Repositório RCAAP

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OBJECTIVE: To evaluate cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease using dynamic electrocardiography. METHODS: Twenty pregnant women with Chagas' disease without apparent heart disease aged 19 to 42 years (26.96 ± 3.6) and a control group of 20 non-chagasic pregnant patients aged 16 to 34 years (22.5 ± 4.8). The patients were submitted to passive hemagglutination and indirect immunofluorescence for the detection of Trypanosoma cruzi evaluation, and electrocardiography, echocardiography and 24-h dynamic electrocardiography. RESULTS: Supraventricular premature depolarizations were observed in 18 (90%) patients and ventricular premature depolarization in 11 (55%) patients of both groups during pregnancy. After delivery, supraventricular premature depolarizations were present in 13 (60%) chagasic patients and in 16 (89.4%) control patients (P<=0.05). Ventricular premature depolarization were observed in 9 (45%) chagasic patients and 11 (57.8%) control patients. CONCLUSION: The prevalence of ventricular premature depolarization was similar for the chagasic and control groups during and after pregnancy. The incidence of supraventricular premature depolarizations was similar in the two groups during pregnancy, while after delivery a predominance was observed in the control group compared to the chagasic group.

OBJECTIVE: To assess, in myocardium specimens obtained from necropsies, the correlation between the concentration of hydroxyproline, measured with the photocolorimetric method, and the intensity of fibrosis, determined with the morphometric method. METHODS: Left ventricle myocardium samples were obtained from 45 patients who had undergone necropsy, some of them with a variety of cardiopathies and others without any heart disease. The concentrations of hydroxyproline were determined with the photocolorimetric method. In the histologic sections from each heart, the myocardial fibrosis was quantified by using a light microscope with an integrating ocular lens. RESULTS: A median of, respectively, 4.5 and 4.3 mug of hydroxyproline/mg of dry weight was found in fixed and nonfixed left ventricle myocardium fragments. A positive correlation occurred between the hydroxyproline concentrations and the intensity of fibrosis, both in the fixed (Sr=+0.25; p=0.099) and in the nonfixed (Sr=+0.32; p=0.03) specimens. CONCLUSION: The biochemical methodology was proven to be adequate, and manual morphometry was shown to have limitations that may interfere with the statistical significance of correlations for the estimate of fibrosis intensity in the human myocardium.

OBJECTIVE: To verify the possible role of adventitial inflammation in atherosclerotic plaque vulnerability and coronary artery remodelling. METHODS: We compared the mean numbers of lymphocytes in the adventitia and in the plaque of ruptured thrombosed and stable equi-stenotic coronary segments of 34 patients who died due to acute myocardial infarction. We also analysed adventitial microvessels, adventitial fibrosis and the external elastic membrane. RESULTS: In the adventitia, the numbers of lymphocytes and microvessels/mm² were 69.5±88.3 and 60.9± 32.1 in culprit lesions and 16.4 ± 21.1 and 44.3±16.1 in stable lesions (p<0.05); within the plaques, the mean number of lymphocytes was 24±40.8 in culprit lesions and 10.9±13.2 in stable ones (p=0.17). The mean percent area of adventitial fibrosis/cross-sectional area of the vessel was significantly lower in unstable plaques (p<0.001). The confocal images showed holes in the external elastic membrane. CONCLUSION: Unstable plaques exhibit chronic pan-arteritis, accompanied by enlargement, medial thinning, and less fibrosis than in stable lesions, which is compatible with vessel aneurysm. Adventitial inflammation may contribute significantly to atheroma instability.

OBJECTIVE: To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. METHODS: We retrospectively analyzed the in-hospital and late evolution of 189 patients with multivessel coronary disease, who underwent percutaneous coronary stent placement. These patients were divided into 2 groups as follows: group I (GI) - 59 patients with involvement of the proximal segment of the anterior descending coronary artery; and group II (GII) - 130 patients without involvement of the proximal segment of the anterior descending coronary artery. RESULTS: No significant difference was observed in the success rate of the procedure (91.5% versus 97.6%, p=0.86), nor in the occurrence of major adverse cardiac events (5.1% versus 1.5%, p=0.38), nor in the occurrence of major vascular complications (1.7% versus 0%, p=0.69) in the in-hospital phase. In the late follow-up, the incidence of major adverse cardiac events (15.4% versus 13.7%, p=0.73) and the need for new revascularization (13.5% versus 10.3%, p=0.71) were similar for both groups. CONCLUSION: The in-hospital and late evolution of patients with multivessel coronary disease with and without involvement of the proximal segment of the anterior descending coronary artery treated with coronary stent placement did not differ. This suggests that this revascularization method is an effective procedure and a valuable option for treating these types of patients.

