Variability in the perception of palliative care and end-of-life care among hematology professionals from the same reference center in Bahia, Brazil: A descriptive cross-sectional study

ABSTRACT BACKGROUND: There are several illness-specific cultural and system-based barriers to palliative care (PC) integration and end-of-life (EOL) care in the field of oncohematology. OBJECTIVES: This study aimed to investigate the variability in the perceptions of PC and EOL care. DESIGN AND SETTING: A cross-sectional study was conducted in the Hematology Division of our University Hospital in Salvador, Bahia, Brazil. METHODS: Twenty physicians responded to a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies from October to December 2022. RESULTS: The median age of the participants was 44 years, 80% of the participants identified as female, and 75% were hematologists. Participants faced a hypothetical scenario involving the treatment of a 65-year-old female with a poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of the participants chose to follow other chemotherapy regimens, whereas 40% opted for PC. Next, participants considered case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct, and the conduct they thought would be better for the patient. Even though participants were from the same center, we found a divergence from the most probable conduct among 40% of the participants, which was due to personal convictions, legal aspects, and other physicians' reactions. CONCLUSIONS: We found considerable differences in the perception of PC and EOL care among professionals, despite following the same protocols. The study also demonstrated variations between healthcare professionals' beliefs and practices and persistent historical tendencies to prioritize aggressive interventions.

Evaluation of cardiac autonomic function and low-grade inflammation in children with obesity living in the Northeast Brazilian region

Abstract Objective Evaluate autonomic function and low-grade inflammation and characterize the correlation between these variables in schoolchildren with obesity living in the Brazilian northeast region. Methods 84 children with obesity and 41 with normal weight were included in this cross-sectional study. Anthropometry, body composition, blood pressure (BP), inflammatory biomarkers, and heart rate variability (HRV) indexes were analyzed in children aged 7 to 11 years. Results children with obesity had increased systolic (p= 0.0017) and diastolic (p= 0.0131) BP and heart rate (p= 0.0022). The children with obesity displayed significantly lower SDNN, RMSSD, NN50, HF (ms), HF (nu), SD1, SD2, and higher LF (ms), LF (nu), LF/HF, SD1/SD2, DFA-α1, and DFA-α2, compared to normal weight. A lower and higher capacity for producing IL-10 (p= 0.039) and IL-2 (p= 0.009), respectively, were found in children with obesity compared to children with normal weight. Although IL-2, IL-4 and IL17A did not correlate with HRV parameters, IL-6 was positively correlated with SDNN, LF (ms) and SD2, TNF-α was positively correlated with LF/HF and SD1/SD2 ratio, and IFN-γ was positively correlated with SDNN, RMMSSD, NN50, LF (ms), HF (ms), SD1, and SD2. Conclusions The findings suggest that children with obesity have impaired autonomic function and systemic low-grade inflammation compared to children within the normal weight range, the inflammatory biomarkers were correlated with HRV parameters in schoolchildren living in the northeastern region of Brazil.

Sorghum hybrids grown in hydroponics contrast for phosphorus use efficiency / Híbridos de sorgo crescidos em hidroponia contrastam para eficiência de uso de fósforo

Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.

A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.

Sorghum hybrids grown in hydroponics contrast for phosphorus use efficiency

Abstract Phosphorus (P) use efficiency is crucial for sorghum production. P acquisition efficiency is the most important component of P use efficiency. The early-stage evaluation of plant development is a useful tool for identifying P-efficient genotypes. This study aimed to identify sorghum hybrids that are efficient in P use efficiency and assess the genetic diversity among hybrids based on traits related to P acquisition efficiency. Thus, 38 sorghum hybrids and two inbred lines (checks) were evaluated under low and high P in a paper pouch system with nutrient solution. Biomass and root traits related to P efficiency were measured. There was no interaction between genotypes and P levels concerning all evaluated traits. The biomass and root traits, except root diameter, presented smaller means under low P than high P. Efficient and inefficient hybrids under each P level were identified. The genetic diversity assessment grouped these genotypes in different clusters. The hybrids AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540, and DKB 590 were superior under low-P and high-P. Hybrids SC121, 1236020 e 1167017 presented the lowest means than all other hybrids, under both conditions. The evaluated hybrids showed phenotypic diversity for traits related to P acquisition, such as root length and root surface area, which can be useful for establishing selection strategies for sorghum breeding programs and increasing P use efficiency.

