Sintomas Cardiopulmonares Pós-COVID-19: Preditores e Características de Imagem de Pacientes após a Alta Hospitalar / Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge

Resumo Fundamento A maioria da evidência sobre o impacto da síndrome COVID pós-aguda (PACS, do inglês, post-acute COVID-19 syndrome) descreve sintomas individuais sem correlacioná-los com exames de imagens. Objetivos Avaliar sintomas cardiopulmonares, seus preditores e imagens relacionadas em pacientes com COVID-19 após alta hospitalar. Métodos Pacientes consecutivos, que sobreviveram à COVID-19, foram contatados 90 dias após a alta hospitalar. A equipe de desfechos clínicos (cega quanto aos dados durante a internação) elaborou um questionário estruturado avaliando sintomas e estado clínico. Uma análise multivariada foi realizada abordando a evolução da COVID-19, comorbidades, ansiedade, depressão, e estresse pós-traumático durante a internação, e reabilitação cardíaca após a alta. O nível de significância usado nas análises foi de 5%. Resultados Foram incluídos 480 pacientes (idade 59±14 anos, 67,5% do sexo masculino) que receberam alta hospitalar por COVID-19; 22,3% necessitaram de ventilação mecânica. A prevalência de pacientes com sintomas cardiopulmonares relacionados à PACS (dispneia, cansaço/fadiga, tosse e desconforto no peito) foi de 16,3%. Vários parâmetros de tomografia computadorizada do tórax e de ecocardiograma foram similares entre os pacientes com e sem sintomas cardiopulmonares. A análise multivariada mostrou que sintomas cardiopulmonares foram relacionados de maneira independente com sexo feminino (OR 3,023; IC95% 1,319-6,929), trombose venosa profunda durante a internação (OR 13,689; IC95% 1,069-175,304), nível elevado de troponina (OR 1,355; IC95% 1,048-1,751) e de proteína C reativa durante a internação (OR 1,060; IC95% 1,023-1,097) e depressão (OR 6,110; IC95% 2,254-16,558). Conclusão Os sintomas cardiopulmonares relacionados à PACS 90 dias após a alta hospitalar são comuns e multifatoriais. Além dos marcadores trombóticos, inflamatórios e de lesão miocárdica durante a internação, sexo feminino e depressão foram associados independentemente com sintomas cardiopulmonares relacionados à PACS. Esses resultados destacaram a necessidade de uma abordagem multifacetada direcionada a pacientes susceptíveis.

Abstract Background Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging. Objectives To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital. Methods Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%. Results A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558). Conclusion PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients.

Tiempos de reperfusión de un programa guiado por telemedicina para la atención del infarto agudo de miocardio con elevación del ST en la Provincia de La Pampa / Reperfusion Times in a Telemedicine-guided Program for the Management of ST-segment Elevation Myocardial Infarction in the Province of La Pampa

RESUMEN Introducción: Los tiempos de atención médica son un factor relevante para la mortalidad por infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Objetivos: Evaluar los tiempos de reperfusión en pacientes con IAMCEST participantes de un programa de atención médica cardiológica basada en telemedicina en la provincia de La Pampa durante el período transcurrido entre agosto de 2018 y diciembre de 2021. Material y Métodos: Este programa consiste en la protocolización de la atención de los pacientes que cursan un síndrome coronario agudo (SCA) en las diferentes localidades de la provincia, con asistencia cardiológica remota las 24 horas del día, que incluye tanto la asistencia diagnóstica como la coordinación de las medidas terapéuticas, incluyendo la posibilidad de administrar trombolíticos a nivel local, con asistencia remota. Resultados: De un total de 72 IAMCEST evaluados, 44 recibieron como terapia de reperfusión trombolisis, 25 angioplastia primaria, y 3 trombolisis seguida de angioplastia de rescate. De los 47 sujetos que recibieron trombolisis, sólo 5 requirieron de traslado al centro de referencia para realizar este procedimiento. La mediana de tiempo puerta-aguja fue de 24 minutos y el tiempo puerta-balón fue de 105 minutos. El 28% de los sujetos con angioplastia primaria tuvieron un tiempo puerta-balón inferior a los 90 minutos y el 53,2% de los tratados con trombolíticos cumplieron con un tiempo puerta-aguja menor a 30 minutos. Conclusiones: La implementación de un programa de atención descentralizada guiada por telemedicina se asoció a un elevado porcentaje de cumplimento de las metas de implementación de la terapia de reperfusión basada en fibrinolíticos.

