Effects of sympathectomy on cardiac remodeling in a doxorrubicin-induced dilated cardiomyopathy model

Introduction: The main cause of cardiac transplantation is dilated cardiomyopathy (DCM), in which there are ventricular dilation and systolic dysfunction, leading to congestive heart failure. Ventricular remodeling involves activation of the sympathetic nervous and renin-angiotensin- aldosterone systems. As such, classic treatments include angiotensin-converting enzyme inhibitors (ACEI), beta-blockers and mineralocorticoid receptor antagonists. Once such treatments only delay the development of the disease, it is important to look for better therapeutic options. Experimental models demonstrated the benefits of sympathetic blockade on preserving ventricular function and preventing left ventricle remodeling after myocardial infarction. Objective: We evaluated the influence of bilateral thoracic sympathectomy on left ventricle remodeling and function in a rat model of doxorubicin induced DCM. Methodology: Animals were randomly divided into 4 groups of 7 rats each. DCM only, bilateral sympathectomy (BS) with DCM, ACEI with DCM and also a negative control group (SHAM). DCM was inducted in the experimental groups through weekly intraperitoneal injection of doxorubicin. Fifteen days after the beginning of DCM induction, bilateral sympathectomy was performed by chemical sclerosis of stellate ganglion with ethanol in the BS group. From this same time point until the end of experimental protocol, animals of the ACEI group received daily, through water ingestion, a enalapril maleate dilution. Ten weeks later, left ventricular function was evaluated with the use of a microtip pressureconductance catheter. Also, extracellular fibrosis were evaluated and BCL-2 expression on myocardial tissue were quantified. Partial Results: DCM group showed an increased left ventricular (LV) end-diastolic volume in relation to Sham group(p=0.034). Also, a significant decrease was observed in LV ejection fraction in DCM group, while bilateral sympathectomy were able to preserve this parameter (p=0,001). Furthermore, both treated groups showed an increased LV stroke work compared to DCM group (p=0,002). Myocardial extracellular fibrosis were more present in control group, whereas both BS and ACE inhibitor treatments reduced the areas of fibrotic tissue (p<0,0001), which can be associated with increased expression of anti-apoptotic BCL-2 in treated groups (p=0,0004). Discussion and Conclusion: Sympathetic blockade was able to suppress myocardial tissue fibrosis, most likely due to increasing anti-apoptotic BCL-2 expression. Moreover, LV function was maintained as observed through LV ejection fraction,stroke work and cardiac efficiency levels. Although ACE inhibitor was also able to inhibit extracellular fibrosis and increase BCL- 2 expression, cardiac function has not been preserved as in BS group. Therefore, we conclude that BS was able to decrease myocardial tissue deterioration and also to preserve LV in a doxorubicin model of DCM in rats. Keywords: Sympathectomy; Cardiomyopathy; Cardiac transplantation; Doxorubicin

Acute rheumatic fever in a 61-year-old patient

O estudo e a descrição da febre reumática aguda (FRA) em adultos é escasso, dado que sua ocorrência é rara acima dos 40 anos de idade. Descrevemos um episódio de FRA em paciente feminina de 61 anos com uma história de um mês de dor retrosternal, dispnéia, ortopnéia e tosse não-produtiva. Dopplerecocardiograma revelou achados novos de espessamento da valva mitral, calcificação, mobilidade reduzida e regurgitação significativa, além de uma fração de ejeção de 39% e aumento dos diâmetros do ventrículo esquerdo e do átrio esquerdo. Ressonância magnética cardíaca confirmou importante disfunção e aumento de diamêtro sistólico do ventrículo esquerdo, com insuficiência mitral grave e ausência de realce tardio ou edema miocárdico. PET/CT com 18F-FDG mostrou aumento de captação na parede ventricular esquerda e na musculatura papilar. A biópsia endomiocárdica confirmou miocardite linfohistiocitária leve. Tratada com prednisona e azatioprina, além de profilaxia secundária com penicilina G e otimização da prescrição, a paciente apresentou melhora clínica significativa no seguimento.The study and description of Acute Rheumatic Fever (ARF) in adults is scarce as its occurrence is rare over the age of 40 years old. We describe an ARF episode in a 61-year-old woman that presented with a one-month history of retrosternal pain, dyspnea, orthopnea and nonproductive cough. Her doppler echocardiogram revealed new findings of mitral valve thickening, calcification, reduced mobility and significant regurgitation, in addition to an ejection fraction of 39% and increased left ventricular and left atrium diameters. Cardiac magnetic resonance confirmed important left ventricular systolic dysfunction and enlargement, with severe mitral regurgitation and no delayed myocardial enhancement or edema. PET/CT with 18F-FDG showed increased uptake in the left ventricular wall and papillary musculature. Endomyorcadial biopsy confirmed mild lymphohistiocytic myocarditis. Treated with Prednisone and Azathioprine, besides secondary prophylaxis with Penicillin G and prescription optimization, the patient presented significant clinical improvement on follow-up

Influência da hereditariedade para hipertensão arterial na hipotensão pós-exercício

Verificar o comportamento cardiovascular de homens normotensos com histórico familiar positivo para hipertensão arterial proveniente da mãe e de homens normotensos com histórico familiar proveniente do pai após uma sessão de exercício aeróbio. Foram selecionados 35 homens adultos divididos nos grupos: HF+mãe (somente mãe com hipertensão arterial, n=14) e HF+pai (somente pai com hipertensão arterial, n=21). Os participantes foram submetidos ao exercício aeróbio, em cicloergômetro (Kikos®), por 50 minutos, em intensidade de 50 a 70% da frequência cardíaca de reserva (sessão exercício) e a uma sessão controle. As variáveis pressão arterial média (FinometerPro®) e fluxo sanguíneo do antebraço (Pletismografia de Oclusão Venosa-Hokanson®) foram registradas continuamente durante 10 minutos pré e 30 minutos pós cada sessão. A resistência vascular do antebraço foi calculada pela divisão da pressão arterial média pelo fluxo sanguíneo do antebraço. Foi considerado p≤0,05 como diferença significativa. No grupo HF+mãe a pressão arterial média e a resistência vascular do antebraço não modificaram significativamente no momento pós em relação ao momento pré-exercício. Diferentemente, no grupo HF+pai a pressão arterial média e resistência vascular do antebraço reduziram significativamente na recuperação do exercício. Na sessão controle essas variáveis aumentaram significativamente no pós em relação ao pré, em ambos os grupos. O exercício físico não provocou modificações no sistema cardiovascular de homens normotensos, com histórico familiar positivo para hipertensão proveniente da mãe. Enquanto aqueles com histórico familiar positivo para hipertensão proveniente do pai apresentaram hipotensão pós-exercício, comportamento parcialmente justificado pela diminuição da resistência vascular do antebraço.To verify the cardiovascular response of normotensive men with positive family history of arterial hypertension from the mother and of normotensive men with positive family history of arterial hypertension from the father after an aerobic exercise session. Were selected 35 adult men divided into groups: HF+mother (only mother with arterial hypertension, n = 14) and HF+father (only father with arterial hypertension, n = 21). The participants underwent aerobic exercise, on a cycle ergometer (Kikos®), for 50 minutes, at intensity of 50 to 70% of the reserve heart rate (exercise session) and a control session. The variables mean arterial pressure (FinometerPro®) and forearm blood flow (Venous Occlusion Plethysmography-Hokanson®) were continuously recorded for 10 minutes before and 30 minutes after each session. The forearm vascular resistance was calculated by dividing the mean arterial pressure by the forearm blood flow. Was considered significant p≤0.05. In the HF+mother group, mean arterial pressure and forearm vascular resistance did not change significantly in the post-moment compared to the pre-exercise moment. In contrast, in the HF+father group, mean arterial pressure and forearm vascular resistance significantly reduced in recovery from exercise. In the control session, these variables increased significantly in the post compared to the pre, in both groups. Physical exercise did not cause changes in the cardiovascular system of normotensive men, with a positive family history of hypertension from the mother. While those with a positive family history of hypertension from their father presented post-exercise hypotension, behavior partially justified by the decrease in vascular resistance in the forearm

Avaliação da diferenciação osteoblástica de células-tronco mesenquimais de ratos tratados cronicamente com bifosfonatos

Apesar dos bifosfonatos (BPs), fármacos antirreabsortivos, atuarem principalmente nos osteoclastos, a ação desses medicamentos em osteoblastos tem sido demonstrada em experimentos in vitro. Porém, na maioria desses experimentos, há exposição das culturas de osteoblastos aos BPs. Na presente investigação, foram avaliados osteoblastos diferenciados a partir de células-tronco mesenquimais (CTMs) de ratos tratados in vivo com alendronato de sódio (ALE: 1mg/ml/kg/semana), ácido zoledrônico (ZOL: 0,3mg/ml/kg/semana) ou solução salina (VEH: 0,009mg/ml/kg/semana) durante 13 semanas. As CTMs da medula óssea dos fêmures direitos dos animais foram cultivadas em meio osteogênico, na densidade de 5.000 células/200μl/poço. Após 21 dias de cultura, osteoblastos foram avaliados quanto à viabilidade celular e à formação de matriz mineralizada. Foram observadas viabilidades celulares semelhantes nos grupos BPs (ALE e ZOL) e superiores ao controle (VEH). Quanto à formação da matriz mineralizada, houve maior mineralização no grupo ZOL em relação ao grupo ALE, sendo ambas inferiores ao observado no grupo VEH. Os resultados obtidos sugerem que a exposição in vivo das CTMs ao ALE e ao ZOL influenciou a atividade dos osteoblastos in vitro. Ambos os medicamentos utilizados são BPs nitrogenados; contudo, na dose empregada, o ALE afetou mais significativamente a formação de matriz mineralizada

