Explore the vast range of titles available.

Chronic Chagas cardiomyopathy (CCC) is a major public health issue in endemic areas of Latin America, representing one of the leading causes of heart failure and sudden death. The hallmark histopathological lesion of CCC is low-intensity, persistent myocarditis associated with cytokine production. Long-term use of pentoxifylline (PTX) may serve as an effective pharmacological intervention for immunomodulation, reducing inflammation and, consequently, diminishing myocardial perfusion abnormalities and thus preserving left ventricular systolic function. We investigated 38 patients with CCC, randomly assigned to PTX (n = 19), 400 mg 3 times a day for 6 months, or placebo (PLC) (n = 19). At baseline and post-treatment, patients underwent cytokine measurements, quality of life assessment, 2D echocardiography, and myocardial perfusion scintigraphy. After treatment, TNF-α levels in the PTX group decreased from 10.14 ± 5.5 to 8.32 ± 3.6 and from 9.12 ± 4.4 to 10.32 ± 8.5 in the PLC group (p = 0.06). Additionally, IL-10 levels increased from 2.74 ± 0.7 to 5.61 ± 8.6 in the PTX group, while in the placebo group, they decreased from 6.96 ± 11.8 to 5.50 ± 8.3 (p = 0.09); neither of these findings reached statistical significance. Also, no significant changes were observed in the echocardiographic variables after treatment. LVEF showed a modest change from 46.2% ± 7.9 to 47.4% ± 7.0 in the PTX group and from 48.2% ± 6.6 to 48.0% ± 6.9 in the PLC group (p = 0.37). No significant positive effects on myocardial perfusion were noted. However, the quality-of-life assessment documented a significant improvement of functional capacity in the PTX group. The results of this study suggest a potential positive effect of PTX in modulating the inflammatory profile of CCC patients. However, use of pentoxifylline in these patients did not attenuate the degree of ventricular dysfunction or reduce myocardial perfusion defects.

Parte-se do pressuposto de que o filósofo americano Bernard Suits é central para a filosofia do esporte, especialmente na literatura internacional. Sua extensa obra oferece uma teoria do Jogo original e ainda não explorada na Educação Física brasileira. Suits distingue o fenômeno Jogo (game) da experiência do jogar (play), além de propor uma definição analítica de Jogo que é aqui apresentada aos modos de um prelúdio de sua teoria. Discute-se que, do ponto de vista de uma filosofia analítica, avança-se na metafísica do Jogo, ou em uma efetiva filosofia do Jogo, quando mobilizamos a definição de Suits de jogar um Jogo (game-playing). Reconhecem-se ainda subsídios analíticos distintos da definição intencionalmente vaga de famílias de jogos da herança wittgensteiniana, influente nas concepções brasileiras. Acredita-se que tais recursos fornecem renovado material para os estudos do Jogo na filosofia do esporte e Educação Física brasileiras, nos domínios da metafísica, lógica, epistemologia e axiologia. 

Background Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous. We present data on physical signs and symptoms, cardiac and neurological assessments and genetic profile of patients enrolled in the Transthyretin Cardiac Amyloidosis Registry of the State of São Paulo, Brazil. Results Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Eleven different mutations were detected, the most common being Val50Met (47.5%) and V142Ile (39.2%). Overall, more than half of the patients presented cardiac involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p  < 0.001). The prevalence of the neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p  < 0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between ATTRv and ATTRwt groups. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients. Conclusions This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.

Neurohormonal benefits of Chronic Chagas’ Cardiomyopathy (CCC) remain controversial. This study aimed to assess therapeutic interventions on CCC evolution in T. cruzi -infected hamsters at pre and post-treatment (2 months with beta-blocker (CH + BB) or ACE inhibitor (CH + ACEI)). Echocardiography was performed through evolution and compared to histopathological myocardial analysis. At post-treatment, a significant reduction of LV global systolic function and segmental function was observed between the control group and all Chagas’ groups. Compared to the Control, a reduction in LV regional strain was observed in three LV segments, regardless of treatment. No differences were observed in apoptosis, myocardial fibrosis, and the number of inflammatory cells among the groups. In an experimental model of CCC, LV global and regional function is compromised, and the treatment with ACEi and BB did not change LV remodeling. Regional LV function was slightly better in animals treated with BB, and this difference was not observed in the CH + ACEi group.

