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

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Effect of Caffeine on Hemodynamics and Autonomics Parameters in Hypertensive Women after Aerobic Exercise

The aim of this study was to analyse the effect of caffeine consumption on cardiac autonomic modulation and arterial blood pressure after aerobic exercise in hypertensive women. Twelve hypertensive women participated in this study (55±4 years old), habitual consumers of caffeine. The electrocardiogram and the arterial blood pressure were recorded during rest and after aerobic exercise. All subject ingested caffeine or placebo (4mg/kg), waited 30 minutes and exercised on a treadmill for 30 minutes with intensity of 60% and 70% of the reserve heart rate. Systolic arterial blood pressure rose significantly in the caffeine session compared to rest and placebo session (p < 0.05). Spectral component of low frequency and sympathovagal balance increased dramatically when compared to baseline in caffeine session. In contrast, during the placebo session, the low frequency and sympathovagal balance decreased significantly (p < 0.05). When compared the caffeine and placebo sessions, it could be seen that the low frequency and sympathovagal balance were significantly higher in caffeine session (p < 0.05). Thus, it can be suggested that the consumption of caffeine increased the cardiac sympathetic activity with resulting increase of systolic arterial blood pressure after aerobic exercise, which could be related to a possible hypertensive reaction in hypertensive middle-aged women

Surgery is unlikely to be enough for a patient to stop smoking 24 h prior to hospital admission

Introduction: The need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24 h before hospital admission and possible relapse on the last 24 h before hospital admission for ex-smokers. Methods: Smoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6 h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements. Results: 241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97 ± 6.50 vs. 2.26 ± 1.65 vs. 2.98 ± 2.69; p = 0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93 ± 7.5 vs. 8.65 ± 4.56; p = 0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9 ± 2.3 vs. 2.82 ± 2.15; p = 0.45). Conclusion: A medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24 h prior to admission. The proximity of a surgery was not associated with smoking relapse 24 h before the procedure. Resumo: Introdução: A necessidade de cirurgia pode ser um fator decisivo para a cessação do tabagismo a longo prazo. Por outro lado, situações que precipitam o estresse podem precipitar a recaída do tabagismo. Decidimos avaliar o impacto de uma cirurgia no esforço do paciente para deixar de fumar durante pelo menos 24 horas antes da internação hospitalar e a possível recaída nas últimas 24 horas anteriores à internação em ex-fumantes. Métodos: : Fumantes, ex-fumantes e não fumantes adultos, quer de clínica pré-anestésica ou recentemente internados para cirurgias eletivas programadas que ficariam, no máximo, seis horas dentro das unidades hospitalares, foram incluídos no estudo. Os pacientes responderam um questionário na enfermaria ou na entrada da sala de operação (Grupo Internação) ou no início da primeira consulta pré-anestesia (Grupo Clínico) e fizeram mensurações dos níveis de CO. Resultados: No total, 241 pacientes foram incluídos: 52 ex-fumantes, 109 que nunca fumaram e 80 não fumantes. Os fumantes apresentaram níveis mais elevados de monóxido de carbono expirado que os não fumantes e ex-fumantes (9,97 ± 6,50 vs. 2,26 ± 1,65 vs. 2,98 ± 2,69; p = 0,02). Entre os fumantes, o Grupo Clínico apresentou níveis de CO não estatisticamente diferentes daqueles do Grupo Internação (10,93 ± 7,5 vs. 8,65 ± 4,56; p = 0,21). Os ex-fumantes não apresentaram diferenças significativas entre os grupos Clínico e Internação para os níveis de monóxido de carbono (2,9 ± 2,3 vs. 2,82 ± 2,15; p = 0,45). Conclusão: É improvável que uma condição médica, como uma cirurgia, sem assistência adequada seja suficiente para que um paciente pare de fumar, pelo menos, 24 horas antes da internação. A proximidade de uma cirurgia não foi associada à recaída do tabagismo nas 24 horas anteriores ao procedimento. Keywords: Smoking, Carbon monoxide, Elective surgery, Palavras-chave: Fumar, Monóxido de carbono, Cirurgia eletiv

Efeito agudo do alongamento estático sobre o desempenho na resistência de força em homens treinados: estudo piloto