Reflexões sobre o acolhimento de profissionais de saúde na pandemia

O presente artigo tem como objetivo, por meio de um relato de experiência, compartilhar reflexões a respeito das ações de um projeto de extensão realizado em 2020 com o intuito de fortalecer trabalhadores de saúde durante a pandemia da Covid-19. Estudantes de psicologia, psicólogos residentes e uma docente participaram da experiência, oferecendo acolhimento psicológico a treze trabalhadoras de instituições públicas de saúde, em sua maioria profissionais da enfermagem, que buscaram o projeto por demanda espontânea. Durante os encontros, estimulou-se a análise do cotidiano do trabalho e dos mecanismos de enfrentamento individuais e coletivos, metodologia baseada na Ergologia. Os temas convergentes nos acolhimentos foram: senso de responsabilidade, sentimento de culpa e sofrimento no trabalho; risco de contaminação, distanciamento social e estigmas; gestão do trabalho e humanização do cuidado. Por fim, considera-se a importância do projeto para o suporte e reflexão crítica das trabalhadoras sobre os processos de trabalho

Febre Maculosa: Relatos de caso.

Spotted Fever (FM) is a disease caused by gram-negative bacteria of the Rickettsia species, transmitted through the bite of ticks of the Dermacentor variabilis and Dermacentor variabilis andersoni species, usually during the summer months. Thus, the present work aimed to review case reports on Rocky Mountain Spotted Fever, listing the main symptoms found, the most used diagnostic methods and the forms of treatment administered. A literature review was carried out in the PUBMED and Periódico da Capes databases, published from 2018 to 2023. In the analysis of the selected cases, it was found that the main clinical manifestations were fever, rash, myalgia, headache, asthenia, pain abdominal pain, arthralgia, edema and loss of consciousness. Regarding laboratory findings. the results of thrombocytopenia, transaminitis, leukopenia, hyponatremia and leukocytosis deserve to be highlighted. The main diagnostic tests used in the reports studied were indirect immunofluorescence (IFAT), PCR and the Weil-Felix test. In Brazil, the standard treatment is performed with doxycycline, with chloramphenicol used as a second choice and prioritized in severe forms, in which parenteral administration is necessary. In the general context, therapeutic management should be carried out early so that there are greater chances of cure for the patient with a reduction in mortality.A Febre Maculosa (FM) é uma doença causada pela bactéria gram-negativa da espécie Rickettsia, transmitida por meio da picada de carrapatos das espécies Dermacentor variabilis e Dermacentor variabilis andersoni, geralmente durante os meses de verão. Dessa forma, o presente trabalho teve como objetivo fazer uma revisão de relatos de casos sobre a Febre Maculosa, elencando os principais sintomas encontrados, os métodos de diagnósticos mais utilizados e as formas de tratamento administradas. Foi realizada uma revisão de literatura nos bancos de dados da PUBMED e Periódico da Capes, publicados no período de 2018 a 2023. Na análise dos casos selecionados verificou-se que as principais manifestações clínicas foram febre, exantema, mialgia, cefaléia, astenia, dor abdominal, artralgia, edema e a perda de consciência. Em relação aos achados laboratoriais. merecem destaque os resultados de trombocitopenia, transaminite, leucopenia, hiponatremia e leucocitose. Os principais testes de diagnósticos utilizados nos relatos estudados foram a Imunofluorescência indireta (RIFI), o PCR e o teste de Weil-Felix. No Brasil, o tratamento padrão é realizado com a doxiciclina, sendo o cloranfenicol utilizado como segunda escolha e priorizado em formas graves, nas quais a administração parenteral é necessária. No contexto geral, o manejo terapêutico deve ser realizado de forma precoce para que haja maiores chances de cura do paciente com a redução dos quadros de mortalidade

Impact of periprocedural myocardial injury after transcatheter aortic valve implantation on long-term mortality: a meta-analysis of Kaplan-Meier derived individual patient data

BackgroundPeriprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain.MethodsWe performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed.ResultsEighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30–1.65, p < 0.01). This was also observed when restricting the analysis to overall VARC-2-defined PPMI (HR = 1.23, 95% CI 1.07–1.40, p < 0.01). For VARC-2 PPMI criteria and VARC-2 troponin-only, higher mortality was restricted to the first 2 months after TAVI (HR = 1.64, 95% CI 1.31–2.07, p < 0.01; and HR = 1.32, 95% CI 1.05–1.67, p = 0.02, respectively), while for VARC-2 defined CK-MB-only the increase in mortality was confined to the first 30 days (HR = 7.44, 95% CI 4.76–11.66, p < 0.01).ConclusionPPMI following TAVI was associated with lower overall survival compared with patients without PPMI. PPMI prognostic impact is restricted to the initial months after the procedure. The analyses were consistent for VARC-2 criteria and for both biomarkers, yet CK-MB was a stronger prognostic marker of mortality than troponin

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