Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians.

Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 -0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.

Air velocity spatial variability in open Compost-Bedded Pack Barn system with positive pressure ventilation.

In Compost-Bedded Pack Barn (CBP) systems, air velocity is linked with the thermal comfort of housed dairy cattle and bedding quality and, therefore, assessing ventilation efficiency is essential. In this context, the objective of this study was to evaluate and characterize dependence and spatial distribution of air velocity at the 1.5 m height (vair,M) and at bedding level (vair,B) in an open CBP system with positive pressure ventilation. The study was conducted in 2021, in a facility located in the Zona da Mata region, Minas Gerais, Brazil. The facility area was divided into a mesh composed of 55 equidistant points, where vair,M and vair,B data were collected in the morning (09:00 a.m.) and afternoon (03:00 p.m.) periods, during three weeks in Brazilian winter. Geostatistics techniques were used to assess dependence and spatial distribution. In both periods evaluated, there were a strong occurrence of spatial dependence and non-uniform vair,M and vair,B distributions. The vair,M and vair,B values were lower than recommended (1.8 m∙s-1) in more than 65.0% of the area. Adequate ventilation levels were observed only in the first 20.0 m of the facility, from Southeast to Northwest, because of the fan lines present.

Spatial analysis of microclimatic variables in compost-bedded pack barn with evaporative tunnel cooling.

In this study, we aimed to assess the spatial variability of microclimate inside a closed compost-bedded pack barn (CBP) with a negative ventilation system during summer and winter. The research was carried out in a CBP located in the Zona da Mata region, Minas Gerais, Brazil. For each of the stations analyzed, the following environmental mean variables observed inside a CBP were measured: air dry-bulb temperature (tdb), air relative humidity (RH), and windspeed, Temperature-Humidity index, and specific enthalpy. The kriging maps showed that the most critical housing conditions in the thermal environment were found, mainly, from the central part of the CBP, close to the exhaust fans. The analyses also pointed out that the system presented temperature gradients along the length, up to 3°C. During the summer afternoon, the entire region of the CBP was in a discomfort situation (tdb>26°C; RH>75%). During the winter, the measured environmental data remained within the comfort zone throughout the facility. However, probably due to the lack of thermal insulation of the material used to close the sides of the CBP, it did not allow spatial thermal uniformity for both seasons. It was also inefficient to keep the animals within the comfort zone for lactating cattle during the critical summer period.

Spatial variability of soil physical properties in longitudinal profiles.

The spatial variability of physical properties, such as bulk density, penetration resistance and gravimetric moisture, obtained by applying geostatistics in precision agriculture, can effectively indicate the physical behavior of agricultural soils in longitudinal profiles. In this way, the spatial dependence of physical properties in streets of coffee plantations with different lengths was evaluated in the southern Minas Gerais, Brazil. For this purpose, five longitudinal profiles were measured in streets, each one with depths ranging from 0 to 0.60 m, in six layers of 0.10 m, being the database composed of 432 property, 144 by property, submitted to the ordinary kriging geostatistical method in order to obtain spatial variability maps using the R software. They were evaluated by the lower mean cross-validation error of theoretical models fitted by ordinary least squares (OLS), being detected in higher superficial layers, from 0 to 0.30 m, lower bulk density and lower penetration resistance, with variable gravimetric moisture in the length direction of some streets of coffee plantations, being that these properties presented different structures of spatial dependence for each street.

Shade Modifies Behavioral and Physiological Responses of Low to Medium Production Dairy Cows at Pasture in an Integrated Crop-Livestock-Forest System.

Under conditions of high temperature, humidity, and incidence of solar radiation, dairy cows use behavioral changes as a strategy to decrease the metabolic heat production at pasture. The objective of this study was to evaluate the behavioral and physiological responses of Gyr and Girolando (5/8 Holstein 3/8 Gyr, and ½ Holstein ½ Gyr) dairy cows submitted to environments with and without shade. The experiment was conducted at Embrapa Cerrados (Technology Center for Dairy Zebu breeds-CTZL), Brasilia, Distrito Federal-Brazil, with 48 Gyr and Girolando cows total in the lactation group, with low to medium milk production, in full sun or shade with Eucalyptus urograndis (267 plants/ha-1). The physiological and behavioral characteristics evaluated were panting score, superficial temperature, and time spent grazing, ruminating, and lying down. Other traits included skin and coat thickness, hair diameter, density and length, and predominant coat color. In addition, body measurements, such as body length, the height of withers, chest circumference, and shin circumference, were measured. Shaded cows had 34% longer rumination times than cows in full sun (p = 0.01). With a temperature-humidity index ranging from 79 to 83, the rumination time was 1.7 times higher in cows under shade (p = 0.01) during a 24-h period of observation. There were no significant differences in the grazing time between the environments, but lying time was 23% longer in cows under the sun (p = 0.01). The panting score was not influenced by the environment (p = 0.17). Girolando cows had a 35% higher panting score than Gyr cows (p = 0.01) regardless of the environment. The panting score increased two and a half times during the afternoon compared with the morning (p = 0.01). The surface and rectal core temperatures had significant differences between treatments and time of the day. Body measurements were not different between cows in both environments, but there was a difference between breeds. The use of trees in pastures with a silvopastoral system for dairy zebu cows is indicated to improve grazing behavior, as well as time spent ruminating and lying down.

Assessment of spatial variability of bedding variables in compost bedded pack barns with climate control system.

The aim of this research was to evaluate the spatial distribution of bedding variables in a climate-controlled compost bedded pack barn (CBP) equipped with an evaporative cooling system associated with a tunnel ventilation mode. The study was conducted on a farm in the West Mesoregion of Minas, MG, Brazil. The interior of the animal facility was divided into a mesh of 120 equidistant points, where the bedding surface temperature (tb-sur), the bedding temperature at 0.20 m depth (tb-20) and the bedding penetration resistance (PRb) of layer 0 to 0.20 m depth were measured. Bedding samples were collected to obtain the moisture (Mb) and pH in the surface and at 0.20 m depth. Geostatistics technique was used to evaluate the dependence and spatial distribution. Through the bedding area, the tb-sur presented low variability, with 6 ºC of amplitude, and tb-20 presented highest values (up to 55 °C). The spatial distribution of Mb-20 was similar to that observed on the surface and its highest levels occurred in the region near the feed alley (> 40%). The distribution of pH was similar in both layers. The tendency of high PRb occurred in the layer between 0.15 and 0.20 m (0 and 1500 kPa).

Photoactivation of Erythrosine in simulated body fluids.

Photodynamic Therapy (PDT) is a powerful technique for the treatment of cancer and non-cancerous diseases. The precise PDT treatment protocol definition must consider the performance difference between in vitroand in vivoapplications. This also occurs in other biological studies, and to partially overcome this difficulty, the simulated body fluids are generally applied as a prior understanding of the particularities of the different systems. However, in PDT these studies are scarce. In this work, we investigated the photoactivation of Erythrosine, a photosensitizer widely used in PDT, in different simulated body fluids. Differences in the photodegradation kinetics, triplet lifetime, and singlet oxygen generation were observed. The results can help to explain and to define PDT application protocols.

Induction and detection of pressure waves by pulsed thermal lens technique in water-ethanol mixtures.

The mode-mismatched dual-beam thermal lens technique is widely applied in the characterization of optical and thermo-physical properties of solids and liquids. The technique has also been used to investigate transient acoustic waves induced by pulsed laser excitation at the nanosecond time scale. In this paper, we developed a semi-analytical model to describe the transient acoustic wave that allows a fitting procedure to get the physical properties of fluid samples. The method was used to investigate samples with different mixtures of ethanol and water, and quantitative information of piezo-optic coefficient and sound speed are evaluated for the fluid mixtures.

Geminiviral Triggers and Suppressors of Plant Antiviral Immunity.

Geminiviruses are circular single-stranded DNA plant viruses encapsidated into geminate virion particles, which infect many crops and vegetables and, hence, represent significant agricultural constraints worldwide. To maintain their broad-range host spectrum and establish productive infection, the geminiviruses must circumvent a potent plant antiviral immune system, which consists of a multilayered perception system represented by RNA interference sensors and effectors, pattern recognition receptors (PRR), and resistance (R) proteins. This recognition system leads to the activation of conserved defense responses that protect plants against different co-existing viral and nonviral pathogens in nature. Furthermore, a specific antiviral cell surface receptor signaling is activated at the onset of geminivirus infection to suppress global translation. This review highlighted these layers of virus perception and host defenses and the mechanisms developed by geminiviruses to overcome the plant antiviral immunity mechanisms.

Characterization of noise emitted by a low-profile tractor and its influence on the health of rural workers.

Noise is one of the main physical agents in the rural work environment and it can be harmful to the health of workers exposed to it. Thus, research on the spatialization of noise emitted by agricultural machinery can help minimize harmful health effects. This study sets out to evaluate the spatial distribution of the noise emitted by an agricultural tractor with and without the activation of a rotary cutter. A wave model geostatistical analysis was used to identify healthy working zones according to current legislation. The experiment was carried out using a 75 hp tractor at 2000 rpm with the rotary cutter on the on and off modes. A digital sound level meter was used to register noise in a regular 2.0 x 2.0 m sample mesh within a 10-meter radius. The semivariogram was adjusted using the weighted least squares method, wave model and kriging interpolation to obtain the maps. The magnitude and spatial structure of the noise emitted by the tractor were identified. The results show that the equipment produced noise levels above the limits recommended by Brazilian regulatory standard NR 15. Thus, both the machine operator and the workers involved in the operation should use Personal Protective Equipment.

Comparative economic analysis of soil sampling methods used in precision agriculture.

Precision agriculture is an alternative for reducing costs. This study evaluated and economically compared three sampling methods used in precision agriculture with respect to the acquisition of inputs and machines and equipment. The sampling methods used were zone management by elevation (ZME), grid sampling (GS) and sampling guided by apparent electrical conductivity of the soil (OS). Soil samples for the ZME were collected after the definition of zones according to the elevations of the plots. The sample mesh was in a georeferenced mesh of 100 x 100 m. The targeted sampling was performed after a ground proximity sensor was used to identify the apparent electrical conductivity of the soil to define the management areas. From the results of the laboratory tests, the application costs were calculated for lime, phosphorus, potassium and nitrogen to allow a comparison between the methods, volumes and costs. This approach considered the costs of depreciation, insurance, interest, operating costs, labor, maintenance and fuel. With this study, it was possible to compare the volumes of the recommended fertilizers and estimate the overall economic cost of using the technology via sensor. Taking the GS as a reference, the ZME presented as the best alternative compared to other methods.

Nanosecond pressure transient detection of laser-induced thermal lens.

We use the thermal lens technique in the nanosecond time scale to describe the acoustic wave effect in liquids and the corresponding correlation with the speed of sound in the fluid, volumetric thermal expansion, and piezo-optic coefficient. These physical properties are found to be directly correlated to the anomalous effects observed in the transients at the nanosecond time scale, where acoustic waves dominate the thermal lens signal inducing an oscillating transient. Our results suggest the application of the thermal lens to study the generation and the detection of thermo-acoustic waves in liquids, which makes this method interesting for all-optoacoustic ultrasound detection and imaging.

A Begomovirus Nuclear Shuttle Protein-Interacting Immune Hub: Hijacking Host Transport Activities and Suppressing Incompatible Functions.

Begomoviruses (Geminiviridae family) represent a severe constraint to agriculture worldwide. As ssDNA viruses that replicate in the nuclei of infected cells, the nascent viral DNA has to move to the cytoplasm and then to the adjacent cell to cause disease. The begomovirus nuclear shuttle protein (NSP) assists the intracellular transport of viral DNA from the nucleus to the cytoplasm and cooperates with the movement protein (MP) for the cell-to-cell translocation of viral DNA to uninfected cells. As a facilitator of intra- and intercellular transport of viral DNA, NSP is predicted to associate with host proteins from the nuclear export machinery, the intracytoplasmic active transport system, and the cell-to-cell transport complex. Furthermore, NSP functions as a virulence factor that suppresses antiviral immunity against begomoviruses. In this review, we focus on the protein-protein network that converges on NSP with a high degree of centrality and forms an immune hub against begomoviruses. We also describe the compatible host functions hijacked by NSP to promote the nucleocytoplasmic and intracytoplasmic movement of viral DNA. Finally, we discuss the NSP virulence function as a suppressor of the recently described NSP-interacting kinase 1 (NIK1)-mediated antiviral immunity. Understanding the NSP-host protein-protein interaction (PPI) network will probably pave the way for strategies to generate more durable resistance against begomoviruses.

Virus perception at the cell surface: revisiting the roles of receptor-like kinases as viral pattern recognition receptors.

Activation of antiviral innate immune responses depends on the recognition of viral components or viral effectors by host receptors. This virus recognition system can activate two layers of host defence, pathogen-associated molecular pattern (PAMP)-triggered immunity (PTI) and effector-triggered immunity (ETI). While ETI has long been recognized as an efficient plant defence against viruses, the concept of antiviral PTI has only recently been integrated into virus-host interaction models, such as the RNA silencing-based defences that are triggered by viral dsRNA PAMPs produced during infection. Emerging evidence in the literature has included the classical PTI in the antiviral innate immune arsenal of plant cells. Therefore, our understanding of PAMPs has expanded to include not only classical PAMPS, such as bacterial flagellin or fungal chitin, but also virus-derived nucleic acids that may also activate PAMP recognition receptors like the well-documented phenomenon observed for mammalian viruses. In this review, we discuss the notion that plant viruses can activate classical PTI, leading to both unique antiviral responses and conserved antipathogen responses. We also present evidence that virus-derived nucleic acid PAMPs may elicit the NUCLEAR SHUTTLE PROTEIN-INTERACTING KINASE 1 (NIK1)-mediated antiviral signalling pathway that transduces an antiviral signal to suppress global host translation.

Array comparative genomic hybridisation on first polar bodies suggests that non-disjunction is not the predominant mechanism leading to aneuploidy in humans.

INTRODUCTION: Aneuploidy (the presence of extra or missing chromosomes) arises primarily through chromosome segregation errors in the oocyte at meiosis I but the details of mechanism by which such errors occur in humans are the subject of some debate. It is generally believed that aneuploidy arises primarily as a result of segregation of a whole chromosome to the same pole as its homologue (non-disjunction). Nonetheless, classical cytogenetic studies suggest that this model does not fully account for the patterns observed in human oocytes. An alternative model (precocious separation of sister chromatids) has thus been proposed, but recurring criticism of this model purports that technical issues may have led to interpretation errors. MATERIALS AND METHODS: Array comparative genomic hybridisation (aCGH) was used on 164 human first polar bodies to distinguish between whole chromosome (non-disjunction) and chromatid (precocious separation) errors. RESULTS: Single chromatid errors were over 11 times more common than whole chromosome errors, consistent with prior classical cytogenetic and fluorescence in situ hybridisation (FISH) studies. DISCUSSION: The received wisdom that non-disjunction is the primary mechanism leading to human aneuploidy should be reconsidered.

Postoperative atrial fibrillation after cardiac surgery: who should receive chemoprophylaxis?

To evaluate arrhythmogenic risk factors associated with greater incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery (CABG and/or valvular surgery) in order to identify those more prone to the development of this arrhythmia for possible chemoprophylaxis. Sixty-six patients who underwent elective cardiac surgery were assessed. The following risk factors for the development of POAF were correlated: advanced age, valvular heart disease (VHD), left atrial (LA) enlargement, left ventricular dysfunction (LVD), electrolyte imbalance (EI), previous CABG, prior use and withdrawal of beta-blockers (BB) and/or digitalis 24 hours before surgery). The incidence of AF was high (47%) in our study, most frequently on the first postoperative day. Sixty-four percent of the study sample was male, and the mean age was 62 years. Among patients with two or less risk factors for AF, only 24% developed arrhythmia, while the presence of three or more risk factors was associated with increased incidence of postoperative AF (69%), (p = 0.04). Age > 65 years (58% of the patients) was the most prevalent risk factor, followed by LA enlargement in 45% (p = 0.001), and VHD in 38% (p = 0.02). The presence of three or more risk factors increases significantly the incidence of this arrhythmia in the postoperative period after cardiac surgery. Among the primary risk factors are advanced age, left atrial enlargement, and valvular heart disease.

Fibrilação atrial no pós-operatório de cirurgia cardíaca: quem deve receber quimioprofilaxia? / Fibrilación atrial en el postoperatorio de cirugía cardiaca: ¿quién debe recibir quimioprofilaxia? / Postoperative atrial fibrillation after cardiac surgery: who should receive chemoprophylaxis?

Avaliar fatores de risco arritmogênicos associados à maior incidência de fibrilação atrial (FA) no pós-operatório (PO) de cirurgia cardíaca (revascularização miocárdica e/ou cirurgia valvar), com o intuito de selecionar os mais propensos ao desenvolvimento dessa arritmia para possível quimioprofilaxia. Avaliarem-se 66 pacientes submetidos à cirurgia cardíaca eletiva. Correlacionaram-se os principais fatores de risco (idade avançada, doença valvar (DV), aumento atrial esquerdo (AE), disfunção ventricular (DVE), distúrbio eletrolítico (DHE), cirurgia cardíaca prévia (CCP), uso prévio e suspensão de betabloqueador (B-Bloq) e/ou digital 24 horas antes da cirurgia) para o desenvolvimento de FA no PO. A incidência de FA foi elevada (47 por cento) em nossa casuística e mais freqüente no primeiro dia de PO. Dos pacientes pesquisados, 64 por cento eram do sexo masculino com idade média de 62 anos. Entre os pacientes com dois ou menos fatores de risco para FA, apenas 24 por cento desenvolveram a arritmia, enquanto a presença de três ou mais desses fatores esteve associada à sua maior incidência no PO (69 por cento), (p = 0,04). Em ordem de maior freqüência, idade > 65 anos (em 58 por cento dos pacientes) foi o fator de risco mais prevalente, seguido de aumento do AE em 45 por cento (p = 0,001) e DV em 38 por cento (p = 0,02). A presença de três ou mais fatores de risco aumenta consideravelmente a incidência dessa arritmia no PO de cirurgia cardíaca. Entre os principais fatores, destacaram-se idade avançada, aumento do AE e doença valvar.

To evaluate arrhythmogenic risk factors associated with greater incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery (CABG and/or valvular surgery) in order to identify those more prone to the development of this arrhythmia for possible chemoprophylaxis. Sixty-six patients who underwent elective cardiac surgery were assessed. The following risk factors for the development of POAF were correlated: advanced age, valvular heart disease (VHD), left atrial (LA) enlargement, left ventricular dysfunction (LVD), electrolyte imbalance (EI), previous CABG, prior use and withdrawal of beta-blockers (BB) and/or digitalis 24 hours before surgery). The incidence of AF was high (47 percent) in our study, most frequently on the first postoperative day. Sixty-four percent of the study sample was male, and the mean age was 62 years. Among patients with two or less risk factors for AF, only 24 percent developed arrhythmia, while the presence of three or more risk factors was associated with increased incidence of postoperative AF (69 percent), (p = 0.04). Age > 65 years (58 percent of the patients) was the most prevalent risk factor, followed by LA enlargement in 45 percent (p = 0.001), and VHD in 38 percent (p = 0.02). The presence of three or more risk factors increases significantly the incidence of this arrhythmia in the postoperative period after cardiac surgery. Among the primary risk factors are advanced age, left atrial enlargement, and valvular heart disease.

Evaluar factores de riesgo arritmogénicos asociados a la mayor incidencia de fibrilación atrial (FA) en el postoperatorio (PO) de cirugía cardiaca (revascularización miocárdica y/o cirugía valvular), con el intuito de seleccionar los más propensos al desarrollo de esa arritmia para posible quimioprofilaxia. Se evaluaron a 66 pacientes sometidos a la cirugía cardiaca electiva. Se correlacionaron los principales factores de riesgo (edad avanzada, enfermedad valvar (DV), aumento atrial izquierdo (AE), disfunción ventricular (DVE), disturbio electrolítico (DHE), cirugía cardiaca previa (CCP), uso previo y suspensión de betabloqueante (B-Bloq) y/o digital 24 horas antes de la cirugía) para el desarrollo de FA en el PO. La incidencia de FA se mostró elevada (47 por ciento) en nuestra casuística y más frecuente al primer día de PO. De todos los pacientes investigados, el 64 por ciento pertenecían al sexo masculino con edad promedio de 62 años. Entre los pacientes con dos o menos factores de riesgo para FA, sólo el 24 por ciento desarrollaron la arritmia, mientras que la presencia de tres o más de esos factores estuvo asociada a su mayor incidencia en el PO (69 por ciento), (p = 0,04). Por orden de mayor frecuencia, edad > 65 años (en el 58 por ciento de los pacientes) resultó el factor de riesgo más prevalente, seguido de aumento del AE en el 45 por ciento (p = 0,001) y DV en el 38 por ciento (p = 0,02). La presencia de tres o más factores de riesgo aumenta considerablemente la incidencia de esa arritmia en el PO de cirugía cardiaca. Entre los principales factores, se destacaron: edad avanzada, aumento de AE y enfermedad valvular.

Prevention of atrial fibrillation with moderate doses of amiodarone in the postoperative period of cardiac surgery is safe and effective in patients with high risk for developing this arrhythmia.

OBJECTIVE: To assess if prophylaxis with moderate doses of amiodarone in the postoperative period of cardiac surgery (coronary artery bypass grafting and/or valve surgery), reduces the incidence of atrial fibrillation in patients with high risk for developing this arrhythmia. METHODS: A randomized and prospective clinical study involving 68 patients who underwent elective cardiac surgery. Mean age was 64 years and 59% of participants were males. Patients with three or more risk factors for atrial fibrillation, according to the literature, were randomized into two groups to receive or not prophylaxis with amiodarone in the first postoperative day. The dose administered ranged from 600 mg/day to 900 mg/day, intravenously, on the first postoperative day, followed by 400 mg/day orally until hospital discharge or until completing seven days. The other patients, who presented two or fewer risk factors, were followed up until hospital discharge. All patients were evaluated by means of cardiac and/or electrocardiographic monitoring. RESULTS: In the group treated with amiodarone, 7% of patients presented atrial fibrillation, whereas in the control group 70% of patients developed arrhythmia. Among the non-randomized individuals (with two or fewer risk factors), only 24% presented atrial fibrillation. CONCLUSION: The prophylactic use of amiodarone was effective in the prevention of atrial fibrillation in patients with three or more risk factors for this arrhythmia. This treatment can be useful to reduce stay at the Intensive Care Unit and, consequently, the complications originating from longer hospitalization.

Prevenção de fibrilação atrial com amiodarona em moderada dosagem no pós-operatório de cirurgia cardíaca é segura e eficaz em pacientes de alto risco para desenvolver essa arritmia / Prevention of atrial fibrillation with moderate doses of amiodarone in the postoperative period of cardiac surgery is safe and effective in patients with high risk for developing this arrhythmia

OBJETIVO: Avaliar se a profilaxia com amiodarona em moderada dosagem, no pós-operatório de cirurgia cardíaca (revascularização miocárdica e/ou cirurgia valvar), reduz a incidência de fibrilação atrial em pacientes de alto risco para desenvolver essa arritmia. MÉTODOS: Estudo clínico, randomizado e prospectivo, realizado em 68 pacientes submetidos a cirurgia cardíaca eletiva. A média de idade foi de 64 anos e 59 por cento dos participantes eram do sexo masculino. Os pacientes com três ou mais fatores de risco para fibrilação atrial, de acordo com a literatura, foram randomizados em dois grupos, para receber ou não profilaxia com amiodarona no primeiro dia de pós-operatório. A dose administrada foi de 600 mg/dia a 900 mg/dia, por via intravenosa, no primeiro dia de pós-operatório, seguida de 400 mg/dia por via oral até a alta hospitalar ou até completar sete dias. Os demais pacientes, com dois ou menos fatores de risco, foram seguidos até a alta hospitalar. Todos os pacientes foram observados por monitorização cardíaca e/ou eletrocardiografia. RESULTADOS: No grupo que recebeu amiodarona, 7 por cento dos pacientes apresentaram fibrilação atrial, enquanto no grupo controle 70 por cento desenvolveram a arritmia. Nos indivíduos não-randomizados (com dois ou menos fatores de risco), apenas 24 por cento apresentaram fibrilação atrial. CONCLUSÃO: O uso profilático de amiodarona foi eficaz na prevenção de fibrilação atrial nos pacientes com três ou mais fatores de risco para essa arritmia. Esse tratamento pode ser benéfico na redução da permanência na Unidade de Terapia Intensiva e, conseqüentemente, nas complicações advindas do maior tempo de internação hospitalar.

OBJECTIVE: To assess if prophylaxis with moderate doses of amiodarone in the postoperative period of cardiac surgery (coronary artery bypass grafting and/or valve surgery), reduces the incidence of atrial fibrillation in patients with high risk for developing this arrhythmia. METHODS: A randomized and prospective clinical study involving 68 patients who underwent elective cardiac surgery. Mean age was 64 years and 59 percent of participants were males. Patients with three or more risk factors for atrial fibrillation, according to the literature, were randomized into two groups to receive or not prophylaxis with amiodarone in the first postoperative day. The dose administered ranged from 600 mg/day to 900 mg/day, intravenously, on the first postoperative day, followed by 400 mg/day orally until hospital discharge or until completing seven days. The other patients, who presented two or fewer risk factors, were followed up until hospital discharge. All patients were evaluated by means of cardiac and/or electrocardiographic monitoring. RESULTS: In the group treated with amiodarone, 7 percent of patients presented atrial fibrillation, whereas in the control group 70 percent of patients developed arrhythmia. Among the non-randomized individuals (with two or fewer risk factors), only 24 percent presented atrial fibrillation. CONCLUSION: The prophylactic use of amiodarone was effective in the prevention of atrial fibrillation in patients with three or more risk factors for this arrhythmia. This treatment can be useful to reduce stay at the Intensive Care Unit and, consequently, the complications originating from longer hospitalization.

IL-6 and IL-1 receptor antagonist in stable angina pectoris and relation of IL-6 to clinical findings in acute myocardial infarction.

OBJECTIVES: To determine if increased inflammatory activity, as reflected by interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) levels, is present in patients with stable angina pectoris and if IL-6 levels on admission to the coronary care unit in patients with acute myocardial infarction (AMI) are related to heart failure and fever response. SUBJECTS AND METHODS: We studied 28 patients with stable angina pectoris enrolled for coronary angiography, and compared them with sex- and age-matched controls. Thirty-four patients with AMI were studied and samples for determination of IL-6 levels were taken on admission within 36 h of onset of symptoms. IL-6 and IL-1ra were determined in serum by enzyme immunoassay. RESULTS: Levels of IL-6 and IL-1ra were higher in patients with stable angina pectoris than in controls (mean 4.6 +/- 3.6 vs. 3.0 +/- 2.9 ng L-1, P < 0.03, and 774 +/- 509 vs. 490 +/- 511 ng L-1, P < 0.01, respectively). IL-6 and IL-1ra levels were not related to angiographic findings. IL-6 levels were high in patients with AMI (38.9 +/- 75.6 ng L-1). Patients with prolonged fever (duration > 4 days) had higher IL-6 levels (94.7 +/- 138.2 vs. 21.7 +/- 29.7 ng L-1, P < 0.05). IL-6 levels were not related to heart failure. CONCLUSIONS: Our results indicate that increased inflammatory activity is present not only in acute coronary syndromes, but also in a chronic form of ischaemic heart disease, giving further evidence for a central role of inflammatory processes in coronary artery disease. With regard to AMI, we found increased inflammatory activity in patients with prolonged fever.