Índice de Alerta Alimentar (IAA): um instrumento de triagem nutricional do hipertenso para o cardiologista / Food Alert Index (IAA): a nutritional screening tool for hypertensive patients for cardiologists

INTRODUÇÃO: O impacto da reeducação alimentar no controle da pressão arterial (PA) pode equivaler ao de uma ou mais classes de anti-hipertensivos. Apesar disso, a avaliação alimentar é comumente negligenciada na prática médica. A falta de instrumentos de mensuração clinicamente aplicáveis em ambiente de consultório é uma das possíveis explicações. Elaboramos o Índice de Alerta Alimentar (IAA) como ferramenta de triagem alimentar para o cardiologista. O objetivo do presente estudo foi avaliar uma população de hipertensos resistentes por meio do IAA e comparar o grau de concordância inter-avaliadores. MÉTODOS: O IAA é um escore que inclui 7 dimensões: aporte calórico; consumo de frutas; verduras e legumes; gordura saturada; sal; ultraprocessados; e preparo dos alimentos. A avaliação é realizada a partir de registro alimentar fotográfico (RAF) de 3 dias que o paciente encaminha por meio de aplicativo. Cada dimensão recebe uma pontuação de 0 (ótimo); 1 (intermediário); ou 2 (péssimo). A pontuação total do IAA varia de 0 a 14. Recrutamos 30 hipertensos resistentes. O RAF dos 30 pacientes foi avaliado de forma cega e independente por cardiologista sênior (S); médico residente (J); e nutricionista (N). Estudamos o grau de concordância inter-avaliadores por meio do coeficiente de concordância Kappa de Cohen; do coeficiente de correlação linear de Pearson; e de gráficos de dispersão e de Bland-Altman. Foi aceita uma margem de discordância de até 1 ponto para cada dimensão e de até 3 pontos na pontuação total. RESULTADOS. A idade média dos 30 pacientes avaliados foi 63.9 ± 9.2 anos (83,3% mulheres; IMC médio 33.1 ± 6.1; raça parda ou preta: 57,1%; anti-hipertensivos em uso: 3.9 ± 1.6; PAS média: 137.0 ± 17.4 mmHg). Foram avaliadas uma média de 11,2 fotografias por paciente. As dimensões de maior alerta (Escore 1 + 2) foram: consumo excessivo de sal (87%); excesso calórico (86,7%); e consumo de ultraprocessados (75,5%). Apenas 58,9% apresentou consumo adequado (Escore 0) de verduras e 46,7% de frutas. O Coeficiente de Correlação de Pearson entre S e N foi 0,816. Aceitando-se margem de diferença ≤3 pontos a concordância inter-avaliadores foi de 100%. O grau de concordância entre J e S/N foi significativamente menor (Correlação de Pearson: 0,455; após ajuste: 83,3% de concordância). CONCLUSÕES: O IAA apresentou alto grau de concordância inter-avaliadores, constituindo uma ferramenta promissora na prática clínica. 2/3 dos hipertensos resistentes apresentaram altos índices de alerta, sendo candidatos a acompanhamento nutricional especializado.

Chemical management of aquatic macrophytes under simulated floodplain condition in mesocosms.

Floating natives (Eichhornia crassipes and Pistia stratiotes) and emergent exotic invasives (Hedychium coronarium and Urochloa arrecta) macrophytes grow as aquatic weeds in both natural and artificial floodplain areas in Brazil, where the chemical control should be researched. The herbicides glyphosate and saflufenacil, alone or mixed, were tested for weed control under simulated floodplain condition in mesocosms. Glyphosate (1,440 g ha-1), saflufenacil (120 g ha-1), or glyphosate (1,440 g ha-1) + saflufenacil (42, 84, and 168 g ha-1) were applied firstly; and 75 days after treatment (DAT), glyphosate (1,680 g ha-1) was applied as a follow-up treatment to control plant regrowth. An herbicide-free check was also used. Echhinornia crassipes was the species most susceptible to the different herbicides. Saflufenacil alone presented the lowest control on the macrophytes (≤45%) from 7 to 75 DAT, and in most cases they presented high regrowth rates, i.e., this herbicide was the least effective treatment in reducing the dry mass production of the macrophyte community. Glyphosate alone presented low efficacy to control H. coronarium (30-65%), but for the other macrophytes, it presented control peaks ≥90%, maintaining control levels ≥50% until 75 DAT. Glyphosate + saflufenacil, regardless rate of saflufenacil, caused similar damage to glyphosate in E. crassipes and P. stratiotes; however, in U. arrecta it caused 20-30% less injury. In contrast, these treatments provided the best control of H. coronarium. The complementary application of glyphosate was essential to improve the level of control of the first application, after plant regrowth.

The role of Cardiopulmonary Exercise Testong (CPET) in predicting morbidity outcomes in grown-up congenital heart (GUCH) disease ­ a preliminary study

INTRODUCTION: Given the advances in diagnosis and clinicalsurgical therapies, congenital heart defects are increasing their prevalence in the adult population. Yet, there is still no consensus on the best way to follow up with these patients. Among the validated tools for monitoring patients with heart disease, the Cardiopulmonary Exercise Test (CPET) plays an important role. However, the use of this test for monitoring the population of Grown Up Congenital Heart (GUCH) still lacks studies. This study aimed to assess the correlation between ergospirometry variables and the severity of the GUCH population measured by echocardiographic aspects. METHODS: A retrospective cohort with 248 GUCH (Table 1) over 18 years old, was referred to CPET, from 2015 to 2021, in a tertiary hospital in the state of São Paulo. Patients were sequentially included, and those in functional class IV or with contraindications to CPET were excluded. Ergospirometry variables were analyzed in association with ventricular function - estimated by echocardiogram in the same period. RESULTS: Most patients were in functional class I and II (86.3%). In the echocardiographic findings, 40% had pulmonary hypertension and almost all had preserved left ventricle function. The CPET showed a median VO2 peak around 69% of predict. Other parameters are summarized in Table 2. CPET variables were able to stratify the severity of GUCH, mainly by pulmonary hypertension. Comparing CPET data and imaging diagnosis, VE/VCO2 slope> 32 and OUES <60% were related to the presence of pulmonary hypertension. CONCLUSION: The CPET is an important resource for prognostic and diagnostic definition in the evolution of GUCH patients.

Fractional anisotropy of the optic radiations correlates with the visual field after epilepsy surgery.

PURPOSE: This study assessed whether optic radiations (OR) microstructure after temporal lobe epilepsy (TLE) surgery correlated with visual field defects (VFD). METHODS: Patients were subjected to diffusion tensor imaging (DTI) tractography of the OR and Humphrey perimetry after TLE surgery. We used Spearman's test to verify correlations between tractographic parameters and perimetry mean deviation. Tractographic variables were compared between patients with VFD or intact perimetry. Multiple logistic regression was applied between DTI and perimetry values. DTI sensitivity and specificity were assessed with a receiver operating characteristic (ROC) curve to evaluate VFD. RESULTS: Thirty-nine patients had reliable perimetry and OR tractography. There was a significant correlation between (1) fractional anisotropy (FA) and both total (rho = 0.569, p = 0.0002) and quadrant (rho = 0.453, p = 0.0037) mean deviation and (2) radial diffusivity and total mean deviation (rho = - 0.350, p = 0.0286). There was no other significant correlation. Patients with VFD showed a significantly lower FA compared with patients with normal perimetry (p = 0.0055), and a 0.01 reduction in FA was associated with a 44% increase in presenting VFD after surgery (confidence interval, CI = 1.10-1.88; p = 0.0082). Using a FA of 0.457, DTI tractography showed a specificity of 95.2% and a sensitivity of 50% to detect VFD after surgery (area under the curve = 0.7619, CI = 0.6020-0.9218). CONCLUSION: The postoperative OR microstructure correlated with visual loss after epilepsy surgery. DTI postoperative OR tractography may be helpful in evaluating VFD.

Clinical and Imaging Evaluation of Transuncus Selective Amygdalohippocampectomy.

BACKGROUND: Various reports have described the transuncus (TU) approach as a selective route to the amygdala and hippocampus, but this approach has not yet been submitted to solid postoperative imaging analysis. The objective of this study was to evaluate the anatomy, surgical technique, postoperative imaging analysis, and outcome in a series of patients with temporal lobe epilepsy who underwent selective amigdalohippocampectomy via a TU approach. METHODS: This was a prospective study of 25 consecutive patients who underwent selective amigdalohippocampectomy through a TU approach. The temporal stem and temporal pole were evaluated through different modalities of 3-Tesla magnetic resonance imaging, including tractography of optic radiation (OR), uncinate fascicle, and inferior fronto-occipital fascicle. Visual field analysis was performed with automated perimetry. RESULTS: The mean age was 40 ± 8.21 years, and mean follow-up was 26.44 + 12.58 months. Postoperatively, 21 patients (84%) were classified as Engel I (good seizure control). Diffusion tensor imaging (DTI) data showed that 78.2% of patients had some structural damage to the temporal stem and fibers of the uncinate fascicle were identified postoperatively in only 3 patients (13.04%). The inferior fronto-occipital fascicle was identified in 18 patients (78.3%); however, subsequent DTI analysis of the remaining fibers showed them to be damaged. Integrity of the OR did not differ between these 2 groups. CONCLUSIONS: A TU approach is a feasible and efficient approach to selective amigdalohippocampectomy for surgical treatment of temporal lobe epilepsy. Postoperative DTI analysis suggests that a TU approach results in more injury to the temporal stem and its associated white matter fiber tracts than expected by previous anatomic studies; however, it was efficient in preserving OR.