Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI)

Environmental temperature and cloacal and surface temperatures of broiler chicks in first week post-hatch

Adequate environmental temperature during the brooding period is very important to future broiler performance. Thus, the objective of this study was to investigate the extent to which environmental temperature affects the body weight and cloacal and surface (back, head, wing, and shank) temperatures. The study also investigated the sensible heat loss by radiation of broiler chicks reared at three environmental temperatures (35, 25, and 20 degrees C) up to 7 days of life. The results showed that chicks raised at low environmental temperature (20 degrees C) had lower body weight at 7 days of age. Birds kept at 20 degrees C also had significantly lower cloacal and surface temperatures than did other birds. The most marked difference was seen in the shanks. These findings revealed that body weight declined in chicks reared at 20 degrees C, and radiant heat loss (W) was nine times higher than for the birds kept at 35 degrees C at 7 days of age

Prevalence and sociodemographic factors associated with meeting the 24-hour movement guidelines in a sample of Brazilian adolescents.

BackgroundThe present cross-sectional study aimed to determine the proportion of adolescents meeting the 24-hour movement guidelines, and investigate sociodemographic factors associated with meeting them.MethodsSelf-reported (average daily volume of MVPA, sleep duration, and time watching videos and playing videogames) and accelerometer-measured (MVPA and sleep duration) 24-hour movement behaviors were classified according to recommendations, and sex, age, socioeconomic status (SES), family structure, parental education, and number of people in the household were tested as correlates of meeting recommendations using multilevel logistic regressions.ResultsThe proportion of adolescents (n = 867, mean age: 16.4 years, 50.3% girls) meeting the MVPA, ST, and sleep duration guidelines was of 25%, 28%, and 41%, respectively, for self-reported data. From accelerometer data (n = 688), 7.1% met MVPA and 31.7% met sleep duration recommendations. Adherence to all three recommendations was 3% with self-report and 0.2% with accelerometer data. Boys were more likely to meet MVPA, but not ST and sleep-duration recommendations. A positive relationship was observed between age and meeting the ST recommendation.ConclusionsAdherence to the sleep duration recommendation was higher than to the screen-time and MVPA recommendations and few in this sample of Brazilian adolescents achieved the 24-hour guidelines. Efforts are needed to improve 24-hour movement behaviors

A study of new antimalarial artemisinins through molecular modeling and multivariate analysis

Artemisinin and 18 derivatives with antimalarial activity against W-2 strains of Plasmodium falciparum were studied through quantum chemistry and multivariate analysis. The geometry optimization of the structures was realized with the Hartree-Fock (HF) theory and 3-21G basis set. Maps of molecular electrostatic potential (MEP) and molecular docking were used to investigate the interaction between the ligands and the receptor (heme). Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) were employed to select the most important descriptors related to activity. A predictive model was generated by the Partial Least Square (PLS) method through 15 molecules and 4 used as an external validation set, which were selected in the training set, the validation parameters of which are Q2 = 0.85 and R2 = 0.86. The model included as molecular parameters, the radial distribution function, RDF060e, the hydration energy, HE, and the distance between the O1 atom from the ligand and the iron atom from heme, d(Fe-O1). Thus, the synthesis of new derivatives may follow the results of the MEP maps and the PLS analysis

Multiclass Segmentation of Breast Tissue and Suspicious Findings: A Simulation-Based Study for the Development of Self-Steering Tomosynthesis

In breast tomosynthesis, multiple low-dose projections are acquired in a single scanning direction over a limited angular range to produce cross-sectional planes through the breast for three-dimensional imaging interpretation. We built a next-generation tomosynthesis system capable of multidirectional source motion with the intent to customize scanning motions around “suspicious findings”. Customized acquisitions can improve the image quality in areas that require increased scrutiny, such as breast cancers, architectural distortions, and dense clusters. In this paper, virtual clinical trial techniques were used to analyze whether a finding or area at high risk of masking cancers can be detected in a single low-dose projection and thus be used for motion planning. This represents a step towards customizing the subsequent low-dose projection acquisitions autonomously, guided by the first low-dose projection; we call this technique “self-steering tomosynthesis.” A U-Net was used to classify the low-dose projections into “risk classes” in simulated breasts with soft-tissue lesions; class probabilities were modified using post hoc Dirichlet calibration (DC). DC improved the multiclass segmentation (Dice = 0.43 vs. 0.28 before DC) and significantly reduced false positives (FPs) from the class of the highest risk of masking (sensitivity = 81.3% at 2 FPs per image vs. 76.0%). This simulation-based study demonstrated the feasibility of identifying suspicious areas using a single low-dose projection for self-steering tomosynthesis

Quantum chemical modeling of perovskite: An investigation of piezoelectricity in ferrite of yttrium

In a previous article, we used Hartree-Fock (HF) theory to study the piezoelectricity in BaTiO(3). In this paper, we applied the Douglas-Kroll-Hess second order scalar relativistic method to investigate the possible piezoelectric properties in the perovskite YFeO(3) structure, which has not yet been studied experimentally. The 30s20p13d and 31s21p17d Gaussian basis sets for the Fe ((5)D) and Y ((2)D) atoms, respectively, were built with the Generator Coordinate HF method. After contraction to [13s7p5d] and [13s8p7d], in combination with the 20s14p/6s4p basis set for the O ((3)P) atom from literature, they had their quality evaluated using calculations of the total and the orbital energies for the (2)FeO(+1) and (1)YO(+1) fragments. The dipole moment, the total energy, and the total atomic charges in YFeO(3) in C(s) space group were calculated. The results and the analysis lead us to believe that the perovskite YFeO(3) does not present piezoelectric properties.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES