Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Disfunções respiratórias em pacientes de pós-operatório de cirurgia bariátrica: uma revisão sistemática

Introduction: Alarming data from the Ministry of Health show that in Brazil 52.5% of the population is overweight. Individuals suffering from chronic obesity have a high metabolic repercussion and respiratory dysfunctions, among them are diaphragmatic compression, changes in respiratory mechanics and a decrease in thoracic complacency. The objective of the study was to demonstrate the respiratory dysfunctions arising from each type of surgery, laparotomy and laparoscopy, the results of the application of low intensity physical therapy in the postoperative period. Methods: The systematic review followed the criteria of the Preferred Reporting Items for Systematic Reviewsand Meta-Analyzes (PRISMA) with researches in the PubMed®, SciELO®, PeDro® and Lilacs® platforms in English and Portuguese published in the last ten years. Results: The total search resulted in 36,931 articles, where 36,916 were excluded based on pre-determined criteria. 15 articles were used for analysis and comparison. Discussion: According to the studies laparoscopic surgery, it was shown to be less invasive, with less risk to the patient. As for treatment, low-intensity physical therapy to, support pressure of use and conventional therapy was positive. Although bariatric surgery is an effective method to reduce weight and solve obesity complications, studies show that postoperative complications can occur, among them, the most frequent are atelectasis and dysfunction of the thoracoabdominal movement.Introdução: Dados alarmantes do Ministério da Saúde mostram que no Brasil 52,5% da população está acima do peso. Os indivíduos que sofrem de obesidade crônica têm uma altíssima repercussão metabólica e disfunções respiratórias, entre elas está a compressão diafragmática, mudanças da mecânica respiratória e diminuição da complacência torácica. O objetivo do estudo foi demonstrar as disfunções respiratórias proveniente de cada tipo de cirurgia, laparotomia e laparoscopia, os resultados da aplicação de fisioterapia de baixa intensidade no pós-operatório. Métodos: A revisão sistemática seguiu os critérios do Preferred Reporting Items for Systematic Reviewsand Meta-Analyses (PRISMA) com pesquisas nas plataformas PubMed®, SciELO®, PeDro® e Lilacs®, nos idiomas inglês e português publicados nos últimos dez anos. Resultados: A pesquisa total resultou em 36.931 artigos, onde 36.916 foram excluídos com base nos critérios pré-determinados. 15 artigos foram utilizados para análise e comparação. Discussão: Segundo os estudos a cirurgia por via laparoscópica, mostrou-se menos invasiva, com menor risco ao paciente. Quanto a terapêutica, a fisioterapia de baixa intensidade, uso de pressão de suporte e fisioterapia convencional apresentou resultado positivo. Ainda que a cirurgia bariátrica seja um método eficaz para a redução de peso e solucione as complicações provenientes da obesidade, estudos mostramque podem ocorrer complicações no pós-operatório, entre elas as mais frequentes são atelectasia e disfunção do movimento toracoabdominal.

Disfunções respiratórias em pacientes de pós-operatório de cirurgia bariátrica: uma revisão sistemática

Introdução: Dados alarmantes do Ministério da Saúde mostram que no Brasil 52,5% da população está acima do peso. Os indivíduos que sofrem de obesidade crônica têm uma altíssima repercussão metabólica e disfunções respiratórias, entre elas está a compressão diafragmática, mudanças da mecânica respiratória e diminuição da complacência torácica. O objetivo do estudo foi demonstrar as disfunções respiratórias proveniente de cada tipo de cirurgia, laparotomia e laparoscopia, os resultados da aplicação de fisioterapia de baixa intensidade no pós-operatório. Métodos: A revisão sistemática seguiu os critérios do Preferred Reporting Items for Systematic Reviewsand Meta-Analyses (PRISMA) com pesquisas nas plataformas PubMed®, SciELO®, PeDro® e Lilacs®, nos idiomas inglês e português publicados nos últimos dez anos. Resultados: A pesquisa total resultou em 36.931 artigos, onde 36.916 foram excluídos com base nos critérios pré-determinados. 15 artigos foram utilizados para análise e comparação. Discussão: Segundo os estudos a cirurgia por via laparoscópica, mostrou-se menos invasiva, com menor risco ao paciente. Quanto a terapêutica, a fisioterapia de baixa intensidade, uso de pressão de suporte e fisioterapia convencional apresentou resultado positivo. Ainda que a cirurgia bariátrica seja um método eficaz para a redução de peso e solucione as complicações provenientes da obesidade, estudos mostramque podem ocorrer complicações no pós-operatório, entre elas as mais frequentes são atelectasia e disfunção do movimento toracoabdominal. ABSTRACT Respiratory disfunctions in patients of post bariatric sugery: a systematic reviewIntroduction: Alarming data from the Ministry of Health show that in Brazil 52.5% of the population is overweight. Individuals suffering from chronic obesity have a high metabolic repercussion and respiratory dysfunctions, among them are diaphragmatic compression, changes in respiratory mechanics and a decrease in thoracic complacency. The objective of the study was to demonstrate the respiratory dysfunctions arising from each type of surgery, laparotomy and laparoscopy, the results of the application of low intensity physical therapy in the postoperative period. Methods: The systematic review followed the criteria of the Preferred Reporting Items for Systematic Reviewsand Meta-Analyzes (PRISMA) with researches in the PubMed®, SciELO®, PeDro® and Lilacs® platforms in English and Portuguese published in the last ten years. Results: The total search resulted in 36,931 articles, where 36,916 were excluded based on pre-determined criteria. 15 articles were used for analysis and comparison. Discussion: According to the studies laparoscopic surgery, it was shown to be less invasive, with less risk to the patient. As for treatment, low-intensity physical therapy to, support pressure of use and conventional therapy was positive. Although bariatric surgery is an effective method to reduce weight and solve obesity complications, studies show that postoperative complications can occur, among them, the most frequent are atelectasis and dysfunction of the thoracoabdominal movement

Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 The HD-RECOVERY randomized clinical trial.

Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19. Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated. Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups. Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Note: These guidelines are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data