genéticos por meio de seleção. As correlações genéticas entre PA70 e GPD (LW = 0,46; LD = 0,08; e DU = -0,47) e entre PA70 e ET (LW = 0,48; LD = 0,31; e DU = 0,47) indicam que a pré-seleção, efetuada aos 70 dias, pode influir na seleção de GPD e ET. As correlações entre GPD e ET (LW = 0,31; LD = 0,33; e DU = 0,02) indicam que a associação entre essas duas características pode atrasar o progresso genético, quando estas são selecionadas, separadamente, em programas de melhoramento genético, razão por que deverão ser selecionadas pelo uso de metodologias ou procedimentos multivariados. As estimativas de tendência genética, para PA70 (LW = -0,22; LD = -0,24; e DU = -0,57), foram negativas, em razão, provavelmente, da maior ênfase dada à seleção de GPD e ET e das correlações entre essas características. As estimativas de tendência genética, para GPD (LW = 14,11; LD = 9,81; e DU = 2,75) e ET (LW = -0,07; LD = -0,05; e DU = -0,04), estão de acordo com os objetivos do programa e com a correlação existente entre essas características, assim como os valores econômicos, para GPD (aGPD = 0,0052) e ET (aET = -3,70), estão em conformidade com o objetivo da indústria suinícola, que é obter um animal com maior quantidade de carne magra, por meio de maior ênfase na seleção de ET do que de GPD.Data for of Large White (LW), Landrace (LD) and Duroc (DU) swine were used in estimation of the variance components, breeding values and genetic trends as well as in determination of the economic values for adjusted weight at 70-days old (PA70), daily weight gain (GPD) and backfat thickness (ET). The (co)variance components were estimated by the restricted maximum likelihood method (REML). These components were used in calculation of the estimates of heritabilities; common litter effect; and genetic, common litter and residual correlations; as well as in the genetic evaluation of the animals. The genetic trends were estimated by regression of the averages of breeding values as a function of the animal birth year. The economic values were obtained by the partial derivative of the profit equation for each pig in relation to PA70, GPD and ET. The heritability values for the traits ranged from medium to high, so indicating the probability of genetic gains by selection. The genetic correlations between PA70 and GPD (LW = 0.46; LD = 0.08; and DU = -0.47) and between PA70 and ET (LW = 0.48; LD = 0.31; and DU = 0.47) indicate that the prior selection performed at 70-days old might affect the GPD and ET selection. Correlations between GPD and ET (LW = 0.31; LD = 0.33; and DU = 0.02) indicate that the association between these traits might decrease the genetic advance, when these traits are selected separately in the genetic improvement programs, suggesting that their selection should be based on multivariate methodologies or procedures. The estimates of the genetic trend for PA70 (LW = -0.22; LD = -0.24; and DU = -0.57) were negative, probably due to a greater emphasis given to the selection for GPD and ET and the correlations between these traits as well. The estimates of the genetic trend for GPD (LW = 14.11; LD = 9.81; and DU = 2.75) and ET (LW = -0.07; LD = -0.05; and DU = -0.04) are according to the objectives of the genetic improvement program and to correlation existing between these traits as well. Also the economical values for GPD (aGPD = 0.0052) and ET (aET = -3.70) are according to the objective of the swine industry, which consists in obtaining an animal with a greater amount of lean meat by selecting with more emphasis upon ET than GPD.Conselho Nacional de Desenvolvimento Científico e Tecnológic