A Machine Learning Algorithm Facilitates Prognosis Prediction and Treatment Selection for Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma.

PURPOSE: Given its heterogeneity and diverse clinical outcomes, precise subclassification of Barcelona Clinic Liver Cancer stage C (BCLC-C) hepatocellular carcinoma (HCC) is required for appropriately determining patient prognosis and selecting treatment. EXPERIMENTAL DESIGN: We recruited 2,626 patients with BCLC-C HCC from multiple centers, comprising training/test (n = 1,693) and validation cohorts (n = 933). The XGBoost model was chosen for maximum performance among the machine learning (ML) models. Patients were categorized into low-, intermediate-, high-, and very high-risk subgroups based on the estimated prognosis, and this subclassification was named the CLAssification via Machine learning of BCLC-C (CLAM-C). RESULTS: The areas under the receiver operating characteristic curve of the CLAM-C for predicting the 6-, 12-, and 24-month survival of patients with BCLC-C were 0.800, 0.831, and 0.715, respectively-significantly higher than those of the conventional models, which were consistent in the validation cohort. The four subgroups had significantly different median overall survivals, and this difference was maintained among various patient subgroups and treatment modalities. Immune-checkpoint inhibitors and transarterial therapies were associated with significantly better survival than tyrosine kinase inhibitors (TKI) in the low- and intermediate-risk subgroups. In cases with first-line systemic therapy, the CLAM-C identified atezolizumab-bevacizumab as the best therapy, particularly in the high-risk group. In cases with later-line systemic therapy, nivolumab had better survival than TKIs in the low-to-intermediate-risk subgroup, whereas TKIs had better survival in the high- to very high-risk subgroup. CONCLUSIONS: ML modeling effectively subclassified patients with BCLC-C HCC, potentially aiding treatment allocation. Our study underscores the potential utilization of ML modeling in terms of prognostication and treatment allocation in patients with BCLC-C HCC.

Photocatalyzed hydrodecarboxylation of fatty acids: a prospective method to produce drop-in biofuels.

A direct and practical method for photocatalyzed hydrodecarboxylation of fatty acids is reported herein. The catalytic system consists of a commercially available acridinium salt as the photocatalyst and thiophenol as the Hydrogen Atom Transfer (HAT) co-catalyst. Results evidenced that Cn-1 alkanes were obtained in yields up to 77%. Furthermore, the protocol was employed for a complex mixture of fatty acids bio-derived from a real sample of licuri oil to obtain hydrocarbons in the range of C9-C17 with high selectivity and excellent conversion (>90%). This work provides a powerful strategy for producing drop-in biofuels under mild conditions. Finally, an energetic assessment of our proposed protocol (∼22.9 kW h) reveals the benefit of a sustainable production of renewable hydrocarbons.

Kondo screening in a Majorana metal.

Kondo impurities provide a nontrivial probe to unravel the character of the excitations of a quantum spin liquid. In the S = 1/2 Kitaev model on the honeycomb lattice, Kondo impurities embedded in the spin-liquid host can be screened by itinerant Majorana fermions via gauge-flux binding. Here, we report experimental signatures of metallic-like Kondo screening at intermediate temperatures in the Kitaev honeycomb material α-RuCl3 with dilute Cr3+ (S = 3/2) impurities. The static magnetic susceptibility, the muon Knight shift, and the muon spin-relaxation rate all feature logarithmic divergences, a hallmark of a metallic Kondo effect. Concurrently, the linear coefficient of the magnetic specific heat is large in the same temperature regime, indicating the presence of a host Majorana metal. This observation opens new avenues for exploring uncharted Kondo physics in insulating quantum magnets.

Photocatalytic Hydrodecarboxylation of Fatty Acids for Drop-in Biofuels Production.

A mild, practical, and environmentally friendly method for the hydrodecarboxylation of fatty acids using an acridine-based photoredox catalyst and thiophenol was developed. Cn-1 alkanes were synthesized in good to excellent yields (up to 99 %) from C10-C18 saturated fatty acids under visible light irradiation (405 nm). The developed protocol was employed for a mixture of fatty acids obtained from the hydrolysis of Licuri oil, affording a mixture of C9-C17 hydrocarbons in quantitative yield, which demonstrates the potential application of the method to produce drop-in biofuels.

