Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Prevalência de asma em escolares Prevalence of asthama in schoolchildren

OBJETIVO: avaliar a prevalência dos sintomas e da doença de asma em crianças, em razão da alta freqüência de pacientes pediátricos com sintomas sugestivos da doença e da falta de dados de prevalência nesta população. MÉTODOS: Num estudo transversal, foram avaliados 2.735 escolares na faixa etária de 6-7 anos (crianças) e 3.509 na de 13-14 anos (adolescentes), escolhidos por amostragem aleatória. Os dados foram coletados em 1998-99 utilizando-se o questionário escrito traduzido do International Study of Asthma and Allergies in Children (ISAAC), previamente testado e validado. O questionário dirigido às crianças foi respondido pelos seus responsáveis, enquanto os adolescentes responderam em sala de aula. Os dados foram transcritos e analisados pelo programa EPI-info. RESULTADOS: Taxa de devolução: 73,2% (6-7 anos) e 94% (13-14 anos). Prevalência dos sintomas nas crianças e adolescentes: sibilos alguma vez, 46,7% e 44,3% (p < 0,05); sibilos nos últimos 12 meses, 22,7% e 21,2%; fala prejudicada por sibilos, 4,8% e 4,0%, sibilos aos exercícios, 6,3% e 18,2% (p < 0,05); tosse seca noturna, 38,5% e 45,8% (p < 0,05), asma (bronquite) alguma vez 28,2% e 26,4% (p = 0,11). CONCLUSÕES: A prevalência dos sintomas e da doença de asma encontradas nos dois grupos está entre as maiores relatadas no Brasil, sendo compatíveis com as maiores taxas encontradas no mundo com o questionário do ISAAC. A alta prevalência dos sintomas sugere uma elevada prevalência da doença, o que a torna um importante problema de saúde pública nesta região.<br>OBJECTIVE: to assess the prevalence of asthma symptoms and of asthma in children due to the high frequency of pediatrics patients with symptoms suggestive of the disease and to the lack of data regarding prevalence of asthma in this population. METHODS: We carried out a cross-sectional study with 2,735 school-age children aged 6-7 years and 3,509 adolescents aged 13-14 years selected by random sampling. Data were collected between 1998 and 1999 using a translated version of the questionnaire of the International Study of Asthma and Allergies in Children, which has been previously tested and approved. Guardians were responsible for answering the questionnaire of younger children, whereas adolescents answered their own, in classroom. The data were computed and analyzed using EPI-info software. RESULTS: The response rates for questionnaires were 73.2% (6-7-years old) and 94% (13-14 years old). The prevalence of symptoms in children and adolescents were, respectively: wheezing ever 46.7% and 44.3% (P<0.05); wheezing in the last 12 months 22.7% and 21.2%; speech limited due to wheezing 4.7% and 4.0%; wheezing following exercise 6.3% and 18.2% (P<0.05); nighttime cough in the last 12 months 38.5% and 45.8% (P<0.05); asthma (bronchitis) ever 28.2% and 26.4% (P=0.11). CONCLUSIONS: The prevalence of asthma symptoms and of asthma of the two groups are among the highest results ever reported in Brazil; these results were compatible with those of high prevalence results reported worldwide using ISAAC questionnaires. The high prevalence of symptoms suggests a high prevalence of the disease, which makes asthma an important problem for public health in the region

Label-free quantitative proteomics of enriched nuclei from sugarcane (saccharum ssp) stems in response to drought stress

Drought is considered the major abiotic stress limiting crop productivity. This study seeks to identify proteins involved in the drought response in sugarcane stems submitted to drought stress. The integration of nuclei enrichment sample preparation with the shotgun proteomic approach results in great coverage of the sugarcane stem proteome with 5381 protein groups identified. A total of 1204 differentially accumulated proteins are detected in response to drought, among which 586 and 618 are increased and reduced in abundance, respectively. A total of 115 exclusive proteins are detected, being 41 exclusives of drought-stressed plants and 74 exclusives of control plants. In the control plants, most of these proteins are related to cell wall metabolism, indicating that drought affects negatively the cell wall metabolism. Also, 37 transcription factors (TFs) are identified, which are low abundant nuclear proteins and are differentially accumulated in response to drought stress. These TFs are associated to protein domains such as leucine-rich (bZIP), C2H2, NAC, C3H, LIM, Myb-related, heat shock factor (HSF) and auxin response factor (ARF). Increased abundance of chromatin remodeling and RNA processing proteins are also observed. It is suggested that these variations result from an imbalance of protein synthesis and degradation processes induced by drought1914CNPQ - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulo008/58035-6; 2013/10779-5; 14/25994-1; 2016/06236sem informaçã

Growth of exclusively breast-fed infants from a poor urban population

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-upCrescimento de crianças exclusivamente amamentadas ao seio em população urbana pobre. O crescimento de dois grupos de crianças foi avaliado, um deles amamentado exclusivamente ao seio (105 crianças) e o outro exclusivamente de forma artificial (61 crianças), comparando-os entre si e com os padrões internacionais (NCHS). Todas as crianças foram avaliadas por antropometria nas idades de 1, 2, 3, 4, 5 e 6 meses. Adotou-se um polinômio de quarta ordem para cada criança e para cada medida antropométrica, a fim de estimar o seu crescimento individual, obtendo-se os percentis 5, 50 e 95, para peso e comprimento. Para a idade de 6 meses, os pesos de meninos e meninas em aleitamento natural foram sempre estatisticamente maiores ou iguais em relação às crianças que usaram leite de vaca ou em relação aos padrões do NCHS. Os meninos em aleitamento natural apresentaram comprimento estatisticamente superior àqueles em aleitamento artificial mas inferior aos padrões do NCHS; as meninas em aleitamento natural apresentaram comprimento estatisticamente inferior tanto em relação àquelas em aleitamento artificial quanto aos padrões do NCHS. Ressalta-se que, provavelmente, o grande sucesso obtido em relação ao peso das crianças em aleitamento materno exclusivo ainda aos seis meses de idade, diferenciando esse estudo de vários outros realizados em países em desenvolvimento, deva-se à somatório dos efeitos benéficos do aleitamento materno ao acompanhamento de Puericultur

Is Suppression of Hypothalamic-Pituitary-Adrenal Axis Significant During Clinical Treatment of Phimosis?

Purpose: Corticoids have been an option for phimosis treatment since 1993. However, long-term use or repeated cycles pose a concern regarding drug absorption and consequent systemic effects. The aim of this study was to investigate the effect of topical corticoids used in treating phimosis on the hypothalamus-pituitary-adrenal axis in children. Materials and Methods: A total of 31 children were included in the study. Cortisol secretion was evaluated by the measurement of salivary cortisol in saliva samples collected at 9:00 a.m, before starting treatment and after 8 weeks of topical treatment with 0.05% clobetasol propionate. Salivary cortisol was determined by radioimmunoassay. To confirm that use of clobetasol propionate was not detected by the assay, the presence of cortisol circadian rhythm was checked by an extra saliva sample obtained at 11:00 p.m. from 10 children, and was observed to be maintained in all of them. Results: No significant difference in salivary cortisol levels was observed between samples obtained at 9:00 a.m. before starting treatment and after completing treatment when the entire group was analyzed. However, in 2 children the salivary cortisol levels after treatment were lower than the cutoff value (358 ng/dl) assumed to be suggestive of hypothalamus-pituitary-adrenal axis suppression. Conclusions: Topical clobetasol propionate used twice daily for clinical treatment of phimosis does not affect the hypothalamus-pituitary-adrenal axis in most patients. However, salivary cortisol level should be considered as a laboratory marker in long-term treatment or during repeated cycles to detect possible hypothalamus-pituitary-adrenal axis suppression

Can the Insulin Sensitivity Index (ISI) in Association with Insulin-like Growth Factor Binding Protein-1 Identify Insulin Resistance Early in Overweight Children?

Association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has been reported. This prompted us to evaluate the power of the insulin sensitivity index (ISI) in association with IGFBP-1 to identify IR early in obese children/adolescents. OGTT was performed in 34 obese/overweight children/adolescents. Glucose, insulin and IGFBP-1 were measured in serum samples and ISI was calculated. Considering the presence of three or more risk factors for IR as a criterion for IR, ISI 4.6 showed very low IGFBP-1 levels. Conclusion: ISI <4.6 is a good indicator of early peripheral IR and, associated with IGFBP-1, can identify increased risk of hepatic IR. Low IGFBP-1 levels among non-IR children may indicate increased portal insulin levels.Univ Sao Paulo, Sch Med Ribeirao Preto, Dept Pediat, BR-14049900 Ribeirao Preto, SP, BrazilUniv Sao Paulo, Sch Med Ribeirao Preto, Dept Med, BR-14049900 Ribeirao Preto, SP, BrazilWeb of Scienc

Impact of maternal vitamin A supplementation on the mother-infant pair in Brazil

Background/Objectives: Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother-infant pair. Subjects/Methods: This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations <= 0.70 mu mol/l in serum and 1.05 mu mol/l in milk were considered to indicate VAD. Results: Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 mu mol/l, respectively; P = 0.026) and to the post-supplementation levels of the control group (1.02 mu mol/l; P = 0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 mu mol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 mu mol/l; P = 0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P = 0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64 +/- 0.30 mu mol/l in the control group and of 0.69 +/- 0.26 mu mol/l in the supplemented group. Conclusions: Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose. European Journal of Clinical Nutrition (2010) 64, 1302-1307; doi: 10.1038/ejcn.2010.165; published online 15 September 2010CAPESFAEPA-HCFMRP-US