OBJECTIVE: Physical exercise helps to prevent cardiovascular disorders. Campaigns promoting exercise have taken many people to the parks of our city. The most appropriate exercise for preventing cardiovascular disorders is the aerobic modality; inappropriate exercise acutely increases cardiovascular risk, especially in individuals at higher risk. Therefore, assessing the cardiovascular risk of these individuals and their physical activities is of practical value. METHODS: In the Parque Fernando Costa, we carried out the project "Exercício e Coração" (Exercise and Heart) involving 226 individuals. Assessment of the cardiovascular risk and of the physical activity practiced by the individuals exercising at that park was performed with a questionnaire and measurement of the following parameters: blood pressure, weight, height, and waist/hip ratio. The individuals were lectured on the benefits provided by exercise and how to correctly exercise. Each participant received a customized exercise prescription. RESULTS: In regard to risk, 43% of the individuals had health problems and 7% of the healthy individuals had symptoms that could be attributed to heart disorders. High blood pressure was observed in a large amount of the population. In regard to the adequacy of the physical activity, the individuals exercised properly. The project was well accepted, because the participants not only appreciated the initiative, but also reported altering their exercise habits after taking part in the project. CONCLUSION: Data obtained in the current study point to the need to be more careful in assessing the health of individuals who exercise at parks, suggesting that city parks should have a sector designated for assessing and guiding physical activity.

OBJECTIVE: Evaluation of the long-term clinical results of the Fontan operation in patients with tricuspid atresia. METHODS: A retrospective analysis was made at the Instituto de Cardiologia do Rio Grande do Sul (Institute of Cardiology of Rio Grande do Sul), from August 1980 through January 2000, of 25 patients with a long-term follow-up, out of a series of 36 patients who underwent the Fontan operation or one of its variants due to tricuspid atresia. Their mean age at surgery was 5.4±3.1 years, and their mean weight was 15.8±6.1 kg, the majority of them (63.9%) being males. Four patients underwent the classical Fontan operation, 12 the Kreutzer variant, 6 the Björk variant, 9 total cavopulmonary shunt with a fenestrated tube, and 5 total cavopulmonary shunt with a nonfenestrated tube. RESULTS: The patients were followed-up on an outpatient basis, with a mean long-term survival time of 5.5±4.2 years (50 days to 17.8 years) and a late mortality rate of 8%. Arterial saturation increased from 77.2±18.8% in the preoperative period to 91±6.7% upon the last outpatient visit (p>0.05). At the final check, most (67%) patients were asymptomatic and 87% could tolerate exercise. Ten (40%) patients experienced some kind of complication during the long-term follow-up, such as cardiac arrhythmia, cyanosis, protein-losing enteropathy, neurological events, right heart failure, intolerance to exercise and reoperation. CONCLUSION: The results indicate that, once the immediate postoperative period is over, during which the adaptations to the new circulatory physiology occur, the evolution of patients with tricuspid atresia who underwent the Fontan operation is satisfactory, in spite of a low, yet significant, morbidity.

OBJECTVE: To objectively and critically assess body mass index and to propose alternatives for relating body weight and height that are evidence-based and that eliminate or reduce the limitations of the body mass index. METHODS: To analyze the relations involving weight and height, we used 2 databases as follows: 1) children and adolescents from Brazil, the United States, and Switzerland; and 2) 538 university students. We performed mathematical simulations with height data ranging from 115 to 190 cm and weight data ranging from 25 to 105 kg. We selected 3 methods to analyze the relation of weight and height as follows: body mass index - weight (kg)/height (m²); reciprocal of the ponderal index - height (cm)/weight1/3 (kg); and ectomorphy. Using the normal range from 20 to 25 kg/m² for the body mass index in the reference height of 170 cm, we identified the corresponding ranges of 41 to 44 cm/kg1/3 for the reciprocal of the ponderal index, and of 1.45 to 3.60 for ectomorphy. RESULTS: The mathematical simulations showed a strong association among the 3 methods with an absolute concordance to a height of 170 cm, but with a tendency towards discrepancy in the normal ranges, which had already been observed for the heights of 165 and 175 cm. This made the direct convertibility between the indices unfeasible. The reciprocal of the ponderal index and ectomorphy with their cut points comprised a larger age range in children and adolescents and a wider and more central range in the university students, both for the reported (current) and desired weights. CONCLUSION: The reciprocal of the ponderal index and ectomorphy are stronger and are more mathematically logical than body mass index; in addition, they may be applied with the same cut points for normal from the age of 5 ½ years on.

Congenital supravalvular mitral stenosis is a rare malformation characterized by the presence of a shelf-like fibrous membrane, with 1 or 2 small orifices, covering and obstructing the mitral valve. The membrane is positioned closely to the mitral valve (and sometimes it is attached to it); therefore, a preoperative diagnosis is inevitably difficult, even with the use of biplane echocardiography. Two patients with supravalvular mitral stenosis aged 3 years and 3 months are described. In 1 patient, a preoperative diagnosis was made, and both successfully underwent correction.

Chloroquine has been widely used in rheumatological treatment, but potential severe side effects require careful follow-up. Cardiac damage is not a common consequence, but its clinical relevance has not yet been described. We report the case of a 58-year-old woman with rheumatoid arthritis, in whom chronic chloroquine use resulted in major irreversible cardiac damage. She presented with syncopal episodes due to complete atrioventricular block confirmed by electrophysiological study whose changes were concluded to be irreversible and a permanent pacemaker was indicated. Endomyocardial biopsy was also performed to search for histopathological and ultrastructural cardiac damage. We also reviewed the 22 cases of chloroquine-induced cardiopathy described to date as well as its pathophysiology.

OBJECTIVE - To evaluate the Coronary Flow Reserve in the Coronary Sinus through transesophageal Doppler echocardiography in normal subjects. METHODS - We obtained technically adequate flow samples for analysis in 10 healthy volunteers (37±8 years, 5 men) with no history of heart or systemic disease and with mean left ventricular mass index by transthoracic echocardiography of 87±18 g/m². Coronary sinus flow velocity was recorded within the coronary sinus with the patient in a resting condition and during intravenous adenosine infusion at a dose of 140 µg/kg/min for 4 minutes. Recording of coronary sinus blood flow was possible in all cases with measurement of peak systolic, diastolic, and retrograde velocities (PSV, PDV, and PRV, cm/sec), mean systolic and diastolic velocities (MSV and MDV, cm/sec), and systolic and diastolic velocity time integral (VTI S and VTI D, cm/sec). RESULTS - The coronary flow reserve was calculated as the ratio between the blood flow in the basal state and the maximum measured hyperemic blood flow with adenosine infusion. Results are shown as mean and standard deviations. (CFR = PSV + PDV -- PRV/basal PSV): 1st min = 2.2±0.21; 2nd min = 3±0.3; 3rd min = 3.4±0.37; 4th min = 3.6 ± 0.33. CONCLUSION - Although coronary sinus flow had significantly increased in the first minute, higher velocities were seen at third and fourth minutes, indicating that these should be the best times to study coronary sinus flow with intravenous adenosine in continuous infusion.

OBJECTIVE - To assess the surgical results of endoventricular patch plasty repair in akinetic and dyskinetic left ventricular areas. METHODS - We studied 52 patients who had undergone endoventricular patch plasty repair associated with myocardial revascularization. The preoperative functional class distribution was as follows: class I in 1 (1.9%) patient; class II in 2 (3.8%) patients; class III in 23 (44.2%) patients; and class IV in 26 (50%) patients. RESULTS - The immediate mortality rate was 7.6% (4 patients). The clinical outcome of 44 patients followed up within a mean postoperative time of 29±25 months was as follows: class I in 33 (75%) patients; class II in 7 (15.9%) patients; class III in 2 (4.5%) patients; and class IV in 2 (4.5%) patients. Comparison between pre- and postoperative catheterization in 21 patients showed that the ejection fraction increased from 46.3% to 51.3% (p=0. 17); the left ventricular systolic volume decreased from 76.4 mL to 57.5 mL, (p=0.078); and the left ventricular diastolic volume decreased from 141.2 mL to 105.8 mL (p=0.0 73). These findings showed the tendency toward improvement, but with nonsignificant results. CONCLUSION - The technique proved to be effective, to have a low mortality rate, to cause significant clinical improvement, an increase in ejection fraction, and a reduction in left ventricular volumes.