Rotational thromboelastometry during Cesarean section as a predictive evaluation for the progression of persistent postpartum hemorrhage in parturients with placenta previa: A prospective observational study.

Background: The rotational thromboelastogram (ROTEM) has been used in the management of massive bleeding and transfusion strategy. This study investigated ROTEM parameters measured during Cesarean section as predictors for the progression of persistent postpartum hemorrhage (PPH) in parturients with placenta previa. Methods: This prospective observational study recruited 100 women scheduled for elective Cesarean section after being diagnosed with placenta previa. Recruited women were divided into two groups according to the amount of estimated blood loss: the PPH group (PPH > 1500 ml) vs. the non-PPH group. ROTEM with laboratory tests was performed three times, preoperative, intraoperative, and postoperative time, which were compared between the two groups. Results: The PPH and non-PPH groups included 57 and 41 women, respectively. The area under the receiver-operating characteristic curve of postoperative FIBTEM A5 to detect PPH was 0.76 (95% CI = 0.64 to 0.87; P < 0.001). When postoperative FIBTEM A5 was 9.5, the sensitivity and specificity were 0.74 (95% CI = 0.55 to 0.88) and 0.73 (95% CI = 0.57 to 0.86), respectively. When subgrouping the PPH group based on the postoperative FIBTEM A5 value of 9.5, intraoperative cEBL was similar between the two subgroups; however, postoperative RBC was transfused more in the subgroup with FIBTEM A5 < 9.5 than the subgroup with FIBTEM A5 ≥ 9.5 (7.4 ± 3.0 vs 5.1 ± 2.3 units, respectively; P = 0.003). Conclusion: Postoperative FIBTEM A5, with appropriate selection of the cut-off value, can be a biomarker for more prolonged PPH and massive transfusion following Cesarean section by placenta previa.

Nickel-catalyzed reductive decarboxylation of fatty acids for drop-in biofuel production.

An operationally simple and highly selective method for the decarboxylation of fatty acids under remarkably mild conditions is described herein. The activation of the aliphatic carboxylic acids by esterification with N-hydroxyphthalimide (NHPI) enabled efficient deoxygenation to synthesize n-alkanes in up to 67% yield, employing inexpensive PMHS as a hydrogen source, NiCl2·6H2O, bipyridine, and zinc in THF. In contrast to the conventional thermo-catalytic approaches, this protocol does not require high temperature and high pressure of hydrogen gas to deoxygenate biomass-derived carboxylic acids, thus representing an attractive alternative for producing drop-in biofuels.

A Computational Approach Applied to the Study of Potential Allosteric Inhibitors Protease NS2B/NS3 from Dengue Virus.

Dengue virus (DENV) is a danger to more than 400 million people in the world, and there is no specific treatment. Thus, there is an urgent need to develop an effective method to combat this pathology. NS2B/NS3 protease is an important biological target due it being necessary for viral replication and the fact that it promotes the spread of the infection. Thus, this study aimed to design DENV NS2B/NS3pro allosteric inhibitors from a matrix compound. The search was conducted using the Swiss Similarity tool. The compounds were subjected to molecular docking calculations, molecular dynamics simulations (MD) and free energy calculations. The molecular docking results showed that two compounds, ZINC000001680989 and ZINC000001679427, were promising and performed important hydrogen interactions with the Asn152, Leu149 and Ala164 residues, showing the same interactions obtained in the literature. In the MD, the results indicated that five residues, Lys74, Leu76, Asn152, Leu149 and Ala166, contribute to the stability of the ligand at the allosteric site for all of the simulated systems. Hydrophobic, electrostatic and van der Waals interactions had significant effects on binding affinity. Physicochemical properties, lipophilicity, water solubility, pharmacokinetics, druglikeness and medicinal chemistry were evaluated for four compounds that were more promising, showed negative indices for the potential penetration of the Blood Brain Barrier and expressed high human intestinal absorption, indicating a low risk of central nervous system depression or drowsiness as the the side effects. The compound ZINC000006694490 exhibited an alert with a plausible level of toxicity for the purine base chemical moiety, indicating hepatotoxicity and chromosome damage in vivo in mouse, rat and human organisms. All of the compounds selected in this study showed a synthetic accessibility (SA) score lower than 4, suggesting the ease of new syntheses. The results corroborate with other studies in the literature, and the computational approach used here can contribute to the discovery of new and potent anti-dengue agents.

Association of the rs4646994 in ACE gene with susceptibility to tuberculosis in a region of the Brazilian Amazon.

Background: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis and represents an important global public health issue. Single-nucleotide polymorphisms and INDELs are common genetic variations that can be located in genes associated with immune response and, therefore, they may have direct implications over the phenotype of susceptibility to infections like tuberculosis. This study aimed to investigate the association between the 17 genetic polymorphisms and susceptibility to tuberculosis in a Brazilian population. Methods: This case-control study enrolled 283 individuals with active tuberculosis and 145 health care workers. Four INDELs and 13 single nucleotide polymorphisms and were genotyped using Multiplex PCR method and TaqMan SNP Genotyping Assays. Group comparisons for categorical variables were performed using the chi-squared test, whilst the t-Student test was used to analyze the continuous variables. Multiple logistic regression analyses were performed to estimate the odds ratio (OR) with 95% confidence intervals (CI). Deviation from Hardy-Weinberg equilibrium was assessed using chi-squared tests with Bonferroni correction. The results were analyzed comparing the genotypic distributions adopting the dominant model and the estimated values ​​of p corrected for multiple tests through FDR (False Discovery Rate) test. Results: The HWE test confirmed that the genotypic frequencies for polymorphisms were balanced. The frequency of Del allele was 73 and 75%, in cases and controls respectively. Frequency of Del allele was significantly higher in the control group than TB group. The homozygous Del/Del genotype was present in 51.6% of cases and 58.6% of controls. The rare Ins/Ins genotype was present in only 7.6% of controls and 6% of cases. The ACE Del/Del genotype was significantly higher in the cases than in controls revealing significant protection for TB in the domain model (OR = 0.465; p < 0.005). Conclusions: The Del/Del genotype of the rs4646994 in ACE gene was associated with susceptibility to tuberculosis. The identification of genetic variants responsible for susceptibility to tuberculosis will allow the development of new diagnostic tools for tuberculosis infection. These studies will help improve control and the future eradication of this disease.

Surgical Description of Laparoscopic Ovum Pick-Up in Buffalo Calves.

The technique of laparoscopic oocyte aspiration has been increasingly used in animals; however, there are few records of its use in buffaloes. To describe this technique, six suckling Murrah buffaloes aged between 3 and 5 months were used. Three laparoscopic ovum pick-ups were performed in each animal, with intervals of 15 days between surgeries, completing a total of 18 procedures. The technique used three surgical ports with optics and a high-definition video camera. The introduction of the first portal and insufflation of the abdomen was performed through the open technique, with aspiration using a 20 G needle transabdominally and a vacuum pump calibrated at 50 mmHg. The mean complete surgical time from anesthesia to the removal of the animal from the litter was 49 ± 9.8 min. There were 27.8% cases of insufflation on the wrong side of the omentum. The oocyte recovery rate of 60.3% remained within the normal range. However, the rate of viable oocytes recovered was low, with only 40.8% of those recovered undergoing in vitro embryo production (IVEP). These data demonstrate that this simple, minimally invasive technique is an excellent reproductive tool for the genetic improvement of buffalo species.

FTIR analysis of pyrogallol and phytotoxicity-reductive effect against mercury chloride.

Human activities, especially in industry, have contributed to soil contamination with heavy or toxic metals. The objective of this study was to determine the chelating effect and antioxidant activity of pyrogallol, as well as to evaluate its cytoprotective activity in prokaryotic and eukaryotic models, animal and plant, respectively, against toxic mercury chloride action. Antioxidant activity was determined by DPPH where pyrogallol showed considerable action, chelating even iron ions. For the microbiologic activity assays, microdilution was performed to obtain the minimal inhibitory concentration, minimum bactericidal and minimum fungicide concentration, from which the sub-inhibitory concentrations were determined. The product did not conferred cytoprotection to the tested bacteria and fungi. To evaluate plant cytoprotection, Lactuta sativa seeds were used together with the product at a sub-allelopathic concentration with different HgCl2 concentrations. In this case, the tannin conferred cytoprotection to the plant model, allowing the best growth and development of caulicles and radicles, thus preserving tissues necessary for plant survival. From the results, it is observable that pyrogallol possesses cytoprotective action in the eukaryotic plant model, this action being useful as an alternative which favors the growth of plants in contaminated areas, as the recovering of crop fields or reforestation projects.

Evaluation of chelating and cytoprotective activity of vanillin against the toxic action of mercuric chloride as an alternative for phytoremediation.

Mercury is widely found in nature, however, in low concentrations, but anthropological activities have increased its concentration considerably. This causes various environmental hazards and human health. Many substances are capable of reversing the toxicity of mercuric chloride in the environment. The aim of the present study was to determine the chelating effect of vanillin, as well as to evaluate its capacity for cytoprotection in prokaryotic and eukaryotic plant models. Chelating activity was determined from vanillin's ability to reduce iron III ions. To evaluate cytoprotection in a unicellular prokaryotic and eukaryotic model, Escherichia coli and Candida albicans, respectively, were used. And to evaluate the cytoprotective activity in vegetables, lettuce seeds were submitted to different concentrations of mercuric chloride and its association with the sub-allelopathic concentration of vanillin (32 µg/mL). Vanillin has been found to have antioxidant activity as it can reduce iron III ions. The use of vanillin also allows for better growth and development of Lactuca sativa seed root and stem, also allowing better preservation of its biochemical structures. These results are quite important, as environmental contamination by heavy metals has increased dramatically and finding a viable alternative to grow vegetables in contaminated areas is very valid.

Gas chromatography coupled to mass spectrometry (GC-MS) characterization and evaluation of antibacterial bioactivities of the essential oils from Piper arboreum Aubl., Piper aduncum L. e Piper gaudichaudianum Kunth.

The objective of this study was to determine the chemical profile and to evaluate the antibacterial activity of the essential oils of Piper species and modulation of the antibiotic activity, using the microdilution method to determine the minimum inhibitory concentration. The chemical components were characterized by gas chromatography coupled to mass spectrometry, which revealed ß-copaen-4-α-ol (31.38%), spathulenol (25.92%), and germacrene B (21.53%) as major constituents of the essential oils of Piper arboreum, Piper aduncum, and Piper gaudichaudianum, respectively. The essential oils analyzed in this study did not present a clinically relevant activity against standard and multiresistant Escherichia coli. However, in the case of multiresistant Staphylococcus aureus, there was a significant activity, corroborating with reports in the literature, where Gram-positive bacteria are more susceptible to antimicrobial activity. The essential oils modulated the effect of the antibiotics norfloxacin and gentamicin, having on the latter greater modulating effect; however, for erythromycin, no statistically significant effect was observed. In conclusion, the results obtained in this study demonstrated that the essential oils of the analyzed Piper species present an inhibitory effect against S. aureus and modulate antibiotic activity, most of which presents synergistic activity.

Case-fatality From Orally-transmitted Acute Chagas Disease: A Systematic Review and Meta-analysis.

Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this study was to analyze and summarize data on orally-transmitted acute CD. We searched for publications from 1968 to 31 January 2018. We included studies and unpublished data from government sources that reported patients with acute orally-transmitted CD. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0-4.0%). Lethality rates have declined over time (P = .02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease has declined over the years.

A aplicação da escala KTK para a análise do desenvolvimento motor grosso em crianças / The KTK scale application for the analysis of the gross motor development in children

Introdução: A escala Körperkoordinations test für Kinder (KTK) destaca-se por ser uma forma indireta e eficaz de mapear a coordenação motora grossa entre crianças de 5 a 14 anos de idade. O teste é constituído por quatro etapas, nas quais avaliam-se: 1) equilíbrio em marcha para trás; 2) saltos laterais; 3) saltos monopedais e 4) transferência sobre plataformas. Objetivo: Buscar através de revisão narrativa a aplicabilidade da escala KTK na pesquisa do desenvolvimento motor grosso com crianças sobrepeso/obesas e eutróficas. Métodos: Foi realizada uma revisão narrativa da literatura nacional e internacional através das bases de dados Lilacs, PubMed, Scielo e Bireme e por meio do cruzamento das palavras-chave: Child, Overweight, Obesity, Motor skills, Körperkoordinationstest für Kinder (KTK) e os seus correspondentes em português. Os artigos de observação e experimentação realizados no período de 2003 até o presente momento foram incluídos desde que atendessem aos critérios de inclusão. Conclusão: A bateria de testes KTK mostrou-se eficiente para pesquisa do desenvolvimento motor grosso de menores sobrepeso/obesos e eutróficos. (AU)

Introduction: The Körperkoordinations test für Kinder scale (KTK) stands out as an indirect and effective way of mapping gross motor coordination between 5 to 14 years old. The test consists of four stages, which evaluate: 1) backward balance; 2) side jumps; 3) single jump and 4) transfer on platforms. Objective: To search through narrative review the applicability of the KTK scale in the research of gross motor development with overweight/obese and eutrophic children. Methods: A narrative review of the national and international literature was performed through the Lilacs, PubMed, Scielo and Bireme databases and by crossing the keywords: Child, Overweight, Obesity, Motor skills, Körperkoordinationstest für Kinder (KTK) and their correspondents in Portuguese. Observation and experimentation articles conducted from 2003 to the present moment were included if they met the inclusion criteria. Conclusion: The KTK test battery proved to be efficient for researching the gross motor development of underweight/obese and eutrophic individuals. (AU)

Hierarchical Nano/Micro Moth Eyelike Polymer Film Using Solid/Liquid Interfacial Reaction at Room Temperature.

A simple pathway for the fabrication of real moth eyelike patterned (MEP) polymer film with a double-layered nano/microhierarchical structure is demonstrated through a solid/liquid interfacial reaction at atmospheric conditions. A convex-structured polyvinyl alcohol (PVA) film containing CdCl2 was first fabricated using a self-organized honeycomb-patterned porous film as a template. The CdCl2/PVA convex film was immersed into Na2S/ethanol solution to facilitate the reaction between CdCl2 and Na2S at the solid/liquid interface, which led to the functionalization of CdS nanoparticles in the convex-structured PVA film. The tunable introduction of interfacial reaction resulted in the formation of a CdS moth eyelike nanoarray on the top surface of the PVA convex microarray, which mimicked the real moth eye (PVA-CdS MEP). PVA-CdS MEP film with a double moth eyelike structure showed improved antireflective property in comparison with flat and convex-structured PVA films. The PVA-CdS MEP film showed photoresponse under simulated solar light radiation and flexible duration after 500 cycles of folding.

Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection. / Ausência de Descenso da Pressão Arterial Detectada pela Monitorização Ambulatorial da Pressão Arterial em Pacientes com Doença de Chagas Aguda Transmitida por Via Oral.

Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715).

Phytochemical characterization of the Ziziphus joazeiro Mart. metabolites by UPLC-QTOF and antifungal activity evaluation.

The aim of this study was to evaluate the antifungal and modulatory potential of the Ziziphus joazeiro bark and leaf extracts, both in isolation and in association with fluconazole, against resistant species from the Candida genus. Antifungal assays were used to determine the half maximal inhibitory concentration (IC50) of the extract in isolation and in combination with fluconazole using the broth microdilution method and spectrophotometric readings, followed by verification of the minimum fungicidal concentration by solid medium subculture. According to the cell viability curve, both extracts inhibited fungal growth in a concentration dependent manner, in addition to showing inhibitory concentrations similar to fluconazole. However, the extracts behaved in a fungistatic manner with minimum inhibitory concentration > 8.19 mg/mL and IC50 values ranging from 0.450 mg/mL to 9 mg/mL. The minimum inhibitory concentration for both extracts decreased when in combination with fluconazole, with the AEL standing out against Candida albicans URM 4387, displaying an IC50 equal to that of fluconazole (0.002 mg/mL). Nevertheless, fluconazole antagonism was observed against the tested strains. Overall, the evaluation of both extracts against Candida spp. presented inhibitory concentration values greater than fluconazole. Moreover, despite these being chemically complex crude extracts, they did demonstrate antifungal effects and properties that concur with their ethno-biological aspect.