ABSTRACT Background: Timing of medical care is a relevant factor for ST-segment elevation myocardial infarction (STEMI) mortality. Objectives: The aim of the present study is to evaluate reperfusion times in STEMI patients participating in a telemedicinebased cardiology care program in the province of La Pampa during the period between August 2018 and December 2021. Methods: This program consists of a protocol for the management of patients with acute coronary syndrome (ACS) in the different locations of the province, with 24-hour remote assistance provided by cardiologists including both diagnostic support and coordination of on-site thrombolysis. Results: Of a total of 72 STEMI patients evaluated, 44 received thrombolysis as reperfusion therapy, 25 received primary percutaneous coronary intervention, and 3 received thrombolysis followed by rescue percutaneous coronary intervention. Of the 47 subjects who received thrombolysis, only 5 required to be transferred to the referral center for this procedure. Median door-to-needle time was 24 minutes and door-to balloon-time was 105 minutes. Twenty-five percent of the subjects had a door-to-balloon time <90 minutes and 53.2% fulfilled a door-to-needle time <30 minutes. Conclusions: The implementation of a telemedicine-guided program for decentralized management of STEMI patients was associated with a high percentage of compliance with the goals of implementing fibrinolytic-based reperfusion therapy.

Biodiversity Management and Research in Multifunctional Landscapes / Gestão e pesquisa da biodiversidade em paisagens multifuncionais

Abstract: Despite their negative environmental impacts, human-modified environments such as agricultural and urban landscapes can have a relevant role on biodiversity conservation as complements of protected areas. Such anthropized landscapes may have endangered, valuable, and nuisance species, although most of them do not fit in any of these categories. Therefore, in such environments we must deal with the same decision-making process concerning the same possible interventions proposed by Caughley (1994) to wildlife management, which are related to biological conservation, sustainable use, control/coexistence, and monitoring. Such decision-making process should be based on good science and good governance. On such context, the first step should be to implement multifunctional landscapes, which keep their primary mission of human use, but incorporate a second but fundamental mission of biological conservation. In this study we present a summary of the research carried out at the Biota Program of Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) in this field since the late 1990's and propose priorities for biodiversity research and governance in multifunctional landscapes for the near future.

Resumo Apesar de seus impactos ambientais negativos, ambientes modificados pelo homem, como paisagens agrícolas e urbanas, podem ter um papel relevante na conservação da biodiversidade como complementos de áreas protegidas. Tais paisagens antropizadas podem ter espécies ameaçadas, valiosas e incômodas, embora a maioria delas não se enquadre em nenhuma dessas categorias. Portanto, em tais ambientes devemos lidar com o mesmo processo de tomada de decisão sobre as mesmas possíveis intervenções propostas por Caughley (1994) para o manejo da vida selvagem, que estão relacionadas à conservação biológica, uso sustentável, controle/coexistência e monitoramento. Esse processo de tomada de decisão deve ser baseado em boa ciência e boa governança. Neste contexto, o primeiro passo deverá ser a implementação de paisagens multifuncionais, que mantenham a sua missão primordial de uso humano, mas que incorporem uma segunda, mas fundamental missão de conservação biológica. Neste estudo apresentamos um resumo das pesquisas realizadas no Programa Biota da Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) neste campo desde o final da década de 1990 e propomos prioridades para pesquisa e governança da biodiversidade em paisagens multifuncionais para o futuro próximo.

Molecular diagnosis of avian viruses in grassland passerines and captive yellow cardinals Gubernatrix cristata in Brazil

ABSTRACT: Avian influenza viruses (AIVs), Newcastle disease virus (NDV), West Nile virus (WNV), adenovirus (AV) and herpesvirus (HV) play an important role in the health of human and animal populations. However, knowledge of the prevalence of these viruses in wild birds is restricted to some groups (e.g. shorebirds) or regions worldwide. Information on grassland birds of South America, which is essential for their conservation, is scarce. The objectives of the present study were to evaluate occurrences of AIV, NDV, WNV, AV and HV for the first time in a bird community of a unique protected area in southern Brazil, which is home for the critically endangered yellow cardinal (Gubernatrix cristata), and captive yellow cardinals from fauna maintainers of the Brazilian Captive Program of the Yellow Cardinal. Passerine species of wild life were caught, identified and samples (swabs) were collected from the oropharynx and cloaca of 64 passerines of 26 species (including 3 yellow cardinals) and 30 yellow cardinals of captive, for molecular diagnosis. The samples were subjected to RNA and DNA extraction and the real-time polymerase chain reaction (RT-PCR) for AIV, NDV and WNV and nested PCR for AV and HV. One yellow cardinal of captive presented a positive result for AV, this result is important for planning, managing natural attributes and making decisions in relation to integrated conservation of threatened species. This is the first report of AV in yellow cardinal and epidemiological investigation of viruses in wild passerines of the Pampa biome, in Rio Grande do Sul, Brazil.

RESUMO: Os vírus da gripe aviária (VGA), vírus da doença de Newcastle (VDN), vírus do Nilo Ocidental (VNO), adenovírus (AV) e herpesvírus (HV) desempenham um papel importante na saúde das populações humana e animal. No entanto, o conhecimento da prevalência desses vírus em aves selvagens é restrito a alguns grupos (por exemplo, aves limícolas) ou regiões em todo o mundo. As informações sobre as aves campestres da América do Sul, essenciais para a sua conservação, são escassas. Os objetivos do presente estudo foram avaliar a ocorrência de VGA, VDN, VNO, AV e HV pela primeira vez em uma comunidade de aves de uma área única protegida no Sul do Brasil, que abriga o cardeal-amarelo (Gubernatrix cristata) criticamente ameaçado de extinção e em cardeais-amarelos de cativeiro dos mantenedores de fauna do Programa Brasileiro de Cativeiro do Cardeal-amarelo. Espécies de passeriformes silvestres foram capturadas, identificadas e amostras (swabs) foram coletadas da orofaringe e cloaca de 64 passeriformes de 26 espécies (incluindo 3 cardeais-amarelos) e 30 cardeais-amarelos de cativeiro, para diagnóstico molecular. As amostras foram submetidas à extração de RNA e DNA e à reação em cadeia da polimerase em tempo real (RT-PCR) para VGA, VDN e VNO e nested PCR para AV e HV. Um cardeal-amarelo de cativeiro apresentou resultado positivo para AV, este resultado é importante para o planejamento, manejo dos atributos naturais e tomada de decisões em relação à conservação integrada de espécies ameaçadas. Este é o primeiro relato de AV em cardeal-amarelo e de investigação epidemiológica de vírus em passeriformes silvestres do bioma Pampa, no Rio Grande do Sul, Brasil.

Molecular diagnosis of avian viruses in grassland passerines and captive yellow cardinals Gubernatrix cristata in Brazil / Diagnóstico molecular de vírus aviários em passeriformes campestres e cardeais-amarelos Gubernatrix cristata cativos no Brasil

Avian influenza viruses (AIVs), Newcastle disease virus (NDV), West Nile virus (WNV), adenovirus (AV) and herpesvirus (HV) play an important role in the health of human and animal populations. However, knowledge of the prevalence of these viruses in wild birds is restricted to some groups (e.g. shorebirds) or regions worldwide. Information on grassland birds of South America, which is essential for their conservation, is scarce. The objectives of the present study were to evaluate occurrences of AIV, NDV, WNV, AV and HV for the first time in a bird community of a unique protected area in southern Brazil, which is home for the critically endangered yellow cardinal (Gubernatrix cristata), and captive yellow cardinals from fauna maintainers of the Brazilian Captive Program of the Yellow Cardinal. Passerine species of wild life were caught, identified and samples (swabs) were collected from the oropharynx and cloaca of 64 passerines of 26 species (including 3 yellow cardinals) and 30 yellow cardinals of captive, for molecular diagnosis. The samples were subjected to RNA and DNA extraction and the real-time polymerase chain reaction (RT-PCR) for AIV, NDV and WNV and nested PCR for AV and HV. One yellow cardinal of captive presented a positive result for AV, this result is important for planning, managing natural attributes and making decisions in relation to integrated conservation of threatened species. This is the first report of AV in yellow cardinal and epidemiological investigation of viruses in wild passerines of the Pampa biome, in Rio Grande do Sul, Brazil.(AU)

Os vírus da gripe aviária (VGA), vírus da doença de Newcastle (VDN), vírus do Nilo Ocidental (VNO), adenovírus (AV) e herpesvírus (HV) desempenham um papel importante na saúde das populações humana e animal. No entanto, o conhecimento da prevalência desses vírus em aves selvagens é restrito a alguns grupos (por exemplo, aves limícolas) ou regiões em todo o mundo. As informações sobre as aves campestres da América do Sul, essenciais para a sua conservação, são escassas. Os objetivos do presente estudo foram avaliar a ocorrência de VGA, VDN, VNO, AV e HV pela primeira vez em uma comunidade de aves de uma área única protegida no Sul do Brasil, que abriga o cardeal-amarelo (Gubernatrix cristata) criticamente ameaçado de extinção e em cardeais-amarelos de cativeiro dos mantenedores de fauna do Programa Brasileiro de Cativeiro do Cardeal-amarelo. Espécies de passeriformes silvestres foram capturadas, identificadas e amostras (swabs) foram coletadas da orofaringe e cloaca de 64 passeriformes de 26 espécies (incluindo 3 cardeais-amarelos) e 30 cardeais-amarelos de cativeiro, para diagnóstico molecular. As amostras foram submetidas à extração de RNA e DNA e à reação em cadeia da polimerase em tempo real (RT-PCR) para VGA, VDN e VNO e nested PCR para AV e HV. Um cardeal-amarelo de cativeiro apresentou resultado positivo para AV, este resultado é importante para o planejamento, manejo dos atributos naturais e tomada de decisões em relação à conservação integrada de espécies ameaçadas. Este é o primeiro relato de AV em cardeal-amarelo e de investigação epidemiológica de vírus em passeriformes silvestres do bioma Pampa, no Rio Grande do Sul, Brasil.(AU)

Factors associated with actively working in the very long-term following acute coronary syndrome

OBJECTIVES: Returning to work after an episode of acute coronary syndrome (ACS) is challenging for many patients, and has both personal and social impacts. There are limited data regarding the working status in the very long-term after ACS. METHODS: We retrospectively analyzed 1,632 patients who were working prior to hospitalization for ACS in a quaternary hospital and were followed-up for up to 17 years. Adjusted models were developed to analyze the variables independently associated with actively working at the last contact, and a prognostic predictive index for not working at follow-up was developed. RESULTS: The following variables were significantly and independently associated with actively working at the last contact: age>median (hazard-ratio [HR], 0.76, p<0.001); male sex (HR, 1.52, p<0.001); government health insurance (HR, 1.36, p<0.001); history of angina (HR, 0.69, p<0.001) or myocardial infarction (MI) (HR, 0.76, p=0.005); smoking (HR, 0.81, p=0.015); ST-elevation MI (HR, 0.81, p=0.021); anterior-wall MI (HR, 0.75, p=0.001); non-primary percutaneous coronary intervention (PCI) (HR, 0.77, p=0.002); fibrinolysis (HR, 0.61, p<0.001); cardiogenic shock (HR, 0.60, p=0.023); statin (HR, 3.01, p<0.001), beta-blocker (HR, 1.26, p=0.020), angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB) (HR, 1.37, p=0.001) at hospital discharge; and MI at follow-up (HR, 0.72, p=0.001). The probability of not working at the last contact ranged from 24.2% for patients with no variables, up to 80% for patients with six or more variables. CONCLUSIONS: In patients discharged after ACS, prior and in-hospital clinical variables, as well as the quality of care at discharge, have a great impact on the long-term probability of actively working.

El paraganglioma como tumor mesentérico infrecuente / Mesenteric paraganglioma: a rare tumor

RESUMEN Los paragangliomas son tumores originados en las células neuroendocrinas que forman el sistema nervioso autónomo. Se consideran benignos aunque pueden desarrollar malignidad, por lo que su tra tamiento es quirúrgico. La presentación de paraganglioma de ubicación mesentérica es muy inusual.

ABSTRACT Paragangliomas are rare neuroendocrine tumors that arise in the autonomic nervous system. Although these tumors are considered benign, they must be removed by surgery due to their potential malig nant transformation. Mesenteric paragangliomas are extremely rare.

Health self-perception and its association with physical activity and nutritional status in adolescents / Autopercepção de saúde e sua associação com atividade física e estado nutricional em adolescentes

Abstract Objective: To evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders. Methods: This is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14 -19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ 2) and the Poisson regression model with robust variance were used in the data analyses. Results: It was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p < 0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR = 1.44, 95% CI: 1.15 -1.81) and were classified as insufficiently active (PR = 1.27, 95% CI: 1.04 -1.56), as well as girls who did not practice physical activity during free time (PR = 1.15, 95% CI: 1.02 -1.29) and were classified as overweight (PR = 1.27, 95% CI: 1.01 -1.29) had a greater chance of negative health self-perception. Conclusion: Behavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders.

Resumo Objetivo: Avaliar a associação entre atividade física total, atividade física no tempo livre e estado nutricional com a autopercepção de saúde em adolescentes de ambos os sexos. Métodos: Trata-se de um estudo com abordagem quantitativa, que integra o levantamento epidemiológico transversal de base escolar e abrangência estadual, cuja amostra foi constituída por 6.261 adolescentes (14 a 19 anos) selecionados por meio de uma estratégia de amostragem aleatória de conglomerados. Os dados foram coletados a partir do questionário Global School-based Student Health Survey. O teste de qui-quadrado (χ2) e o modelo de regressão de Poisson com variância robusta foram usados nas análises dos dados. Resultados: Observou-se que 27,3% dos adolescentes tinham uma autopercepção de saúde negativa, maior entre as meninas (33,0% vs. 19,0%; p < 0,001). Após o ajuste pelos potenciais fatores de confusão, constatou-se que tinham maior chance de ter uma autopercepção de saúde negativa os meninos que não praticavam atividade física no tempo livre (RP = 1,44; IC 95%: 1,15-1,81) e que eram classificados como insuficientemente ativos (RP = 1,27; IC 95%: 1,04-1,56) e as meninas que não praticavam atividade física no tempo livre (RP = 1,15; IC 95%: 1,02-1,29) e que eram classificadas como sobrepesadas (RP = 1,27; IC 95%: 1,01-1,29). Conclusão: Questões comportamentais podem ter diferentes repercussões na autopercepção de saúde quando comparados os meninos e meninas. A autopercepção de saúde negativa esteve associada ao estado nutricional entre as meninas e a um menor nível de atividade física entre os meninos e a prática de atividade física no tempo livre foi tida como fator de proteção para uma autopercepção de saúde negativa para os adolescentes de ambos os sexos.

Human parainfluenza virus surveillance in pediatric patients with lower respiratory tract infections: a special view of parainfluenza type 4 / Vigilância dos vírus parainfluenza humanos em pacientes pediátricos com infecções do trato respiratório inferior: uma visão especial do parainfluenza tipo 4

Abstract Objective: Characterize the role of human parainfluenza virus and its clinical features in Brazilian children under 2 years of age presenting with acute lower respiratory tract infections. Methods: Real-time assays were used to identify strains of human parainfluenza virus and other common respiratory viruses in nasopharyngeal aspirates. One thousand and two children presenting with acute lower respiratory tract illnesses were enrolled from February 2008 to August 2010. Results: One hundred and four (10.4%) patients were human parainfluenza virus positive, of whom 60 (57.7%) were positive for human parainfluenza virus-3, 30 (28.8%) for human parainfluenza virus-4, 12 (11.5%) for human parainfluenza virus-1, and two (1.9%) for human parainfluenza virus-2. Seven (6.7%) patients had more than one strain of human parainfluenza virus detected. The most frequent symptoms were tachypnea and cough, similar to other viral respiratory infections. Clinical manifestations did not differ significantly between human parainfluenza virus-1, -2, -3, and -4 infections. Human parainfluenza virus-1, -3, and -4 were present in the population studied throughout the three years of surveillance, with human parainfluenza virus-3 being the predominant type identified in the first two years. Conclusion: Human parainfluenza viruses contribute substantially to pediatric acute respiratory illness (ARI) in Brazil, with nearly 30% of this contribution attributable to human parainfluenza virus-4.

