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

Biology and behavior of the strawberry guava sawfly, Haplostegus epimelas Konow 1901 (Hymenoptera: Pergidae), in southern Brazil

Volume: 102Start Page: 129End Page: 13

Eurytoma sp. - agente promissor para o controle biológico do araçazeiro no Havaí

Uma espécie do gênero Eurytoma (Hymenoptera, Eurytomidae) causa a galha-do-ramo do araçazeiro - Psidium cattleianum Sabine, 1821 (Myrtaceae). O inseto não foi identificado a nível de espécie, mas seus aspectos bioecológicos foram estudados em laboratório e em campo. É um possível agente para o controle biológico do araçazeiro que é planta daninha invasora em vários países. As coletas foram realizadas no primeiro planalto do Paraná. Estudou-se vários parâmetros de Eurytoma sp.: forma, cor, número de segmentos do corpo, largura da cabeça, comprimento do corpo, mortalidade e ciclo de desenvolvimento na fase larval; duração, tamanho, comprimento na fase pupal; cópula, proporção sexual, longevidade de machos e fêmeas, comportamento no acasalamento e alimentação na fase adulta. A galha é um dos fatores limitantes do araçazeiro, sendo a atividade larval a principal causa de danos na planta. Durante o ano seguinte à emergência do adulto, a galha seca, todas as folhas caem e o ramo morre, estabilizando o crescimento do araçazeiro. Eurytoma sp. - agent promising for biological control of strawberry guava in Hawaii Abstract A species from Eurytoma (Hymenoptera, Eurytomidae) genus causes a gall in the stems of strawberry guava - Psidium cattleianum Sabine, 1821 (Myrtaceae). The insect was not identified in the specie level, but its biecological aspects were studied in laboratory and fields conditions, seeking the possible use as specific natural enemy of the strawberry guava. Sample collection was done in the first plateau of Paraná State, natural occurrence area of the plant. It was determined the following parameters for Eurytoma sp.: shape, color, number of segments of the body, width of the head, length of the body, mortality, development in larval phase, duration, size, development and length in pupa phase, and copulation, sexual rate, longevity of males and females, copulation behavior and feeding in the adult phase. The gall is one of the limiting factors of strawberry guava, being the larval activity of Eurytoma sp. the main cause of the damages. After the first year of adult emergence, the gall dries out and in the next year the stem dies, stabilizing the strawberry guava growth

Biologia de Neotrioza tavaresi Crawford, 1925 (Hemiptera, Psyllidae), galhador da folha do ara\ue7azeiro (Psidium cattleianum)

Biology of the leaf gall inducer Neotrioza tavaresi Crawford, 1925 (Hemiptera, Psyllidae) on strawberry guava tree (Psidium cattleianum). A field study was conducted in Curitiba region, State of Paraná, southern Brazil, to describe the life cycle of Neotrioza tavaresi Crawford, 1925, a leaf galling insect in strawberry guava trees (Psidium cattleianum). Three cycles were observed (1997, 1998, 1999) during regular field trips and the insects were observed in Piraquara municipality, where 15 samples with 50 infested leaves were sampled in the 1997-98 cycle. Galls were dissected for detailed studies. Neotrioza tavaresi has a univoltine cycle in which adult individuals were found inside the galls from August onwards. The sexually mature insects with sex ratio 1, emerged from the galls after their dehiscence caused by feeding of the adult insects on the gall walls. Adult emergence started in early October and ended by early December, with its peak in November. Copulation took place as soon as adults exit the gall and egg laying started the next day. Females had more than 100 ovarioles containing 218.7±44.7 (n=50) fully formed eggs. This indicated the short sexual adult life-span (aprox. 5-7 days) of the species, also characterized by a concentrated oviposition. Adult individuals fed and laid their eggs on younger shoots of the plant. The bottoms of the yellowish eggs were inserted into the leaf tissue, mainly on its adaxial edge (78.1%). The nymphs hatched and, as they fed on the adaxial side of expanding leaves, modified the cell growth pattern and the round-shape galls developed on the adaxial side with one insect inside. The gall wall showed distinct layers, with the inner one suppliyng the food to the insects, and the outer layer supplying gall protection. Nymphs went through five instars and the exuviae remained stuck on a ball of wax inside the gall. All parasitoids found were Hymenoptera belonging to Chalcidoidea: Eulophidae (1 sp), Pteromalidae (2 spp) and Encyrtidae (3 spp). The findings suggest that leaf gall inducer and parasitoids insects and plant life cycles are closely connected and both leaf sprouting and gall opening seem to be triggered by the same environmental and plant conditions. The high abundance of shoots may favor insect performance as adult individuals can easily find an ideal place for feeding, copulating and laying eggs

Tradescantia fluminensis, an exotic weed affecting native forest regeneration in New Zealand: Ecological surveys, safety tests and releases of four biocontrol agents from Brazil

In the native range of Tradescantia fluminensis in SE Brazil surveys revealed a natural enemy biota attacking the plant that was rich in potential biocontrol agents for New Zealand (NZ), including nine fungi and 10 herbivorous insect species. Similar surveys in NZ, where T. fluminensis is an invasive exotic weed, revealed no specialist insect herbivores or pathogens. The Brazilian insect herbivores included leafmining, stemboring and gall-forming feeding guilds that were absent in NZ. Mean foliar damage levels per site on T. fluminensis were 7.8× higher for folivores in Brazil cf. NZ, and 21.2× higher for pathogens. The presence of rust pustules, or ‘brown lesions’, on leaves in Brazil was negatively associated with damage by folivores, perhaps indicating an antagonistic interaction. In contrast, damage by the white smut fungus, Kordyana sp., was not negatively associated with folivore damage. Mean dry biomass of T. fluminensis was significantly lower in Brazil (164 g m−2) cf. NZ (455 g m−2). In NZ, 85% of sites had biomass measures >200 g m−2 (the previously determined threshold above which native forest regeneration fails). In Brazil, only 27% of sites had biomass measures >200 g m−2. Among the insect herbivores, three chrysomelid beetles, Neolema ogloblini, Neolema abbreviata and Lema basicostata were prioritised as potential biocontrol agents. Their larvae cause potentially complementary damage to leaves, shoot-tips and mature stems, respectively. Several pathogens, including a rust, were rejected before we selected the Kordyana species. Host range testing of all four agents showed sufficient host-specificity for consideration for release in NZ. Neolema ogloblini and L. basicostata were field-released in NZ in 2011 and 2012, with the field-release of N. abbreviata due late 2012. An application to release Kordyana sp. in NZ has been made