End stage cardiomyopathy and secondary mitral insufficiency: surgical alternative with prostesis implant and left ventricular remodelling

OBJECTIVE: To present a new surgical approach that consists of the implantation of a mitral prosthesis smaller than the annulus with traction of the papillary muscles to reduce the sphericalness of the left ventricle. METHODS: Between December 1995 and September 2005, 116 heart disease patients were operated, all of whom were at end-stage despite of full medication. The patients were analysed according to clinical criteria, echocardiographic findings and morphology of the left ventricle. RESULTS: Hospital mortality was 16.3% (19/116) and mid-term follow-up (38 ± 16 months) showed evidence of improvement in the clinical status and some echocardiographic parameters, in particular reduction of the sphericalness of the left ventricle. CONCLUSION: This technique, despite of the high mortality rate, offers a promising therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy associated to moderate or severe secondary mitral regurgitation.OBJETIVO: Analisar o resultado de uma alternativa operatória que envolve a correção da regurgitação mitral pelo implante de uma prótese de diâmetro menor do que o anel mitral e redução da esfericidade do ventrículo esquerdo com tração dos músculos papilares em direção ao anel, em portadores de miocardiopatia terminal e regurgitação mitral secundária. MÉTODO: Entre dezembro de 1995 e setembro de 2005, 116 pacientes foram operados com a técnica proposta. Os pacientes foram analisados de acordo com critérios clínicos, dados ecocardiográficos e aspectos morfológicos do ventrículo esquerdo. RESULTADOS: A mortalidade hospitalar foi 16,3% (19/116). O tempo médio de acompanhamento foi 38±16 meses. Após a alta hospitalar, a curva atuarial de sobrevida permaneceu estável com aceitável taxa de mortalidade tardia. Observou-se importante melhora clínica dos pacientes e de alguns parâmetros ecocardiográficos, especialmente redução da esfericidade do ventrículo esquerdo. CONCLUSÃO: Apesar da alta mortalidade operatória, a técnica apresentada representa uma alternativa aceitável no tratamento de portadores de miocardiopatia terminal com insuficiência cardíaca refratária associada à regurgitação mitral secundária.UNIFESP-EPMUNIFESP, EPMSciEL

Ammonia volatilization from urea with natural zeolite

O objetivo deste trabalho foi avaliar os efeitos da adição de zeólita a grânulos de ureia e dos diâmetros de grânulos nas perdas de NH3 por volatilização e na absorção de N pelo sorgo. Formulações de ureia com adição de zeólita e ligante orgânico, nos diâmetros menores que 2 mm, 2–4 mm e maiores que 4 mm e, sulfato de amônio e ureia‑NBPT, foram aplicados à superfície do solo sobre bandejas, em casa de vegetação. A adição de zeólitas naturais à superfície dos grânulos de ureia ou à composição destes diminuiu as perdas por volatilização em 20% e aumentou a extração de N pelas plantas. A acumulação de N nas plantas de sorgo foiinversamente proporcional às perdas de N por volatilização.The objective of this work was to evaluate the effect of zeolite addition to granules of urea and of its particles sizes on the loss of NH3 by volatilization and on the N uptake by sorghum plants. Formulations of urea with addition of zeolites and organic binder, with three‑size particles (lower than 2 mm, 2–4 mm, and greater than 4 mm), and ammonium sulfate and urea‑NBPT were applied to soil surface on trays in a greenhouse. Natural zeolites addition onto urea granule surface or to granule’s composition decreased NH3‑N volatilization by 20% and increased the amount of N absorbed by plants. Nitrogen accumulation in the sorghum plants wasinversely proportional to N losses by volatilization

Obesidade infantil: contextualização no mundo e em Portugal

Inexistent

Perfis da progesterona sérica durante o ciclo estral de vacas de leite e de corte determinados pela Imunoquimioluminescencia (CLIA) validados pela Imunoabsorção Enzimática (ELISA)

O objetivo do estudo foi validar a metodologia da imunoquimioluminescência (CLIA) através da imunoabsorção enzimática (ELISA), determinando a concentração sérica de progesterona em vacas de leite e de corte, durante o ciclo estral. Foram empregadas 30 vacas multíparas não-prenhes (12 da raça Holandesa Preta e Branca e 18 Nelore). Vacas com corpo luteo foram escolhidas com vistas à sincronização do estro e da ovulação, mediante aplicação de 500 mcg de cloprostenol (im). Após a aplicação do luteolitico, os animais foram diariamente submetidos a exames de ultrasssonagrafia (US) ovariana para verificação da ovulação (=dia 01 do ciclo), bem como eram colhidas 02 amostras de sangue para a determinação da P4 pela CLIA e ELISA. As amostras eram centrifugadas para a obtenção do soro, e congeladas a -20 graus para posterior dosagem. Os valores de ELISA e CLIA foram comparados entre si mediante teste t pareado, regressão, ANOVA e coeficiente de determinação (R2), visando a verificação da sensibilidade e correspondência linear. A concentração de P4 originou perfis similares entre as duas metodologias; os perfis de P4 foram mais elevados em bovinos de corte, que nos de leite. A correspondência entre as metodologias resultou em elevado quociente de R2 nos perfis de P4. Concluiu-se que a CLIA pode ser empregada nas determinações hormonais da P4 serica bovina; a CLIA mostrou elevada correspondência linear com os valores da ELISA; a CLIA pode auxiliar as biotecnicas da reprodução nas determinações hormonais.

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries