Sarcopenia em pacientes de 40 a 64 anos hospitalizados por insuficiência cardíaca / Sarcopenia in patients aged 40­64 years hospitalized for heart failure

Introdução: a insuficiência cardíaca (IC) e a sarcopenia são condições prevalentes e inter-relacionadas, figurando como importantes causas de limitações funcionais. Objetivo: avaliar critérios de sarcopenia, e suas relações com parâmetros cardiometabólicos, em pacientes de 40 a 64 anos hospitalizados por IC. Metodologia: estudo de corte transversal com caráter analítico envolvendo indivíduos com IC confirmada. A massa muscular apendicular (MMA) foi avaliada através da absorciometria por raios-X de dupla energia (DXA), considerando-se baixa MMA mulheres com MMA/altura² <5,5 kg/m² ou MMA/índice de massa corporal (IMC) <0,512 e homens com MMA/altura² <7,0 kg/m² ou MMA/IMC <0,789. Baixa força de preensão manual (FPM) foi considerada quando <16 kg em mulheres e <27 kg em homens. Resultados: avaliou-se 109 pacientes (50,5% mulheres), com mediana de idade de 58 anos. Constatou-se baixa MMA em 41,3% e baixa FPM em 64,2%, não havendo correlação significativa entre FPM e MMA em nenhum dos gêneros. Baixa MMA se associou ao gênero masculino (68,9% versus 35,9%; p=0,001), a maiores idades (60,0 [53,0-63,0] versus 57,0 [51,3-60,0] anos; p=0,039) e maiores níveis séricos de paratormônio (48,0 [30,5-94,4] versus 29,9 [23,0-54,1] pg/mL; p=0,009). Baixa FPM se associou a maior sintomatologia cardíaca (75,7% com baixa FPM tinham classificação funcional da New York Heart Association III-IV, versus 51,3% daqueles com FPM normal; p=0,009). Conclusões: há uma relevante prevalência de sarcopenia em pacientes de 40 a 64 anos hospitalizados por IC, observando-se maior frequência de baixa MMA nos homens, associação entre baixa FPM e sintomatologia cardíaca, e maiores níveis de paratormônio naqueles com perda muscular.

Introduction: heart failure (HF) and sarcopenia are prevalent and interrelated conditions, being important causes of functional limitations. Objective: to evaluate sarcopenia criteria, and their relationship with cardiometabolic parameters, in patients aged 40­64 years hospitalized for HF. Methodology: Cross-sectional study including patients with established HF. Appendicular skeletal muscle mass (ASMM) was assessed using dual-energy X-ray absorptiometry (DXA), considering low ASMM women with ASMM/height² <5.5 kg/m² or ASMM/body mass index (BMI) <0.512 and men with ASMM/height² <7.0 kg/m² or ASMM/BMI <0.789. Low handgrip strength (HGS) was considered when <16 kg in women and <27 kg in men. Results: we evaluated 109 patients (50.5% women), with a median age of 58 years. Low ASMM was found in 41.3% and low HGS in 64.2%, with no significant correlation between HGS and ASMM in either gender. Low ASMM was associated with male gender (68.9% versus 35.9%; p=0.001), older age (60.0 [53.0-63.0] versus 57.0 [51.3-60, 0] years; p=0.039) and higher serum parathyroid hormone (48.0 [30.5-94.4] versus 29.9 [23.0-54.1] pg/mL; p=0.009). Low HGS was associated with greater cardiac symptoms (75.7% with low HGS had a New York Heart Association III-IV functional classification, versus 51.3% of those with normal HGS; p=0.009). Conclusions: there is a relevant prevalence of sarcopenia in patients aged 40­64 years hospitalized for HF, observing a higher frequency of low ASMM in men, an association between low HGS and cardiac symptoms, and higher levels of parathyroid hormone in those with muscle wasting.

Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases.

Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas.

Pyroligneous extracts with therapeutic action: A technological prospect

Abstract The Pyroligneous extract is a product from the combustion of plant biomass with applications in the fields of health, industrial chemistry, and agriculture. The discovery of new molecules with therapeutic potential and of natural origin continues to be one of the great challenges for research centres around the world. The following work aims to analyze, through a technological prospection, the use of pyroligneous extracts for therapeutic purposes. To carry out the study, searches were carried out in documents deposited in Brazil, Europe, and the United States and searched on platforms specialized in patents. The number of inventions using pyroligneous extract with therapeutic applications is still quite small, however, innovations have been observed for the treatment of diseases of great clinical relevance such as cancer and hypertension. The systematic mapping of innovations is of great importance for the development of new technologies.

Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases

ABSTRACT Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas.

Visceral Leishmaniasis: A Case Report of a Challenging Diagnosis After Orthotopic Liver Transplantation.

Leishmaniasis is a disease caused by a protozoan and transmitted by sandfly species in several emerging countries. Visceral leishmaniasis is a serious complication, especially in immunosuppressed patients, and is uncommon after liver transplantation. We report the case of a 48-year-old female patient who underwent liver transplantation owing to polycystic liver disease. Six months after the procedure, she was hospitalized with diarrhea, acute kidney failure, and leukopenia. She had been off steroids for 3 months and was taking mycophenolate and tacrolimus. She had already been treated for cytomegalovirus, which was negative on admission. During hospitalization, fever, splenomegaly, ascites, and pancytopenia appeared. Serology for Leishmania by indirect immunofluorescence was negative. Then, bone biopsy and molecular testing for Leishmania diagnosed it as visceral leishmaniasis. Amphotericin therapy was initiated with resolution of fever after 4 days of treatment and gradual recovery from pancytopenia. This case highlights the challenge of early diagnosis of visceral leishmaniasis in liver transplant recipients with diarrhea and leukopenia, which can be caused by immunosuppression or more prevalent viral diseases. Late onset of fever, splenomegaly, and a first negative serologic test also made early diagnosis difficult. The aim of the report is to emphasize the suspicion of visceral leishmaniasis in symptomatic patients from emerging countries and to question the benefit of including protozoan screening in liver transplant donors and recipients in endemic areas.

Optimization of the Acid Cleavage of Proanthocyanidins and Other Polyphenols Extracted from Plant Matrices.

The chemical mechanism of the acid cleavage of proanthocyanidins (PAs) has been known for decades but has yet to be optimized. Therefore, we optimized this process in Byrsonima crassifolia, Euterpe oleracea and Inga edulis extracts using the response surface methodology and assessed the effect of hydrochloric acid concentration (0.3−3.7 N), time (39−291 min), and temperature (56−98 °C) on the following response variables: PAs reduction, astringency reduction, antioxidant capacity/total polyphenols (TEAC/TP) ratio, and cyanidin content. The response variables were maximized when cleavage was performed with 3 N HCl at 88 °C for 165 min. Under these conditions, the mean PAs value and astringency in the three extracts decreased by 91% and 75%, respectively, the TEAC/TP ratio remained unchanged after treatment (p > 0.05), and the increase in cyanidin confirmed the occurrence of cleavage. Thus, the results suggest that acid cleavage efficiently minimizes undesirable technological PAs characteristics, expanding the industrial applications.

Cardiovascular safety of naltrexone and bupropion therapy: Systematic review and meta-analyses.

Despite being approved for clinical use, evidence of cardiovascular safety (CV) is lacking for treatment with bupropion, naltrexone, or their combination (B-N). The purpose of the study is to determine the relationship between these treatments and the risk of major cardiovascular adverse events (MACE). Phase 3 randomized clinical trials (RCT) evaluating bupropion, naltrexone, or B-N versus control with reported incidence of MACE. The meta-analysis included 12 RCTs, 69% for weight loss and 29% for smoking cessation, with 19,176 patients and 7354 patient-years who were randomized to an active treatment (bupropion [n = 2965] or B-N [n = 6980] or naltrexone [n = 249]) versus control (placebo [n = 6968] or nicotine patch [n = 2014]). The mean age was 54 ± 8 years (55% female), and the baseline BMI was 32 ± 5 kg/m2 . The additive network meta-analysis model for random effects showed no association between bupropion, B-N, or naltrexone and MACE (odds ratio [OR] = 0.90 [95%CI 0.65-1.25], p = 0.52; OR = 0.97 [95%CI 0.75-1.24], p = 0.79; OR = 1.08 [95%CI 0.71-1.63], p = 0.73, respectively; I2 = 0%, p = 0.86). Meta-regression analyses showed no significant association between MACE and potential confounders from RCT demographic disparities (p = 0.58). The statistical power (post hoc two-tailed) for non-inferiority was 91%, giving a strong probability of validity. Naltrexone, bupropion, or B-N is not associated with the incidence of MACE as compared with placebo.

Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus.

BACKGROUND: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. METHODS: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. RESULTS AND CONCLUSIONS: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.

Isolation and Genetic Identification of Endophytic Lactic Acid Bacteria From the Amazonian Açai Fruits: Probiotics Features of Selected Strains and Their Potential to Inhibit Pathogens.

The açai palm (Euterpe oleracea) is native to the Amazon basin, a humid tropical forest. High levels of total mesophilic bacteria with high diversity have been consistently reported in açai fruits. As local consumers have few digestive problems, the results of the present study reveal the lactic acid bacteria (LAB) recovered from açai fruits with characteristics that suggest they are possible candidates for probiotics and antagonistic potential against pathogens for the first time. Açai fruits were sampled from five different locations in the Eastern Amazonia floodplains. Sixty-six isolates were recovered from fruits and tested for some probiotic characteristics following FAO/WHO guidelines. Approximately 65% of the isolates showed no catalase or oxidase activity, Gram-positive staining or cocci and bacilli cell morphology. Furthermore, 48% of the isolates demonstrated preliminary characteristics that suggest safety for use, as they presented no coagulase enzyme activity or gamma-hemolysis. These strains were identified as belonging to the genera Lactiplantibacillus and Pediococcus, and 32 strains also presented resistance to vancomycin, ciprofloxacin and streptomycin. In addition, 28 isolates showed a survival rate, expressed as log cycle reduction, higher than 0.9 under gastric conditions (pH 2). All strains tested positive in bile salts deconjugation tests and showed a survival rate higher than 0.8 in the presence of this salt. Regarding antimicrobial activity against pathogens, all strains were able to inhibit Salmonella Typhimurium (ATCC® 14028TM) and 97% were capable of inhibiting Escherichia coli (ATCC® 25922TM). Concerning the results of in vitro antagonistic assays, three isolates (B125, B135, and Z183 strains) were selected for antagonistic tests using açai juice contaminated with these two pathogens. All tested LAB strains were able to inhibit pathogen growth in açai juice. In summary, açai fruits are a potential source of LAB isolates to be investigated as probiotics.

Dynamics and diversity of the bacterial community during the spontaneous decay of açai (Euterpe oleracea) fruits.

The biodiversity and evolution of the microbial community in açai fruits (AF) between three geographical origins and two spontaneous decay conditions were examined by applying culture-independent methods. Culture-independent methods based on 16S rRNA from fifteen samples revealed that Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Acidobacteria were the most abundant phyla. At the genus level, Massilia (taxon with more than 50% of the sequences remaining constant during the 30h of decay), Pantoea, Naxibacter, Enterobacter, Raoultella and Klebsiella were identified, forming the carposphere bacterial microbiota of AF. AF is fibre-rich and Massilia bacteria could find a large quantity of substrate for its growth through cellulase production. Beta diversity showed that the quality parameters of AF (pH, soluble solids, titratable acidity and lipids) and elemental analysis (C, N, H and C/N ratio) were unable to drive microbial patterns in AF. This research offers new insight into the indigenous bacterial community composition on AF as a function of spontaneous postharvest decay.

Dynamics and diversity of the bacterial community during the spontaneous decay of açai (Euterpe oleracea) fruits

Abstract The biodiversity and evolution of the microbial community in açai fruits (AF) between three geographical origins and two spontaneous decay conditions were examined by applying culture-independent methods. Culture-independent methods based on 16S rRNA from fifteen samples revealed that Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Acidobacteria were the most abundant phyla. At the genus level, Massilia (taxon with more than 50% of the sequences remaining constant during the 30 h of decay), Pantoea, Naxibacter, Enterobacter, Raoultella and Klebsiella were identified, forming the carposphere bacterial microbiota of AF. AF is fibre-rich and Massilia bacteria could find a large quantity of substrate for its growth through cellulase production. Beta diversity showed that the quality parameters of AF (pH, soluble solids, titratable acidity and lipids) and elemental analysis (C, N, H and C/N ratio) were unable to drive microbial patterns in AF. This research offers new insight into the indigenous bacterial community composition on AF as a function of spontaneous postharvest decay.