Resumo Objetivo: Caracterizar o papel do VPH-4 e suas características clínicas em crianças brasileiras com menos de dois anos de idade com infecções agudas do trato respiratório inferior. Métodos: Ensaios em tempo real foram utilizados para identificar tipos de VPH e outros vírus respiratórios comuns em aspirados nasofaríngeos. Mil e duas crianças com doença aguda do trato respiratório inferior foram inscritas para participar de fevereiro de 2008 a agosto de 2010. Resultados: 104 (10,4%) pacientes eram VPH positivos, dos quais 60 (57,7%) eram positivos para VPH-3, 30 (28,8%) para VPH-4, 12 (11,5%) para VPH-1 e dois (1,9%) para VPH-2. Sete (6,7%) pacientes apresentaram mais de um tipo de VPH detectado. Os sintomas mais frequentes foram tosse e taquipneia, semelhantes a outras infecções respiratórias virais. As manifestações clínicas não diferiram de forma significativa entre as infecções por VPH-1, -2, -3 e -4. Os VPH-1, -3 e -4 estavam presentes na população estudada ao longo dos três anos de vigilância, e o VPH-3 foi o tipo predominante identificado nos primeiros dois anos. Conclusão: Os VPHs contribuem substancialmente para a DRA pediátrica no Brasil com quase 30% dessa contribuição atribuível ao VPH-4.

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Objective: To evaluate the prevalence of alcohol abuse and/or dependence in a population-based sample of young adults and assess the prevalence of comorbid mood disorders, anxiety, and suicide risk in this population. Methods: This cross-sectional, population-based study enrolled 1,953 young adults aged 18-35 years. The CAGE questionnaire was used to screen for alcohol abuse and/or dependence, with CAGE scores ≥ 2 considered positive. Psychiatric disorders were investigated through the structured Mini International Neuropsychiatric Interview (MINI). Results: Alcohol abuse and/or dependence was identified in 187 (9.60%) individuals (5.10% among women and 15.20% among men). Alcohol abuse and/or dependence were more prevalent among men than women, as well as among those who used tobacco, illicit drugs or presented with anxiety disorder, mood disorder, and suicide risk. Conclusion: These findings suggest that alcohol abuse and/or dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention programs.

Evaluation of Quality of life, Physical Activity and Nutritional Profile of Postmenopausal Women with and without Vitamin D Deficiency / Qualidade de vida, atividade física e perfil nutricional de mulheres na pós-menopausa com e sem deficiência de vitamina D

Abstract Introduction Vitamin D deficiency is associated with various diseases. Prevalent in Brazil, it can result from inadequate lifestyle habits. Objective To demonstrate that postmenopausal women with vitamin D deficiency have worse quality of health, expressed as worse quality of life, lower levels of physical activity, and worse nutritional profile. Methods Postmenopausal women answered questionnaires about physical activity and quality of life, provided a 24-hour food record, and had serum vitamin D levels measured. Results Among the more active women, those who perform a daily average of one hour of physical activity had vitamin D levels above 20 ng/mL (76.9%), and those, which expose themselves to sunlight, had vitamin D levels above 30 ng/mL (34.6%). Meanwhile the percentages for the women who are less physically active and less exposed to sunlight were 42.2% and 8.9% respectively. Being more active and more exposed to sunlight resulted in a lower fat percentage. Serum vitamin D levels were not correlated with quality of life. Conclusion Walking and gardening increased serum vitamin D levels and decreased the percentage of body fat. The limitations of the study prevented the impact of 25hidroxyvitamin D on the quality of life and nutritional aspects of the women from being evaluated.

Resumo Introdução A deficiência de vitamina D está associada a diversas doenças. Prevalente no Brasil, pode ser consequência de hábitos de vida inadequados. Objetivo Demonstrar que mulheres na pós-menopausa com hipovitaminose D têm pior qualidade de saúde, expressa por piores qualidade de vida, nível de atividade física e perfil nutricional. Métodos Mulheres na pós-menopausa responderam a questionários sobre atividade física, qualidade de vida, registro alimentar de 24 horas, e tiveram os níveis séricos de vitamina D medidos. Resultados Dentre as mulheres mais ativas, as que praticam em média 1 hora de atividade por dia apresentaram níveis de vitamina D superiores a 20 ng/mL (76,9%), e as que se expõem ao sol apresentaram níveis acima de 30 ng/mL (34,6 %). Já as mulheres menos ativas e menos expostas ao sol apresentaram respectivamente 42,2 % e 8,9%. Ser mais ativa e ter maior exposição solar significou ter menor percentual de gordura. O nível sérico de vitamina D não mostrou relação com a qualidade de vida. Conclusão Caminhada e jardinagem aumentam os níveis séricos de vitamina D e diminuem o percentual de gordura corpórea. As limitações do estudo não permitiram avaliar o impacto da 25-hidróxi-vitamina D na qualidade de vida e nos aspectos nutricionais das mulheres.

Association between general and abdominal obesity with high blood pressure: difference between genders / Associação entre a obesidade geral e abdominal com a pressão arterial elevada: diferença entre gêneros

Abstract Objective: To assess the association between general and abdominal obesity with high blood pressure in adolescents of both genders from the public school system. Methods: This was an epidemiological, descriptive, exploratory study, with a quantitative approach and local scope whose sample consisted of 481 high school students (aged 14–19), selected by using a random cluster sampling strategy. Blood pressure was measured through the use of automated monitor and was considered high when the pressure values were at or above the 95th percentile. The analyses were performed using the chi-squared test and binary logistic regression. Results: The prevalence of high blood pressure was 6.4%, and it was higher among boys (9.0% vs. 4.7%, p < 0.05). There was no significant difference between general (p = 0.903) and abdominal obesity (p = 0.157) when genders were compared. After adjusting for age, high blood pressure was associated with general (OR = 6.4; p < 0.001) and abdominal obesity (OR = 7.0; p < 0.001) only among boys, when comparing the fourth quartile with the first quartile of body mass index (≤18.6 kg/m2 vs. ≥23.5 kg/m2) and waist circumference (≤69 cm vs. ≥80.1 cm). Conclusion: It was observed that general and abdominal obesity are associated with high blood pressure only in boys, regardless of age.

Resumo Objetivo: Analisar a associação entre obesidade geral e abdominal com a pressão arterial elevada em adolescentes de ambos os gêneros da rede de ensino público. Métodos: Estudo epidemiológico, descritivo, exploratório, com abordagem quantitativa e abrangência municipal, cuja amostra foi constituída de 481 estudantes (14-19 anos) do ensino médio, selecionados por meio de uma estratégia de amostragem aleatória de cluster. A pressão arterial foi medida com equipamentos automáticos e considerada elevada quando os valores pressóricos estivessem iguais ou acima do percentil 95. As análises foram feitas com os testes de qui-quadrado e da regressão logística binária. Resultados: A prevalência de pressão arterial elevada foi de 6,4%, maior entre os rapazes (9% vs. 4,7%, p < 0,05). Não foi observada diferença significante entre a obesidade geral (p = 0,903) e abdominal (p = 0,157) quando comparados os gêneros. Após o juste pela idade, a pressão arterial elevada foi associada com a obesidade geral (OR = 6,4; p < 0,001) e abdominal (OR = 7,0; p < 0,001) apenas entre os rapazes, quando comparado o quarto quartil com o primeiro quartil do índice de massa corporal (≤ 18,6 Kg/m2 vs. ≥23,5 Kg/m2) e da circunferência da cintura (≤ 69 cm vs. ≥80,1 cm). Conclusão: Foi observado que a obesidade geral e abdominal está associada com a pressão arterial elevada apenas entre os rapazes, independentemente da idade.

Advances in Computed Tomography Evaluation of Skull Base Diseases

Introduction: Computed tomography (CT) is a key component in the evaluation of skull base diseases. With its ability to clearly delineate the osseous anatomy, CT can provide not only important tips to diagnosis but also key information for surgical planning. Objectives: The purpose of this article is to describe some of the main CT imaging features that contribute to the diagnosis of skull base tumors, review recent knowledge related to bony manifestations of these conditions, and summarize recent technological advances in CT that contribute to image quality and improved diagnosis. Data Synthesis Recent advances in CT technology allow fine-detailed evaluation of the bony anatomy using submillimetric sections. Dual-energy CT material decomposition capabilities allow clear separation between contrast material, bone, and soft tissues with many clinical applications in the skull base. Dual-energy technology has also the ability to decrease image degradation from metallic hardwares using some techniques that can result in similar or even decreased radiation to patients. Conclusions: CT is very useful in the evaluation of skull base diseases, and recent technological advances can increase disease conspicuity resulting in improved diagnostic capabilities and enhanced surgical planning...