BackgroundMyocardial perfusion defects (MPD) due to coronary microvascular dysfunction is frequent in chronic Chagas cardiomyopathy (CCC) and may be involved with development of myocardial damage. We investigated whether MPD precedes left ventricular systolic dysfunction and tested the hypothesis that prolonged use of dipyridamole (DIPY) could reduce MPD in an experimental model of CCC in hamsters.Methods and resultsWe investigated female hamsters 6-months after T. cruzi infection (baseline condition) and control animals, divided into T. cruzi-infected animals treated with DIPY (CH + DIPY) or placebo (CH + PLB); and uninfected animals treated with DIPY (CO + DIPY) or placebo (CO + PLB). The animals were submitted to echocardiogram and rest SPECT-Sestamibi-Tc99m myocardial perfusion scintigraphy. Next, the animals were treated with DIPY (4 mg/kg bid, intraperitoneal) or saline for 30 days, and reevaluated with the same imaging methods. At baseline, the CH + PLB and CH + DIPY groups showed larger areas of perfusion defect (13.2 ± 13.2% and 17.3 ± 13.2%, respectively) compared with CO + PLB and CO + DIPY (3.8 ± 2.2% e 3.5 ± 2.7%, respectively), P < .05. After treatment, we observed: reduction of perfusion defects only in the CH + DIPY group (17.3 ± 13.2% to 6.8 ± 7.6%, P = .001) and reduction of LVEF in CH + DIPY and CH + PLB groups (from 65.3 ± 9.0% to 53.6 ± 6.9% and from 69.3 ± 5.0% to 54.4 ± 8.6%, respectively, P < .001). Quantitative histology revealed greater extents of inflammation and interstitial fibrosis in both Chagas groups, compared with control group (P < .001), but no difference between Chagas groups (P > .05).ConclusionsThe prolonged use of DIPY in this experimental model of CCC has reduced the rest myocardial perfusion defects, supporting the notion that those areas correspond to viable hypoperfused myocardium.

Chagas disease (CD) has been changing from an endemic Latino-American disease to a condition found outside endemic regions, due to migratory movements. Although often subclinical, its acute phase can be lethal. This study aimed to assess survival during the acute phase of CD and its relationship with ventricular function in an experimental model. To this end, 30 Syrian hamsters were inoculated with Trypanosoma cruzi (IG) and other 15 animals received saline solution (CG). Groups were monitored daily and submitted to echocardiography in two moments: before the challenge and 15 days post-infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of the LV were measured. The IG was divided into groups of animals with and without clinical signs of disease. ANOVA for mixed models was used to compare ventricular function parameters. Survival analysis was studied using Kaplan-Meier curves and the log-rank test. The follow-up lasted 60 days. LVEF in IG was reduced through time (53.80 to 43.55%) compared to CG (57.86 to 59.73%) (p=0.002). There was also a reduction of GLS (-18.97% to -12.44%) in the IG compared to CG (p=0.012). Twelve animals from IG died compared to one animal from CG. Eleven out of the 12 animals from the IG group died before presenting with clinical signs of infection. Survival was reduced in the IG compared to CG over time (p=0.02). The reduced survival during the acute phase of this experimental model of Chagas disease was related to the significant reduction of LV function. The mortality rate in the IG was higher in the group presenting with clinical signs of infection.

Cardiac Amyloidosis (CA), specifically Transthyretin Amyloid Cardiomyopathy (ATTR-CM), is an under-recognized, progressive, and fatal disease. Comprehensive primary data describing awareness, attitudes, and barriers to treatment in Latin America (LATAM) are lacking, highlighting a gap between guidelines and real-world clinical practice. A cross-sectional, questionnaire-based observational study was conducted among 470 physicians actively involved in patient management across 8 LATAM countries (June-August 2023). The study assessed their awareness, attitudes, and barriers concerning ATTR-CM. Descriptive analysis was performed. Limited knowledge of ATTR-CM was observed. Awareness of its pathophysiology was reported by 50.2%. Patients consulted 4-5 physicians before receiving a confirmed diagnosis. Cardiologists managed most day-to-day cases (76.2%). Transthyretin genetic testing was available to only 26.4%. Local treatment protocols relied on international guidelines (87.4%), with Real-World Data considered important by 60.6%. Patient cost and access to tafamidis were frequently reported barriers. Follow-up commonly relied on echocardiography, NT-pro BNP, NYHA classification, and ECG/Holter ECG. Difficulties in ATTR-CM diagnosis and management in LATAM were influenced by varying knowledge levels, gaps in diagnostic algorithms, and significant access barriers. These factors contribute to delayed diagnosis and management. Enhanced, tailored training strategies and collaborative efforts are necessary to improve early diagnosis, effective treatment, and ultimately, patient outcomes in the region.

