American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients.

BACKGROUND: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. HYPOTHESIS: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. METHODOLOGY: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. RESULTS: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). CONCLUSIONS: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Aggression, Micro-aggression, and Abuse Against Health Care Providers During the COVID-19 Pandemic. A Latin American Survey.

The COVID-19 pandemic has had tremendous consequences globally. Notably, increasing complaints of verbal and physical violence against health care providers have been reported. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022 to delineate the violent behavior against front-line health professionals in Latin America. A total of 3544 participants from 19 countries were included. There were 58.5% women, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members. About 54.8% reported acts of abuse: 95.6% verbal abuse, 11.1% physical abuse, and 19.9% other types. Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, 56.2% considered changing their care tasks, and 33.6% considered quitting their profession. In a logistic regression model, nurses (odds ratio (OR) 1.90, P < 0.001), doctors (OR 2.11, P < 0.001), and administrative staff (OR 3.53, P = 0.005) experienced more abuse than other health workers. Women more frequently reported abuse (OR 1.56, P < 0.001), as well as those who worked directly with COVID-19 patients (OR 3.66, P < 0.001). A lower probability of abuse was observed at older ages (OR 0.95, P < 0.001). There has been a high prevalence of abuse against health personnel in Latin America during the COVID-19 pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be at elevated risk. It is imperative to develop strategies to mitigate these acts and their repercussions on the patient-provider relationship and outcomes.

Effect of Hyperbaric Oxygen Therapy (HBOT) on Insulin Resistance Associated with Abdominal Obesity in Wistar Rats with Dietary Sucrose-Induced Metabolic Syndrome.

Metabolic syndrome (MS) is a combination of risk factors related to the development of mainly type 2 diabetes mellitus, cardiovascular disease (CVD) and nonalcoholic fatty liver disease (NAFLD). Its prevalence has increased worldwide, and healthcare systems will face major challenges in addressing this problem. The aim of this work was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on insulin resistance (IR) and obesity associated with MS in Wistar rats. The experimental design consisted of three groups of sucrose-induced MS rats: the MS group that consumed sucrose (MS-Suc; n=5), the MS group that ingested sucrose and HBOT (MS-Suc-HBOT; n=5), the MS group that did not consume sucrose and that received HBOT (MS-HBOT; n=5) and the control group. The rats received HBOT for 20 d at 2.4 atmospheres absolute (ATA) for 60 min. Subsequently, the rats were euthanized, and body fat weight, serum biochemical parameters and microscopic analysis of adipose tissue were determined. Rats with hyperoxia had decreased body weight, adipose tissue hypertrophy, and abdominal and epididymal fat. Likewise, markers of insulin resistance (glucose, insulin and HOMA-IR), biochemical parameters of dyslipidemia (cholesterol and triglycerides) and nonalcoholic fatty liver (AST and ALT) decreased; in contrast, compared to the control group, HBOT increased the 1/HOMA-IR, HOMA-ßCell and McAuley indexes, which were related to the improvement in insulin sensitivity (p<0.05; p<0.01). HBOT showed beneficial effects in the treatment of IR and obesity associated with sucrose-induced metabolic syndrome in Wistar rats.

Reparación de aneurisma de aorta torácica con compromiso de vasos del cuello en paciente con sífilis terciaria. Reporte de caso / Thoracic aortic aneurysm repair involving neck vessels in a patient with tertiary syphilis. Case report

RESUMEN La dilación aneurismática de la aorta es una patología con una prevalencia importante entre las afecciones que aquejan a la misma (dependiendo de la zona que compromete) sea aorta torácica o abdominal presenta una mortalidad variable que exige distintas y específicas formas de reparación acorde a la factibilidad técnica y la fragilidad del paciente. La angiografía por tomografía computada o por resonancia magnética son los exámenes de elección para el diagnóstico diferencial de las distintas patologías de la aorta, aportando detalles estructurales para trazar estrategias en relación a técnicas a emplear para su abordaje o reparación. Entre las múltiples opciones terapéuticas para las dilataciones aneurismáticas que comprometen a la aorta torácica, la reparación endovascular de los aneurismas se han convertido en una opción terapéutica muy viable para proporcionar una menor comorbilidad frente a la reparación quirúrgica a cielo abierto, aun en situaciones muy complejas en donde pudieran coexistir un compromiso de ramas aórticas importantes, en estos casos la reparación endovascular de los aneurismas continua siendo de elección al poder ser complementada con una revascularización quirúrgica mínima en forma previa o concomitante, constituyéndose así en una técnica híbrida eficaz y eficiente. El actual trabajo presenta a un paciente con el diagnóstico de sífilis terciaria en quien se evidencia un compromiso importante de la aorta torácica, consistente en una dilatación aneurismática en su porción descendente que comprime extrínsecamente el nacimiento de las arterias: carótida primitiva y subclavia izquierda. Se realizó en un primer tiempo un puente carótido-carotídeo y en un segundo tiempo el tratamiento endovascular consistente en el implante de una endoprótesis por vía femoral hasta la lesión en la aorta torácica, los mismos sin compromiso de la circulación de los vasos del cuello preservando la indemnidad de la circulación cerebral y lográndose una exclusión exitosa del aneurisma torácico con la endoprótesis.

ABSTRACT The aneurysmal dilation of the aorta is a pathology with a significant prevalence among the conditions that afflict it, depending on the area involved, whether thoracic or abdominal aorta has a variable mortality that requires different and specific forms of repair according to the technical feasibility and fragility of the patient. Computed tomography angiography or magnetic resonance angiography are the tests of choice for the differential diagnosis of the different pathologies of the aorta, providing structural details to design strategies in relation to techniques to be used for its approach or repair. Among the multiple therapeutic options for aneurysmal dilatations involving the thoracic aorta, endovascular repair of aneurysms have become a very viable therapeutic option by providing less comorbidity compared to open surgical repair, even in very complex situations where important aortic branches may coexist, in these cases endovascular repair of aneurysms continues to be of choice as it can be complemented with minimal surgical revascularization either previously or concomitantly, thus constituting an effective and efficient hybrid technique. This work presents a patient with the diagnosis of tertiary syphilis in whom a significant compromise of the thoracic aorta is evidenced, consisting of an aneurysmal dilatation in its descending portion that extrinsically compresses the origin of the arteries: primitive carotid and left subclavian. A carotid:carotid bridge was performed firstly and in the femoral route until the lesion in the thoracic aorta, the same without compromising the circulation of the vessels of the neck preserving the indemnity of the cerebral circulation and achieving a successful exclusion of the thoracic aneurysm with the endoprosthesis.

Ablación septal con alcohol como tratamiento en la miocardiopatía hipertrófica obstructiva. Reporte de caso / Septal alcohol ablation as a treatment for hypertrophic obstructive cardiomyopathy. Case Report

RESUMEN La miocardiopatía hipertrófica obstructiva, es una patología de orden genético, cuyo evento más grave es la muerte súbita. El diagnóstico se basa en los hallazgos imagenológicos, constatándose un ventrículo izquierdo hipertrófico no dilatado, en ausencia de otras patologías que puedan explicar dichas alteraciones. El tratamiento médico tiene como objetivo mejorar la discapacidad funcional y el llenado diastólico, aquellos pacientes que continúan sintomáticos pese al tratamiento farmacológico, con obstrucción del tracto de salida del ventrículo izquierdo significativo, la miomectomía septal es de elección, no obstante, la ablación septal con alcohol es una alternativa a la cirugía. Se presenta una paciente de 39 años con síncope e insuficiencia cardíaca, con diagnóstico confirmado por imágenes de miocardiopatía hipertrófica asimétrica obstructiva, en quien persisten los síntomas a pesar del tratamiento médico, por lo que se realizó la ablación septal con alcohol, obteniendo resultados satisfactorios. La miocardiopatía hipertrófica obstructiva ha sido considerada como una patología poco frecuente, no obstante, en la actualidad es cada vez más diagnosticada, gracias al mayor conocimiento de su expresión fenotípica. La ablación septal con alcohol ha demostrado ser una opción segura y eficaz en nuestro medio, constituyendo una alternativa razonable de tratamiento alternativo a la cirugía, en pacientes seleccionados.

ABSTRACT Hypertrophic cardiomyopathy is a genetic disease, the most serious event of which is sudden death. Diagnosis is based on imaging findings, noting a hypertrophic undilated left ventricle, in the absence of other pathologies that may explain these alterations. The objective of the medical treatment is to improve functional disability and diastolic filling. In those patients who continue to be symptomatic despite drug treatment, with significant left ventricular outflow tract obstruction, septal myomectomy is recommended; however, septal alcohol ablation is an alternative to surgery. We present a 39-year-old patient with syncope and heart failure, with an image-confirmed diagnosis of hypertrophic obstructive cardiomyopathy, in whom symptoms persisted despite medical treatment, for which septal alcohol ablation was performed, obtaining satisfactory results. Hypertrophic obstructive cardiomyopathy has been considered a rare pathology, however, it is currently being diagnosed more and more, thanks to the greater knowledge of its phenotypic expression. Septal alcohol ablation has proven to be a safe and effective option in our setting, constituting a reasonable alternative treatment to surgery in selected patients.

Active and passive responses to catnip (Nepeta cataria) are affected by age, sex and early gonadectomy in male and female cats.

Catnip (Nepeta cataria) is a popular plant among cat owners because in about 60% of felids elicits active behaviors such as rolling over, grooming, motor activity and vocalizations. Herein, we assessed the display of active but also passive responses, such as time in sphinx-like position, and consequently hypothesized that 100% of cats respond to catnip. Accordingly, sixty domestic cats of different age (infant, juvenile, adults), sex (males, females) and gonadal status (early gonadectomized, gonadally intact) were placed in a cylindrical chamber (1.20×1.40m) during 5min and then exposed to 500mg of dehydrated catnip for another 5min. Behaviors were videorecorded and scored. Results indicated that about 20% of the cats (adults and juvenile only) displayed active behaviors (i.e. rolling over), whereas 80% displayed passive responses at any age (sphinx-like position, decreased frequency in vocalizations, and decreased motor activity). These results suggest that all cats respond to catnip but they express it actively, passively or with a combination of both types of responses, which mainly depends on age and sex, and early gonadectomy to a much less extent. We discuss the possible implications of brain maturation on this dichotomy and speculate on the role of opioidergic system on the catnip responses.

Macrophyte Communities of Andean Rivers: Composition and Relation with Environmental Factors / Comunidades de macrófitas en ríos andinos: composición y relación con factores ambientales

RESUMEN Los pequeños ríos de los Andes tropicales se han estudiado escasamente y poco se conoce sobre la composición, diversidad y estructura de sus comunidades de macrófitas. En esta investigación se estudiaron las comunidades de plantas acuáticas de 18 pequeños ríos andinos pertenecientes a las cuencas de los ríos La Vieja (Quindío) y Otún (Risaralda) en la ecorregión cafetera colombiana, una de las más afectadas por actividades antrópicas en el país. Se buscó evaluar el efecto del uso del suelo sobre la estructura de las comunidades de macrófitas. Para ello se seleccionaron ríos que nacen y discurren exclusivamente en cada uno de los usos del suelo dominantes en cada cuenca. El muestreo se realizó en dos épocas climáticas distintas del año 2006. La vegetación acuática encontrada en las dos cuencas (54 especies, pertenecientes a 25 familias) presentó riqueza y abundancia menores que las reportadas en otros sistemas acuáticos tropicales y estuvo dominada por especies con alta capacidad de adaptación a ambientes cambiantes o alterados. Se encontró que variables ambientales de los ríos asociadas con el tipo de uso del suelo, como la temperatura, la conductividad y el tipo de sustrato, fueron las que principalmente explicaron la estructura de las comunidades de macrófitas. Los ríos de zonas ganaderas, con dominancia de sustrato fino y valores más altos de temperatura y conductividad, presentaron mayor riqueza y abundancia de especies que los ríos de zonas con uso forestal, caracterizados por una alta cobertura arbórea del cauce, menor temperatura, baja concentración de nutrientes y predominancia de sustrato rocoso.

ABSTRACT Small streams of tropical Andes have been poorly studied. Therefore, there is little information about the structure, dynamics and function of their macrophyte communities. In this research, aquatic plant communities of 18 Andean streams of La Vieja (Quindío) and Otún (Risaralda) river basins were studied; those are some of the basins most affected by anthropic activities in the country. Streams were selected according to their association with the main land's uses of the region in both basins. The aim of the study was to evaluate the effect of land use on the structure of macrophyte communities. Streams running exclusively through each land use were selected. Sampling was done in two different climatic seasons in 2006. Vegetation found (54 species belonging to 25 families) was dominated by species with high capability of adaptation to changing and disturbed environments. Richness and abundance of macrophytes were lower than those reported in other tropical aquatic systems. Variables associated with land use, such as temperature, conductivity and type of substrate of the streams mainly explained the structure of the macrophyte communities: streams running on meat-cattle areas -with higher temperatures, conductivity and dominance of sandy-slimy substrates- had higher macrophyte species richness and abundance than streams of protected-forest areas, with higher coverage of riparian vegetation, lower temperatures and conductivity and rocky substrates.

Seroepidemiology of Infection with Neospora Caninum, Leptospira, and Bovine Herpesvirus Type 1 in Water Buffaloes (Bubalus Bubalis) in Veracruz, Mexico.

We aimed to determine the seroprevalence of infection with Neospora caninum, Leptospira, and bovine herpesvirus type 1 and risk factors associated with these infections in water buffaloes in Veracruz State, Mexico. Through a cross-sectional study, 144 water buffaloes (Bubalus bubalis) raised in 5 ranches of Veracruz were examined for anti-N. caninum and anti-bovine herpesvirus type 1 antibodies by enzyme immunoassays, and anti-Leptospira interrogans antibodies by microscopic agglutination test. Of the 144 buffaloes studied, 35 (24.3%) were positive for N. caninum, 50 (34.7%) for Leptospira, and 83 (57.6%) for bovine herpes virus. The frequencies of leptospiral serovars in buffaloes were as follows: 18.7% for Muenchen (n = 27), 10.4% for Hardjo LT (n = 15), 9.0% for Pyrogenes (n = 13), and 4.8% for Icterohaemorrhagiae (n = 7). Seropositive buffaloes were found in all 5 ranches studied. Logistic regression showed that cohabitation of buffaloes with cows was associated with infection with Leptospira (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.04-4.5; P = 0.03) and bovine herpesvirus (OR, 12.0; 95% CI, 4.0-36.2; P < 0.01). This is the first study that provides serological evidence of N. caninum, Leptospira, and bovine herpesvirus type 1 infections in water buffaloes in Mexico. Our findings could be used to enhance preventive measures against these infections.

Human case of West Nile neuroinvasive disease in Portugal, 2015.

A case of West Nile virus (WNV) infection was reported in the Algarve region, Portugal, in the first week of September 2015. WNV is known to circulate in Portugal, with occasional reports in horses and birds (2004 to 2011) and very sporadically human cases (in 2004 and in 2010). Here we present the clinical and laboratory aspects related to the first human case of West Nile neuroinvasive disease reported in Portugal.

[Toscana virus in the Portuguese population: serosurvey and clinical cases]. / Vírus Toscana na população Portuguesa: vigilância sero-epidemiológica e casos clínicos.

Toscana virus (Phlebovirus genus, Bunyaviridae family) is a neurotropic virus which circulates in the Mediterranean Basin. Although Portugal has been the second country where its presence was reported, the existence of this virus in our country has been referred only sporadically, and there is a lack of knowledge regarding the prevalence of antibodies in the population. Thus, the objective of this study was to analyse the prevalence of antibodies anti-Toscana virus in the human population in our country. Sero-epidemiological investigations were performed with indirect immunofluorescence assay (IFA) and enzyme linked immunosorbent assay (ELISA) tests. The study population consisted of a control population (blood donors, n=150), a population considered at risk (n=236) and a population of individuals with symptoms and laboratory diagnostic request for vector-borne viruses. The latter population was divided into two groups: those individuals with neurological symptoms (n=165) and those without neurological symptoms (n=373). We tested sera from a total of 924 individuals. The seroprevalence of IgG antibodies in the control population was 2%. In the population considered at risk, the prevalence was 3.4%. In the population with central nervous system disease, we detected a seroprevalence of 4.2%. For the same type of antibodies and in subjects without central nervous system disease, the prevalence was 1.3%. Five cases of recent infection (3%) were detected in the population with neurological signs. Those infections have been acquired in the districts of Faro, Coimbra, Aveiro and Lisbon. The associated clinical diagnoses were meningitis, meningoencephalitis and rash. The observed seroprevalences were, in general, lower than reported in other endemic countries. Only 5 of the 29 sera which gave positive results by IFA and ELISA were confirmed by plaque reduction neutralization tests with the Italian strain ISS.Phl.3. This can indicate the presence of more than one Toscana virus serotype circulating in Portugal and emphasizes the need for more research about this etiological agent in our country.

Boutonneuse fever and climate variability.

Researchers have long appreciated the role of climate in vector-borne diseases, including the resurgence of boutonneuse fever (BF). Portugal usually is classified as having temperate Mediterranean climate. In this new century, in analyzing the data from the Meteorology Institute, this pattern has changed and an accentuated variability in climate is being observed. BF (febre escaro nodular) is endemic and high season is from late spring and summer. The brown dog tick Rhipicephalus sanguineus. is the vector and reservoir of Rickettsia conorii complex strains: R. conorii Malish and Israeli spotted fever strain. To assess the influence of climate change in BF seasonality our aim was to compare the human sera samples received at CEVDI-INSA for laboratory diagnosis of MSF for 5 months per year from October to February, ("off-season") from 2000 to 2005. Of 1,299 sera samples in persons with suspected clinical diagnosis of MSF, 45 (3.4%) were considered positive cases and the number of positive cases has doubled in the last 2 years. BF epidemiology clearly appears to be associated with climate change, especially with low precipitation values. Physicians should be aware of increasing off-season BF cases.