OBJECTIVE - To assess hypertension control rates in a specialized university-affiliated medical department, the influence of sex, diabetes, and obesity on that control, and the strategies for the treatment of hypertension. METHODS - We carried out a cross-sectional study with 1,210 patients followed up for at least 6 months. Information was gathered from medical and nursing records and comprised the following data: sex, age, weight, height, abdominal and hip circumferences, blood pressure, and class and number of the antihypertensive drugs prescribed. To assess obesity, we used body mass index and waist/hip ratio. Blood pressure was considered under control when its levels were below 140/90 mmHg. RESULTS - The study consisted of 73% females and 27% males. Most females (31.7%) were 50 to 59 years of age, and most males (28.3%) were 60 to 69 years. The blood pressure control rate found was 20.9% for the 1,210 patients and 23.4% for the hypertensive diabetic patients (n=290). Despite the low control rates found, 70% of the patients used 1 or 2 antihypertensive medications. A high prevalence of obesity (38%) was observed, and females had a greater abdominal obesity index than males did (90% vs 82%, p<0.05). Patients with a greater body mass index had less control of blood pressure. CONCLUSION - The percentage of hypertensive patients with controlled blood pressure levels was low and was associated with a high prevalence of obesity. These data indicate the need for reviewing the strategies of global treatment for hypertension.

ABSTRACT Phosphorus (P) is one of the most difficult nutrients for plants to acquire because of its low content in the soil solution. Cassava (Manihot esculenta Crantz) has a thick and sparse absorbent root system; therefore, it is dependent on its association with arbuscular mycorrhizal fungi (AMF) for P acquisition from the soil. Thus, inoculation of cassava with AMF can improve the development of this root crop. This study evaluated the effects of soil disinfection (disinfected vs. natural) and the spore rates of Rhizophagus clarus inoculation (0, 50, 100 and 200 spores per plant) in greenhouse conditions on the initial growth, yield, P acquisition, and P use efficiency of cassava, as well as to evaluate the contribution of the native AMF to P acquisition from the soil. For cassava production in P-deficient soil, inoculation with Rhizophagus clarus significantly increased cassava growth, P uptake, and storage root yield only when the soil was disinfected. When the soil is not disinfected, native AMF contributes up to 86 % of the P taken up by cassava. However, high spore rates of Rhizophagus clarus in natural soil cause detrimental consequences for native AMF by reducing the colonization of the absorbent roots. Therefore, for cassava grown in natural soil under greenhouse conditions, a rate of 50 spores per plant of Rhizophagus clarus is sufficient to promote a 14.5 % increase in the yield of fresh storage roots. A management strategy that favors the native AMF multiplication in the soil is a potential strategy to improve P uptake and yield of cassava in P-deficient soils.

ABSTRACT The teacher’s formative process is developed by a critical reflective response to the paths of life, the profession, and its practices. The teacher’s formative process analysis should consider the process’s objectives (theoretical, practical, and emancipatory), and the dimensions that make up the teacher (person, practices, and profession). As a result, this study aims to introduce the elements that outline the categories stemming from the relationship matrix between the objectives and the dimensions, and use them to analyze a formative process in Soil Education assessed using Formative (Auto)biographical Narratives. The research subjects were 61 teachers active in the Public Education System in the cities of Campo Largo and Curitiba, state of Paraná, Brazil, who took part in the formative process known as Soil Program for Teachers within the Soil at School Project from the Federal University of Paraná, held in 2018. Data collection was performed through written narratives given in response to three groups of open-ended questions, which aimed to encourage teachers to think deep. We performed the Content Analysis in the narratives while differentiating expressions associated with the elements in each category, and, consequently, the frequency of the expressions was recorded. As for the Theoretical Objectives within the analysis of the Program, in which the teacher is the study object, we found that the teachers built and rebuilt knowledge and expertise about the soil while drawing on the relationship between the formative conceptual approaches and the recollection of their professional and personal experiences through the Narratives. Within the Practical Objectives, in which self-formation is analyzed, the Narrative influenced a critical and reflective perspective about the person, the practice, and the profession, while driving teachers to their self-formation and creating their professional identity. As for the analysis of the Emancipatory Objectives, which demonstrate the change of reality, the teacher’s transformation was seen in their change of attitude and practices, as well as in their intent to get involved with the school. We concluded that the elements proposed to outline the nine categories were effective to analyze the formative process in Soil Education, by taking into account, in an integral way, the Objectives of the analysis and the Dimensions that make up the teacher while in his/her formative process. We would also like to point out that the Narratives were an important instrument for continuous education in Soil Education.