Effects of the administration of a catalase inhibitor into the fourth cerebral ventricle on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke

OBJECTIVE: Previous studies have demonstrated a relationship between brain oxidative stress and cardiovascular regulation. We evaluated the effects of central catalase inhibition on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke. METHODS: Male Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SH) (16 weeks old) were implanted with a stainless steel guide cannula leading into the fourth cerebral ventricle (4th V). The femoral artery and vein were cannulated for arterial pressure and heart rate measurement and drug infusion, respectively. The rats were exposed to sidestream cigarette smoke for 180 minutes/day, 5 days/week for 3 weeks (CO: 100-300 ppm). The baroreflex was tested using a pressor dose of phenylephrine (8 μg/kg, bolus) and a depressor dose of sodium nitroprusside (50 μg/kg, bolus). Cardiovascular responses were evaluated before and 5, 15, 30 and 60 minutes after injection of a catalase inhibitor (3-amino-1,2,4-triazole, 0.001 g/100 μL) into the 4th V. RESULTS: Vehicle administration into the 4th V did not affect the cardiovascular response, whereas administration of the central catalase inhibitor increased the basal HR and attenuated the bradycardic peak (p<0.05) to a greater extent in WKY rats exposed to sidestream cigarette smoke than in WKY rats exposed to fresh air. However, in spontaneously hypertensive rats, the effect of the catalase inhibitor treatment was stronger in the fresh air condition (p<0.05). CONCLUSION: Administration of a catalase inhibitor into the 4th V combined with exposure to sidestream cigarette smoke has a stronger effect in WKY rats than in SH rats. .

Chemotaxonomic significance of flavonoids, coumarins and triterpenes of Augusta longifolia (Spreng.) Rehder, Rubiaceae-Ixoroideae, with new insights about its systematic position within the family / Significância quimiotaxômica de flavonoides, cumarinas e triterpenos de Augusta longifolia (Spreng.) Rehder, Rubiaceae-Ixoroideae, com novos entendimentos sobre a posição sistemática dentro da família

Augusta has traditionally been placed in the tribe Rondeletieae, subfamily Cinchonoideae. However, recent molecular phylogenies positioned it near to Wendlandia (Ixoroideae), but locate A. longifolia near to the clade Ixoroidinae II. The study of A. longifolia afforded two coumarins, five flavonoids, three triterpenoids and one benzoic acid derivative. These metabolites reinforce the separation of Augusta as a monospecific genus, and Lindenia as a genus of three species, closely related to Wendlandia.

Augusta tem sido tradicionalmente colocada na tribo Rondeletieae, Cinchonoideae subfamília. No entanto, recentes filogenias moleculares posicionou-a perto de Wendlandia, porém localizando A. longifolia perto do clado Ixoroidinae II. O estudo de A. longifolia resultou em duas cumarinas, cinco flavonoides, três triterpenoides e um derivado do ácido benzóico. Estes metabolitos reforçam a separação da Augusta como um gênero monoespecífico, e Lindenia como um gênero de três espécies, intimamente relacionada com Wendlandia.

The role of invasive therapies in elderly patients with acute myocardial infarction

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were ¡Ý70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.

Parentage test in broad-snouted caimans (Caiman latirostris, Crocodylidae) using microsatellite DNA

In this study, microsatellite markers, developed for Alligator mississipiensis and Caiman latirostris, were used to assess parentage among individuals from the captive colony of Caiman latirostris at the University of São Paulo, in Piracicaba, São Paulo, Brazil. Many of the females in the colony were full siblings, which made maternal identification difficult due to genotypic similarity. Even so, the most likely mother could be identified unambiguously among offspring in most of the clutches studied. Two non-parental females displayed maternal behavior which would have misled managers in assigning maternity based on behavior alone. This set of variable loci demonstrates the utility of parentage testing in captive propagation programs.