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

Níveis de proteína bruta em dietas para bovinos de corte: parâmetros ruminais, balanço de compostos nitrogenados e produção de proteína microbiana

RESUMO Avaliaram-se o pH e a concentração de amônia ruminal (N-amoniacal), a taxa de passagem, o balanço de compostos nitrogenados e a produção de proteína microbiana em novilhos Holandês x Zebu alimentados com dietas contendo quatro níveis de proteína bruta (10,5; 12; 13,5 e 15%), com base na matéria seca. As dietas foram constituídas de 65% de feno de capim-tifton 85 e 35% de concentrado. Foram utilizados quatro bovinos castrados fistulados no rúmen e abomaso, com peso vivo médio inicial de 487,3 kg, distribuídos em um quadrado latino 4 x 4. Cada período experimental teve duração de 20 dias: dez para adaptação às dietas e dez para coletas. O pH e N-amoniacal foram mensurados no fluido ruminal imediatamente antes e 2, 4, 6 e 8 horas, após o fornecimento da dieta. A taxa de passagem foi determinada pelo modelo unicompartimental, utilizando-se óxido de cromo como indicador. Para determinação da produção de proteína microbiana, utilizaram-se as bases purinas (RNA) no abomaso como indicador microbiano. A concentração de amônia e o pH ruminal foram influenciados pelos tempos de coleta, estimando-se valores máximos de 17,43 e 6,54 mg/dL, às 3,62 e 4,17 horas após a alimentação, respectivamente. A taxa de passagem da digesta não foi afetada pelas dietas, registrando-se valor médio de 3,69%/h. Os fluxos de compostos nitrogenados no abomaso e a eficiência de síntese microbiana também não foram afetados pelos níveis de proteína bruta das dietas, ao passo que o balanço de nitrogênio, expresso em g/dia, aumentou linearmente com o incremento de proteína bruta

Níveis de proteína bruta em dietas para bovinos de corte: parâmetros ruminais, balanço de compostos nitrogenados e produção de proteína microbiana

Avaliaram-se o pH e a concentração de amônia ruminal (N-amoniacal), a taxa de passagem, o balanço de compostos nitrogenados e a produção de proteína microbiana em novilhos Holandês x Zebu alimentados com dietas contendo quatro níveis de proteína bruta (10,5; 12; 13,5 e 15%), com base na matéria seca. As dietas foram constituídas de 65% de feno de capim-tifton 85 e 35% de concentrado. Foram utilizados quatro bovinos castrados fistulados no rúmen e abomaso, com peso vivo médio inicial de 487,3 kg, distribuídos em um quadrado latino 4 x 4. Cada período experimental teve duração de 20 dias: dez para adaptação às dietas e dez para coletas. O pH e N-amoniacal foram mensurados no fluido ruminal imediatamente antes e 2, 4, 6 e 8 horas, após o fornecimento da dieta. A taxa de passagem foi determinada pelo modelo unicompartimental, utilizando-se óxido de cromo como indicador. Para determinação da produção de proteína microbiana, utilizaram-se as bases purinas (RNA) no abomaso como indicador microbiano. A concentração de amônia e o pH ruminal foram influenciados pelos tempos de coleta, estimando-se valores máximos de 17,43 e 6,54 mg/dL, às 3,62 e 4,17 horas após a alimentação, respectivamente. A taxa de passagem da digesta não foi afetada pelas dietas, registrando-se valor médio de 3,69%/h. Os fluxos de compostos nitrogenados no abomaso e a eficiência de síntese microbiana também não foram afetados pelos níveis de proteína bruta das dietas, ao passo que o balanço de nitrogênio, expresso em g/dia, aumentou linearmente com o incremento de proteína bruta.The objective of this trial was to investigate the effects of different dietary crude protein levels (10.5, 12, 13.5, and 15%) on ruminal pH, ruminal concentration of ammonia nitrogen, ruminal passage rate, nitrogen balance, and microbial protein synthesis in Holstein x Zebu steers. Diets contained 65% of Tifton 85 bermudagrass hay and 35% of concentrate. Four castrated steers averaging 487.3 kg of initial body weight and fitted with ruminal and abomasal cannulas were randomly assigned to a 4 x 4 Latin square design. Each experimental period lasted 20 days with 10 days for diet adaptation and 10 days for sample collection. Ruminal fluid was collected before (0 h) and at 2, 4, 6 and 8 h after feeding for determination of both ruminal pH and ammonia-N. Ruminal passage rate was determined according to a unicompartmental model using chromic oxide as the external marker while abomasal purine bases (RNA) were used as the internal markers for measuring microbial protein synthesis. Ruminal pH and ammonia-N concentration were affected by sampling time with measured maximum values of 6.54 and 17.43 mg/dL at 3.62 and 4.17 h after feeding, respectively. Digesta passage rate did not differ significantly averaging 3.69 %/h across diets. Similarly, abomasal flow of N compounds as well as microbial efficiency were not affected by different dietary crude protein levels while nitrogen balance expressed in g/day increased linearly when the crude protein content increased from 10.5% to 15% in the diet

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

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data