Resumo A eficiência do uso do fósforo (P) é fundamental para a produção de sorgo. A avaliação no estágio inicial do desenvolvimento da planta é uma ferramenta útil para a identificação de genótipos eficientes de P. Este trabalho teve como objetivo identificar híbridos de sorgo que sejam eficientes ao uso de P e avaliar a diversidade genética entre os híbridos com base em características relacionadas à eficiência de aquisição de P. Assim, 38 híbridos de sorgo e duas linhagens (testemunhas) foram avaliados sob baixo e alto P em sistema de pastas de papel com solução nutritiva. Características de biomassa e de raiz relacionadas à eficiência de P foram mensuradas. Não houve interação entre genótipos e níveis de P em todas as características avaliadas. As características de biomassa e raiz, exceto o diâmetro da raiz, apresentaram médias menores sob baixo P em comparação com alto P. Híbridos eficientes e ineficientes sob cada nível de P foram identificados e agrupados quanto à diversidade genética. Os híbridos AG1090, MSK326, AG1060, 1G100, AS 4639, DKB 540 e DKB 590 foram superiores sob baixo-P e alto-P. Os híbridos SC121, 1236020 e 1167017 apresentaram as menores médias que todos os outros híbridos, em ambas condições. Os híbridos avaliados apresentaram diversidade fenotípica para características relacionadas à aquisição de P, como comprimento e área superficial da raiz, o que pode ser útil para estabelecer estratégias de seleção para programas de melhoramento de sorgo e aumentar a eficiência de uso do P.

Reactividad Cardiaca ante Evocación de Eventos Estresantes en Población Universitaria / Cardiac Reactivity to Evocation of Stressful Events in a University Population

Resumen La variabilidad de la frecuencia cardiaca (VFC) se utiliza como una señal fisiológica para evaluar la reactividad psicofisiológica al estrés. El análisis en el dominio de la frecuencia de esta señal se ha usado para describir el papel del sistema nervioso autónomo en los procesos de adaptación al estrés. Sin embargo, el uso de medidas de tendencia central para reportar los resultados de distintas poblaciones desestima las diferencias individuales en la reacción frente al estrés. El objetivo de esta investigación fue caracterizar la reactividad cardiaca ante la evocación de eventos estresantes en población universitaria. Participaron 94 estudiantes de nuevo ingreso a la carrera de psicología, de dos universidades de México. Los resultados indican un decremento consistente en la banda de alta frecuencia ante la evocación de eventos estresantes, en comparación con la banda de baja frecuencia. La caracterización de la respuesta autonómica al estrés presenta dos subgrupos acoplados (co-activación y co-inhibición); y uno desacoplado. Nuestros hallazgos, ratifican la viabilidad de la banda de frecuencia alta de la VFC como un indicador estable de reactividad al estrés, y resaltan la importancia de las diferencias específicas de la actividad autonómica en la caracterización de la respuesta fisiológica al estrés.

Abstract Heart rate variability (HRV) is used as a reliable physiological signal to assess psychophysiological reactivity to stress. Frequency-domain mathematical analysis of the HRV signal provides metrics that are associated with the performance of the autonomic nervous system. However, the use of measures of central tendency to report global results in different populations underestimates individual differences in the way people react to stress and the clinical importance of this response. The objective of this research was to characterize cardiac reactivity to the evocation of stressful events in a university population. The participants were 94 new psychology students from two universities in Mexico. A psychophysiological stress assessment was performed to estimate cardiac reactivity; the evaluation consisted of the following conditions: 1) Baseline; 2) Evocation of stress; and 3) Recovery. The participants were sitting with their eyes closed and without moving during every single one of the conditions. Four subgroups were created depending on the type of cardiac reactivity to stress. The results indicate a significant consistent decrease in the high-frequency band when evoking stressful events, compared to the low-frequency band. Similar responses were observed between the low-frequency band and the high-frequency band in 60.6% of the cases, suggesting that the antagonistic autonomic balance between the two divisions of the ANS was scarce. According to the autonomic space model and the type of stress reactivity of each student, there were two subgroups characterized by co-activation and co-inhibition modes; and one subgroup characterized by uncoupled response mode. Our findings confirm the viability of the high-frequency band of HRV as a stable indicator of stress reactivity. Likewise, evidence is generated in favor of using evocative stress stimuli to assess physiological reactivity like more personal stressors. Lastly, the importance of specific differences in autonomic activity to characterize the physiological response to stress and its possible clinical utility to propose interventions and select techniques that most effectively benefit vulnerable populations are highlighted.

