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

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

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

Alcoolismo em pacientes submetidos a cirurgia bariátrica: uma revisão sistemática: Alcoholism in patients undergoing bariatric surgery: a systematic review

A Cirurgia bariátrica tem sido uma opção de muitas pessoas que visam superar a obesidade e garantir qualidade de vida e saúde. No entanto, casos de complicações clínicas após operação tem ocorrido, sendo comum a incidência de alcoolismo. Este estudo teve como objetivo refletir sobre as causas da incidência de alcoolismo entre pacientes que foram submetidos a cirurgias bariátricas. Para o alcance dessa finalidade, realizou-se uma revisão sistemática de literatura, selecionando-se fontes das bases de dados Scielo Brasil, PubMed e Biblioteca Virtual em Saúde (BVS), publicados em língua portuguesa, nos anos de 2017 a 2022. Realizando-se a análise dos dados concluiu-se que o transtorno do uso de álcool em pessoas submetidas à cirurgia bariátrica tem sido recorrente, especialmente entre homens de baixa renda e que fizeram a cirurgia do tipo bypass gástrico. Observou-se também que o consumo de álcool é maior no pós-operatório e que boa parte dos pacientes que se submeteu a esse tipo de cirurgia ignorava o risco de desenvolver o referido transtorno. Em função disso, boa parte dos estudos que integraram esta revisão reconhece a necessidade do acompanhamento, pela equipe de saúde, dos pacientes logo após a cirurgia bariátrica e a adesão desses ao tratamento devido, visando prevenir o transtorno do uso de álcool

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