Dynamics and diversity of the bacterial community during the spontaneous decay of açai (Euterpe oleracea) fruits

Abstract The biodiversity and evolution of the microbial community in açai fruits (AF) between three geographical origins and two spontaneous decay conditions were examined by applying culture-independent methods. Culture-independent methods based on 16S rRNA from fifteen samples revealed that Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Acidobacteria were the most abundant phyla. At the genus level, Massilia (taxon with more than 50% of the sequences remaining constant during the 30 h of decay), Pantoea, Naxibacter, Enterobacter, Raoultella and Klebsiella were identified, forming the carposphere bacterial microbiota of AF. AF is fibre-rich and Massilia bacteria could find a large quantity of substrate for its growth through cellulase production. Beta diversity showed that the quality parameters of AF (pH, soluble solids, titratable acidity and lipids) and elemental analysis (C, N, H and C/N ratio) were unable to drive microbial patterns in AF. This research offers new insight into the indigenous bacterial community composition on AF as a function of spontaneous postharvest decay.

Transcultural Diabetes Nutrition Algorithm: Brazilian Application.

The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

Kinetic modeling of anthocyanin degradation and microorganism growth during postharvest storage of açai fruits (Euterpe oleracea).

The unavoidable damage of açai (Euterpe oleracea) fruits (AF) during picking leads to microbial contamination and anthocyanin degradation, which prejudice the consumed fruit drink. Thirteen lots of AF (24 kg) from different municipal districts of the Pará State (Brazil) were monitored during a 75-h-long storage in the dark at 30 °C for microbial growth, and 7 lots for anthocyanin degradation. On arrival at the laboratory, anthocyanins presented a mean concentration of 828 mg kg(-1) fruits with a standard deviation of 323 mg kg(-1) fruits whereas mean microbial contamination was 2.64 10(6) CFU g(-1) of dry matter for total mesophilic bacteria, 1.98 10(3) MPN g(-1) DM for fecal coliforms, and 1.11 10(5) CFU g(-1) DM for moulds and yeasts. Kinetic growth of the microbes could be fitted to a quadratic equation with an unusual rapid growth during the 1st 24 h. The kinetics of anthocyanin degradation fitted a 1st-order equation. The mean velocity constant of the reaction (k(1)) was of 0.0137 h(-1) and the mean half-life (t(½)) of the anthocyanins was 50 h. These results indicate that the AF simultaneously suffer extensive anthocyanin degradation and explosive microbial growth during the postharvest period needing a special care.

Técnica para obtenção de sangue central em ratos / Central blood obtainment technique in rats

Introdução: Há muitos métodos descritos para obtenção de sangue em ratos, entre eles a técnica da punção das veias da cauda, da artéria aorta e da veia jugular. Objetivo: Descrever um procedimento para obtenção de sangue central, em dois intervalos regulares, sem necessidade de eutanásia. Método: Utilizaram-se 10 ratos da linhagem Wistar, fêmeas adultas pesando entre 200 e 250 gramas, sendo realizada uma incisão oblíqua, seguida de dissecção da veia femoral. Realizou-se, inicialmente, a punção da veia femoral, através de uma seringa hipodérmica de 1 ml, contendo 0,2 ml de solução de heparina a 5 por cento, para heparinização sistêmica do animal. Seguiu-se, então, punção venosa para a coleta de 1,5 ml de sangue, introduzindo-se um cateter Angiocath nº 24 pelo mesmo orifício criado na heparinização. Fez-se, em seguida, a ligadura definitiva do vaso e o fechamento da ferida operatória com fio Mononylon 3-0. No intervalo de sete dias repetiu-se o procedimento na veia femoral contralateral. Observaram-se os seguintes critérios: incisão, dissecção, heparinização, punção, presença de infecção no pós-operatório e material utilizado, sendo os dados coletados e analisados descritivamente. Resultados: Verificou-se que, em 100 por cento dos animais, a incisão oblíqua foi satisfatória para visibilização do feixe vásculo-nervoso femoral; em 60 por cento das punções nã houve espasmo venoso; 100 por cento dos animais apresentaram heparinização satisfatória; em 70 por cento foi possível a coleta de 1,5 ml de sangue; 80 por cento não apresentaram abcessos e em 100 por cento dos ratos a utilização...