Evaluación de cultivares de arroz (Oryza sativa L.) de Vietnam, para su introducción en Cuba

Con el objetivo de evaluar la diversidad fenotípica de ocho cultivares de arroz (Oryza sativa L.) procedentes de Vietnam, para su introducción en los programas de mejora y en la producción en Cuba, apoyados en caracteres morfoagronómicos y técnicas de análisis multivariado, fue desarrollado este trabajo en la Unidad Científico Tecnológica de Base "Los Palacios", perteneciente al Instituto Nacional de Ciencias Agrícolas de Cuba. Los cultivares vietnamitas se sembraron en campo junto a los comerciales INCA LP-5 e INCA LP-7, para ser caracterizados agronómicamente con la utilización de 29 descriptores cualitativos y 22 cuantitativos. Los resultados mostraron que 16 caracteres cualitativos resultaron homogéneos para los ocho cultivares procedentes de Vietnam y los dos cultivares comerciales cubanos, la asociación entre varios caracteres cuantitativos reafirma la influencia que ejercen algunos componentes sobre el rendimiento, los que son considerados como marcadores para la selección, tres cultivares de procedencia vietnamita (GL301, LCG3-4 y DS1) no pueden ser utilizados en la producción arrocera en Cuba, por su susceptibilidad a Tagosodes. Todos los cultivares mostraron resistencia a Rhizoctonia solani y Sarocladium oryzae y dos (GL 301 y LTH 31) fueron susceptibles a Pyricularia grisea. Los cultivares OM6976, OM5451 y OM8087 alcanzaron valores altos de rendimiento, por lo que pudieran ser utilizados, como progenitores en los programas de mejora, así como cultivares comerciales.

With the objective of evaluating the phenotypic diversity of eight rice cultivars (Oryza sativa L.) from Vietnam, for their introduction in breeding programs and production in Cuba, supported by morphoagronomic characters and multivariate analysis techniques, this work was developed in Scientific and Technological Base Unit belonging to the National Agricultural Sciences Institute of Cuba. The Vietnamese cultivars were planted in the field together with the commercial cultivars INCA LP-5 and INCA LP-7, to be characterized agronomically with the use of 29 qualitative and 22 quantitative descriptors. The results showed that 16 qualitative characters were homogeneous for the eight cultivars from Vietnam and the two Cuban commercial cultivars, the association between various quantitative characters reaffirms the influence exerted by some components on yield, which are considered as markers for selection. Three cultivars of Vietnamese origin (GL301, LCG3-4 and DS1) cannot be used in Cuban rice production, due to their susceptibility to Tagosodes. All cultivars showed resistance to Rhizoctonia solani and Sarocladium oryzae and two (GL 301 and LTH 31) were susceptible to Pyricularia grisea. The OM6976, OM5451 and OM8087 cultivars reached high yield values, so they could be used as parents in breeding programs, as well as commercial cultivars.

Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli

Background: The brain-computer interface (BCI) is gaining much attention to treat neurological disorders and improve brain-dependent functions. Significant achievements over the last decade have focused on engineering and computation technology to enhance the recording of signals and the generation of output stimuli. Nevertheless, many challenges remain for the translation of BCIs to clinical applications. Methods: We review the relevant data on the four significant gaps in enhancing BCI's clinical implementation and effectiveness. Results: The paper describes three methods to bridge the current gaps in the clinical application of BCI. The first is using a brain-directed adjuvant with a high safety profile, which can improve the accuracy of brain signaling, summing of information, and production of stimuli. The second is implementing a second-generation artificial intelligence system that is outcome-oriented for improving data streaming, recording individualized brain-variability patterns into the algorithm, and improving closed-loop learning at the level of the brain and with the target organ. The system overcomes the compensatory mechanisms that underlie the loss of stimuli' effectiveness for ensuring sustainable effects. Finally, we use inherent brain parameters relevant to consciousness and brain function to bridge some of the described gaps. Conclusions: Combined with the currently developed techniques for enhancing effectiveness and ensuring a sustainable response, these methods can potentially improve the clinical outcome of BCI techniques.