ABSTRACT South America covers a vast area with diverse climates and landscapes, with high participation in the global production of food and fibers. It is crucial to understand the risks, vulnerabilities, and opportunities that climate change brings to this region. We analyzed the increasing tension between agribusiness models and smallholder models, the risks, opportunities, and main adaptation measures that can be adopted in the agricultural sector of the South American countries facing climate change. This study is a review of adaptation actions in the agricultural sector for the different regions of South America. Vulnerability exists, firstly, because rural populations are exposed in many of the countries, often with high rates of poverty and low rates of socioeconomic development. Concerning the adaptation measures already taken, there are numerous cases of interventions by national, provincial, and municipal states for planned measures. Farmers are very active in adopting autonomous measures. Many adaptation measures show co-benefits with climate change mitigation or the prevention of land degradation and desertification, but other adaptation measures do not go in this direction. In the forthcoming times, the region’s rich natural resources are going to be subjected to strong market pressures and climate change threats. It is key to generate strategies for the care of these resources for their permanence for future generations.

ABSTRACT Technological advances have demonstrated the need for intellectual property rights, and patent granting is one of its most widespread forms. This includes the protection of inoculant formulations for agriculture, in which Brazil is a leader. This study aimed to analyze the number of patents for formulations of biological inoculants for agriculture in Brazil and the microorganisms used. An advanced search was performed in the National Institute of Industrial Property database, using the title and abstract fields. The indexers included inoculant, bioinoculant, endophyte, endophytic, fungus, bacteria, Rhizobium, Azospirillum and Gluconacetobacter. The inoculant formulation patents were grouped by the number of files per decade, number of patents per holder(s), characterization of granted patents, international patent classification, and main genera of fungi and bacteria used in inoculant formulations per decade. The number of patents filed for inoculant formulations in the last four decades increased from 7 in the first decade (1981–1990) to 37 from 2011–2020. In the first decades of study, the use of Rhizobium in inoculants stood out, followed by other genera of fungi and bacteria. However, most inoculant patent applications are still denied, considering data from 1981 to 2020. This may be partially due to the low reproducibility of inoculant results, as microorganism activity is highly affected by climate, soil, plant cultivars and crop management. The percentage of acceptance equal to or higher than 50 % in the number of applied patents for using endophytic microorganisms may be because this group of microorganisms acts mainly inside plants and is thus more protected from the influence of climate and some soil and management factors. The growing number of patent applications in the last 40 years demonstrates the business and technological development interest in inoculants in Brazil.

ABSTRACT The nature of the soil is shaped by the presence of roots and the soil microbiota. Bacteria, archaea and fungi profoundly alter plant growth and, in turn, depend on root exudation of carbon-rich and energy-yielding compounds. The microbial communities act as facilitators of plant processes by secreting plant growth regulators, solubilizing minerals, providing N for plant growth, altering plant immune responses and competing with plant pathogens. Characterizing and engineering the processes driven by the multiple microbial taxa that make up a “plant growth-promoting soil” represents an ecologically friendly solution that may lead to unprecedented increases in agronomic efficiency. This review outlines the characteristics of soil-plant-microbiota interactions that would lead to enhanced plant growth and the importance of characterizing the soil microbial communities with metabarcoding and shotgun metagenomics allied to machine learning analytics. Although much is still needed to be understood about soil microbial ecology, it is possible to choose the best soil management practices to take advantage of beneficial microbial activity with our current knowledge.

ABSTRACT Conventional tillage and intensive machinery traffic are the major causes of physical soil degradation in sugarcane fields. This study evaluates the impact of adopting conservation management practices during sugarcane planting on soil physical properties and stalk yield of sugarcane in the municipality of Ibitinga, state of São Paulo, Brazil. The experimental design (split-block) included four cover crops and three soil tillage systems, with three repetitions. For comparison purposes, a control treatment was also included (without cover crop and under conventional tillage). Sampling for soil physical analysis was performed in three layers that coincide with soil horizons A (0.00-0.20 m), AB (0.20-0.30 m), and Bt (0.30-0.70 m), during cane-plant and first sugarcane ratoon cycles. The results showed that cultivation of sunn hemp associated with deep subsoiling induced high stalk yield of sugarcane in both production cycles, cane plant (116 Mg ha -1 ) and first ratoon (114 Mg ha -1 ), with a net gain of 11 and 9 Mg ha -1 compared with the control treatment, respectively. However, these results were not sufficient to induce significant differences in sugarcane yield. Nonetheless, the use of sunn hemp and millet, associated with subsoiling (at 0.40 or 0.70 m depth) during sugarcane planting, are promising management strategies to sustain better soil’s physical quality when compared to traditional management, conventional soil tillage without cover crops and/or cash crop, as peanuts, that increase the risks of soil compaction and physical degradation.