Preoperative evaluation of mammographic microcalcifications after neoadjuvant chemotherapy for breast cancer.

AIM: To assess the predictive value of preoperative residual mammographic microcalcifications for residual tumours after neoadjuvant chemotherapy (NAC) for breast cancer. MATERIALS AND METHODS: This single-centre retrospective study included breast cancer patients who underwent NAC and demonstrated suspicious microcalcifications within or near the tumour bed on mammography from June 2015 to August 2018. The residual microcalcifications and remnant lesion on magnetic resonance imaging (MRI) were correlated with histopathological findings of residual tumours and immunohistochemical markers. RESULTS: A total of 96 patients were included. Ten patients achieved pathological complete response (pCR) and previous suspicious microcalcifications were associated with benign pathology in 10.4% (10/96) of the patients. In the remaining 86 patients who did not achieve pCR, 61.5% (59/96) of the residual microcalcifications were associated with invasive or in situ carcinoma and 28.1% (27/96) with benign pathology. Hormone receptor-positive (HR+) patients had the highest proportion of residual malignant microcalcifications compared to HR- patients (48.9% versus 13.5%, respectively; p=0.019). MRI correlated better than residual microcalcifications on mammography in predicting residual tumour extent in all subtypes (ICC=0.709 versus 0.365). MRI also showed higher correlation with residual tumour size for the HR-/HER2+ and HR-/HER2- subtype (ICC=0.925 and 0.876, respectively). CONCLUSION: The extent of microcalcifications on mammography after NAC did not correlate with the extent of residual cancer in 38.5% of women. Regardless of the extent of microcalcifications, residual tumour extent on MRI after NAC and molecular subtype could be an accurate tool in evaluating residual cancer after NAC.

Ausência de Descenso da Pressão Arterial Detectada pela Monitorização Ambulatorial da Pressão Arterial em Pacientes com Doença de Chagas Aguda Transmitida por Via Oral / Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection

Resumo Fundamento O acometimento do sistema nervoso autônomo é um dos mecanismos propostos para explicar a progressão da lesão miocárdica na doença de Chagas. Evidências indicam alterações do sistema nervoso simpático e parassimpático desde a fase aguda, e estudos são necessários para se entender os aspectos fisiopatológicos e o valor prognóstico dessas alterações. Objetivo Analisar o comportamento da pressão arterial pela monitorização ambulatorial da pressão arterial (MAPA) em pacientes normotensos com doença de Chagas aguda (DCA) sem envolvimento cardíaco aparente, e a influência da infecção no descenso fisiológico do sono. Métodos Foi realizado a MAPA em 54 pacientes com DCA e utilizado um grupo controle de 54 indivíduos normotensos, pareados para idade e sexo. O nível de significância adotado foi para um erro tipo I (alfa) de 5%. Resultados Em um total de 54 pacientes com DCA ocorreu ausência de descenso sistólico do sono em 74,0%*, ausência de descenso diastólico do sono em 53,7%*, e ausência de descenso sistólico e diastólico do sono (51,8%)*, (*p<0,05). Em 12,9% ocorreu ascensão sistólica da pressão no sono e em 18,5% ascensão diastólica (p<0,05). Conclusão Em pacientes com Doença de Chagas aguda, houve ausência significativa do descenso fisiológico da pressão arterial durante o sono, tanto da pressão arterial sistólica quanto a diastólica, e alguns pacientes apresentaram ascensão noturna desses parâmetros. Esses achados sugerem alterações autonômicas na doença de Chagas desde a fase aguda. (Arq Bras Cardiol. 2020; 114(4):711-715)

Abstract Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715)