Analysis of Association of Brain Natriuretic Peptide Levels and Blood Pressure Variability

Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023. Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP. Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ??and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

To Assess the Interobserver Variability in Mitotic Figure Counting in Various Grades of Oral Squamous Cell Carcinoma

Background: Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, representing up to 80–90% of all malignant neoplasms of the oral cavity. The increasing cases of oral cancer are the most important concern for community health. Defects of mitosis result in various nuclear abnormalities namely micronuclei, binucleation, broken egg appearance, pyknotic nuclei, and increased numbers of mitotic figures. The rationale for mitotic counting is that it is frequently used for classification and grading of tumors, prediction of prognosis of tumors and even advocated as a decision point for treatment. Reproducibility of the mitotic counting is paramount for the assessment of malignancy on a histologic scale. Considering this, we decided to assess the inter-observer variability in mitotic figure counting in various grades of oral squamous cell carcinoma. Material & Methods: A retrospective study was carried out on 48 formalin fixed paraffin embedded tissue blocks of the confirmed cases of Oral squamous cell carcinoma in the archives of department of oral pathology, Govt. Dental College & Hospital, Srinagar. Mitotic figure counting was done by two independent, mutually blind observers. The data was assessed for inter-observer variability in counting of figures. Results: Least difference was seen in cases of WDSCC up to the maximum difference of 3 mitoses. MDSCC showed modest differences in observations, with a maximum difference of 4 mitoses. PDSCC cases had the highest inter-observer variability, with a maximum difference of 5 mitoses. Conclusion: Mitosis counting has been shown most convincingly to provide independent prognostic value and is the most well established component of the histological grading systems of OSCC. Reproducibility of the mitotic counting is paramount for the assessment of malignancy on a histologic scale.

Comparison of Glucose Control by Added Liraglutide to Only Insulin Infusion in Diabetic Patient Undergoing Cardiac Surgery: A Preliminary Randomized?Controlled Trial

Background: Liraglutide, glucagon-like peptide-1 (GLP-1) receptor agonist, has been investigated for safety and effectiveness for blood glucose (BG) control in a surgical setting. However, there are only a few studies specific to cardiac surgery patients. Aims: To primarily compare perioperative 1) BG and 2) glycemic variability (GV) between added liraglutide and only insulin infusion in diabetes mellitus (DM) patients undergoing cardiac surgery. Setting and Design: A randomized control trial was conducted in DM patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Inclusion criteria were age 20� years and DM Type 2. Material and Methods: The recruited patients were randomly assigned to Group 1 (added liraglutide with insulin infusion) and Group 2 (insulin infusion). Insulin infusion was based on institutional protocol. Point of care testing (POCT) glucose was used for the adjustment of insulin and BG analysis. Continuous glucose monitor (CGM) was for GV analysis (using Standard deviation: SD). Statistics: t?test, Chi?square or Fisher?exact test, or Mann朩hitney U test. Results: Finally, 60 patients were in our study (Group 1 = 32 vs Group 2 = 28). Perioperative mean BG levels of Group 1 were significantly lower than Group 2 with a mean difference of 15.9 mg/dL. Nine patients (18.7% vs 10.7%, P = 0.384) had BG of 60� with mean BGs (109.1 vs 147.9, P = 0.001) in the morning. Thirteen patients (9.4% vs 35.7%, P = 0.025) had BG >180 mg/dL at the 1st operative hour. SDs were increasing, but lower SD of Group 1 were observed at the postoperative period. Mean of SDs at postoperative day 2 were 23.65 vs 32.79 mg/dL, P = 0.018. Conclusions: Liraglutide added with insulin infusion can attenuate perioperative BG and is beneficial in the aspect of lowering GV together with BG at the postoperative period in DM patients. Liraglutide can be applied in cardiac surgery but a rearrangement of time and dosage should be further investigated.