O alongamento ativo-estático não é indicado previamente ao exercício de força por induzir ao um menor desempenho. No entanto, não se sabe se o mesmo ocorre no exercício de resistência de força (RF). Deste modo, o objetivo do estudo foi verificar o efeito agudo do alongamento ativo-estático sobre o desempenho na RF em homens treinados. Para tanto, a amostra foi composta por cinco homens (24,6±3,58 anos) fisicamente ativos e com experiência prévia em musculação (≥ seis meses) que foram submetidos ao teste de uma repetição máxima (1RM) no supino horizontal (SH) e cadeira extensora de joelhos (CE), e duas sessões experimentais: 1) sessão de exercício de RF com 50% de 1RM até a falha concêntrica no SH e, em seguida, na CE (intervalo de 10min) sem alongamento prévio; e 2) igualmente à primeira sessão, no entanto, com alongamento ativo-estático com amplitude máxima por 30s previamente ao exercício. A normalidade foi verificada pelo teste de Shapiro-Wilk e o teste de Wilcoxon foi aplicado para comparação entre as sessões. A sessão com alongamento prévio ao exercício promoveu menor (p<0,05) desempenho no SH. Não houve diferença (p=0,063) do desempenho entre as sessões na CE. Em conclusão, o alongamento ativo-estático realizado antes do exercício de RF provoca diminuição no desempenho durante o exercício de membros superiores, por outro lado, não modifica o desempenho no exercício de membros inferiores em homens treinados. ABSTRACTAcute effects of static stretching on strength endurance performance in trained men: pilot studyThe static active stretching is not recommended before strength exercise because it induces a poor performance. However, it is not clear if this form of stretching can also induce a poor performance in strength endurance (SE) exercises. Therefore, the main objective of this study was to investigate the acute effects of the static active stretching on SE performance in trained men. The sample was composed by five physically active men (24.6±3.58 years) with previous experience in strength training (≥ six months), who were submitted to one-repetition maximum test (1RM) on bench press (BP) and leg extension machine (LEM), and two experimental sessions: 1) session SE exercise on 50% of 1RM until concentric failure on the BP followed by the same amount in the LEM (10min of resting time) without previous stretching in both exercises; 2) second session following the same pattern of the first session; although, it was added a full range-of-motion 30-second static active stretching before the exercise. The normality was analyzed by the Shapiro-Wilk test, and the Wilcoxon test was applied to compare the sessions. The session with stretching before the exercise resulted in a poor (p<0.05) performance in BP. There was no difference (p=0.063) between the sessions in the LEM. In conclusion, the static active stretching before the SE exercise resulted in a decreased performance during the upper limbs exercise. On the other hand, it did not affect the lower limbs exercise performance in trained men

Embolization by Bullet Dislodged from the Heart

Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery

Embolization by Bullet Dislodged from the Heart

<div><p>Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.</p></div

The &ldquo;New Transamazonian Highway&rdquo;: BR-319 and Its Current Environmental Degradation

The Brazilian government intends to complete the paving of the BR-319 highway, which connects Porto Velho in the deforestation arc region with Manaus in the middle of the Amazon Forest. This paving is being planned despite environmental legislation, and there is concern that its effectiveness will cause additional deforestation, threatening large portions of forest, conservation units (CUs), and indigenous lands (ILs) in the surrounding areas. In this study, we evaluated environmental degradation along the BR-319 highway from 2008 to 2020 and verified whether highway maintenance has contributed to deforestation. For this purpose, we created a 20 km buffer adjacent to the BR-319 highway and evaluated variables extracted from remote sensing information between 2008 and 2020. Fire foci, burned areas, and rainfall data were used to calculate a drought index using statistical tests for a time series. Furthermore, these were related to data on deforestation, CUs, and ILs using principal component analysis and Pearson&rsquo;s correlation. Our results showed that 743 km2 of forest was deforested during the period evaluated, most of which occurred in the last four years. A total of 16,472 fire foci were identified. Both deforestation and fire foci occurred mainly outside the CUs and ILs. The most affected areas were close to capital cities, and after resuming road maintenance in 2015, deforestation increased outside the capital cities. Current government policy for Amazon occupation promotes deforestation and will compromise Brazil&rsquo;s climate goals of reducing greenhouse gas (GHG) emissions and deforestation