Study of heart rate variability to assess autonomic dysfunction in patients with chronic obstructive pulmonary disease of a tertiary care hospital of West Bengal: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality throughout the world. COPD and its complications also lead to a large number of deaths every year in our country. Cardiac arrhythmias and sudden cardiac death are the major complications of COPD leading to death and disability. Such cardiac complications are often a result of autonomic dysfunction. Aims and Objectives: This study aims to find out the autonomic dysfunction in moderate COPD patients by comparing their heart rate variability (HRV) parameters with age and sex matched healthy controls. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, 48 patients of moderate COPD and 54 healthy subjects were assessed and compared with respect to their HRV parameters which included Mean RR, Mean HR, SDNN, NN50, pNN50, root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), LF/HF ratio, and SD2/SD1 ratio. Results: It was found that in comparison to healthy controls, patients of moderate COPD had significant alteration in the following HRV parameters – Mean HR (P: 0.001), RMSSD (P: 0.002), SDNN (P: 0.015), NN50 (P: 0.001), pNN50 (P: 0.000), HF (NU/normalized unit) [P: 0.033], HF (%) [P: 0.002], LF (NU/normalized unit) [P: 0.033], LF (%) [P: 0.012], and LF/HF (P: 0.033). Conclusion: As there is a significant alteration of several HRV parameters in moderate COPD patients, we conclude that HRV measurement may subserve as a simple and non-invasive tool to assess autonomic dysfunction in patients of COPD at the earliest.

A correlation study of arterial stiffness, cardiac autonomic neuropathy and lipid profile in type 2 diabetes mellitus patients

Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.

Heart rate variability in patients presenting with anginal symptoms in absence of cardiac and other diseases

Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than >50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2 ), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2 , P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.

Genetic variability in the neurobiology of nicotine dependence: effects on smoking behavior / A variabilidade genética na neurobiologia da adição à nicotina: reflexos no comportamento tabágico

Abstract Background Smoking dependence is a chronic disease and a public health problem. The neurobiology of nicotine addiction can explain smoking behavior. This system has genetic variability that has been associated with vulnerability to dependence. Genetic variability in the neurobiology of smoking can help to understand why individuals exposed to drugs may or may not become addicted. Objective This study aims to address genetic variability in the neurobiology of smoking addiction with a focus on polymorphic genes related to the nicotinic response and the dopaminergic reward pathway. Method This work involved a search of the main scientific research on genetic variability in the neurobiology of smoking and its effects on smoking behavior. One hundred and five studies were selected, most of which highlighted polymorphisms in the genes of nicotinic receptors, dopamine receptors, and nicotine metabolism. Results The majority of studies have focused on genes related to the activation of the dopaminergic reward system by nicotine. Combinations between different polymorphisms were also highlighted, showing that interactions can determine a genetic profile of predisposition to smoking addiction. Additionally, gender and ethnicity were identified as relevant factors. Conclusion Knowledge of the genetic bases involved in the individual response to smoking can enable a better understanding of inter-individual differences in smoking behavior, and contribute to improving the treatment of addiction.

Resumo Introdução A dependência nicotínica é uma doença crônica e um problema de saúde pública. O comportamento tabágico pode ser explicado pela neurobiologia da adição, cujas variações genéticas têm sido associadas à dependência. A variabilidade genética na neurobiologia do tabagismo pode ajudar a entender por que indivíduos expostos a drogas podem ou não se tornar viciados. Objetivo Este estudo tem como objetivo abordar a variabilidade genética na neurobiologia do tabagismo com foco em genes polimórficos relacionados à resposta nicotínica e à via de recompensa dopaminérgica. Método Uma pesquisa foi realizada nas principais bases de dados científicos sobre a variabilidade genética na neurobiologia do tabagismo e seus efeitos no comportamento do tabagismo. 105 estudos foram selecionados, em sua maioria destacando polimorfismos nos genes de receptores nicotínicos, receptores de dopamina e de metabolismo da nicotina. Resultados A maioria dos estudos concentrou-se em genes relacionados à ativação do sistema de recompensa dopaminérgico pela nicotina. Determinadas combinações entre genótipos de diferentes polimorfismos também se destacaram, mostrando que interações gênicas podem determinar um perfil genético de predisposição ao tabagismo. Além disso, gênero e etnia foram identificados como fatores relevantes. Conclusão O conhecimento das bases genéticas envolvidas na resposta individual ao tabagismo pode permitir uma melhor compreensão das diferenças interindividuais no comportamento tabágico e contribuir para melhoria dos tratamentos disponíveis para a dependência.

Genetic diversity of Macroptilium accessions considering the increase in air temperature

Climate changes can influence the genetic diversity of forage plants, which may contribute to the improvement and development of new species. Therefore, this research aimed to evaluate the influence of temperature increase on the genetic diversity of Macroptilium accessions based on morphoagronomic descriptors. The experiment was carried out in a growth chamber in a 2×16 factorial arrangement (temperature regimes x Macroptilium accessions), with the temperatures consisting of T1 (20­26­33 °C) and T2 (24.8­30.8­37.8 °C) and 16 accessions. Eleven morphoagronomic descriptors allowed estimating the diversity among accessions. The measurements of genetic dissimilarity enabled us to observe the genetic distance between the studied materials, standing out the accessions T1.M3 and T2.S4 as the most divergent (446.01). The morphoagronomic descriptors percentage of leaves and stem diameter were the most efficient for estimating the diversity between access. Genetic variability points to the adaptation of Macroptilium accessions in the climate change scenario. The accessions more divergent can be explored in genetic breeding programs for the species aiming at the expansion of genetic variability as an adaptation mechanism to heat stress.

Genetic variability of the 16S rRNA gene of Nocardia brasiliensis, the most common causative agent of actinomycetoma in Latin America and the Caribbean

ABSTRACT Mycetoma is a neglected tropical disease (NTD) declared by the World Health Organization (WHO) in 2016. It is characterized by the progressive growth of nodules and granulomatous lesions on the legs, arms, and trunk. It is potentially disfiguring and causes disability or amputations in working-age people from marginalized areas. The causative agents can be fungi (eumycetoma) or actinobacteria (actinomycetoma), the latter being the most common in America and Asia. Nocardia brasiliensis is the most important causal agent of actinomycetoma in the Americas. Taxonomic problems have been reported when identifying this species, so this study aimed to detect the 16S rRNA gene variations in N. brasiliensis strains using an in silico enzymatic restriction technique. The study included strains from clinical cases of actinomycetoma in Mexico, isolated from humans and previously identified as N. brasiliensis by traditional methods. The strains were characterized microscopically and macroscopically, then subjected to DNA extraction and amplification of the 16S rRNA gene by PCR. The amplification products were sequenced, and consensus sequences were constructed and used for genetic identification and in silico restriction enzyme analysis with the New England BioLabs® NEBcutter program. All study strains were molecularly identified as N. brasiliensis; however, in silico restriction analysis detected a diversity in the restriction patterns that were finally grouped and subclassified into 7 ribotypes. This finding confirms the existence of subgroups within N. brasiliensis. The results support the need to consider N. brasiliensis as a complex species.

Autonomic dysfunction in COVID-19 patients receiving mechanical ventilation: A cross-sectional study

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES: To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS: Patients were divided into COVID-19-positive (COVID(+)) and COVID-19-negative (COVID(-)) groups. Clinical data were collected and heart rate variability (HRV) records obtained using a heart rate monitor. RESULTS: The study sample comprised 82 subjects: 36 (44%) in the COVID(-) group (58.3% female; median age, 64.5 years) and 46 (56%) in the COVID(+) group (39.1% females; median age, 57.5 years). The HRV indices were lower than the reference values. An intergroup comparison identified no statistically significant differences in the mean normal-to-normal (NN) interval, standard deviation of the NN interval, or root mean square of successive differences in NN intervals. The COVID(+) group had an increased low frequency (P = 0.05), reduced high frequency (P = 0.045), and increased low frequency/high frequency (LF/HF) ratio (P = 0.048). There was a weak positive correlation between LF/HF and length of stay in the COVID(+) group. CONCLUSION: Patients who received mechanical ventilation had lower overall HRV indices. COVID(+) patients who received mechanical ventilation had lower vagal HRV components. These findings likely indicate clinical applicability, as autonomic control impairments are associated with a greater risk of cardiac death.

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Clinical research status and application progress of heart rate variability / 中国综合临床

Heart rate variability is one of the methods to evaluate cardiac autonomic nervous function. It is widely used because of its non-invasive, convenient, fast and other advantages. Various heart diseases, including cardiovascular disease, arrhythmia and myocardial disease, are closely related to autonomic dysfunction, so heart rate variability has also become one of the important indicators to predict the prognosis of heart disease. This article reviews the research status of heart rate variability and its application in heart disease.