ABSTRACT Objective: To compare the distributions of measurements of the Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS), and Fatigue Pictogram tools, according to the New York Heart Association (NYHA) Functional Classification and left ventricular ejection fraction (LVEF). Method: Methodological, cross-sectional study with 118 patients with heart failure. Variance analysis, Pearson's correlation, and Fisher's exact tests were carried out, with a significance level of 0.05. Results: There was an increase in the DUFS and DEFS means with worsening of the NYHA-FC (p<0.001, for both tools). Correlations among the LVEF resulted in positive and weak magnitude for the DEFS (r=0.18; p=0.05) and for the DUFS (r=0.16; p=0.08). Just the item A on the Fatigue Pictogram had an association with the NYHA-FC (p<0.001) and the LVEF (p=0.03). Conclusion: Three tools detected worsening in fatigue levels according to the illness severity assessed by the NYHA-FC. RESUMO Objetivo: Comparar as distribuições das medidas dos instrumentos Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS) e Pictograma de Fadiga, segundo a Classe Funcional da New York Heart Association (CF-NYHA) e a Fração de Ejeção do Ventrículo Esquerdo (FEVE). Método: Estudo metodológico, transversal, com 118 pacientes com insuficiência cardíaca. Foram realizados os testes Análise de Variância, Correlação de Pearson e Exato de Fisher, com nível de significância de 0,05. Resultados: Houve aumento nas médias do DUFS e do DEFS com a piora da CF-NYHA (p<0,001, para ambos os instrumentos). As correlações entre a FEVE foram de positiva e fraca magnitude para o DEFS (r=0,18; p=0,05) e para o DUFS (r=0,16; p=0,08). Somente o item A do Pictograma de Fadiga teve associação com a CF-NYHA (p<0,001) e com a FEVE (p=0,03). Conclusão: Os três instrumentos detectaram piora nos níveis de fadiga, de acordo com a gravidade da doença avaliada pela CF-NYHA. RESUMEN Objetivo: Comparar las distribuciones de medidas de los instrumentos Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS) y Pictograma de Fatiga, según la Clase Funcional de la New York Heart Association (CF-NYHA), y la fracción de eyección del ventrículo izquierdo (FEVE). Método: Estudio metodológico, transversal, con 118 pacientes con insuficiencia cardíaca. Fueron realizados los tests Análisis de Varianza, Correlación de Pearson y Exacto de Fisher, nivel de significatividad de 0,05. Resultados: Hubo aumentos en los promedios del DUFS y del DEFS, empeorando la CF-NYHA (p<0,001 en ambos instrumentos). Las correlaciones entre FEVE fueron de magnitud positiva a débil para DEFS (r=0,18; p=0,05) y para DUFS (r=0,16; p=0,08). Solo el ítem A del Pictograma de Fatiga tuvo asociación con la CF-NYHA (p<0,001) y con la FEVE (p=0,03). Conclusión: Los tres instrumentos detectaron empeoramiento de niveles de fatiga de acuerdo con la enfermedad evaluada por la CF-NYHA.

To identify and describe the profile of potential transthyretin cardiac amyloidosis (ATTR-CM) cases in the Brazilian public health system (SUS), using a predictive machine learning (ML) model. This was a retrospective descriptive database study that aimed to estimate the frequency of potential ATTR-CM cases in the Brazilian public health system using a supervised ML model, from January 2015 to December 2021. To build the model, a list of ICD-10 codes and procedures potentially related with ATTR-CM was created based on literature review and validated by experts. From 2015 to 2021, the ML model classified 262 hereditary ATTR-CM (hATTR-CM) and 1,581 wild-type ATTR-CM (wtATTR-CM) potential cases. Overall, the median age of hATTR-CM and wtATTR-CM patients was 66.8 and 59.9 years, respectively. The ICD-10 codes most presented as hATTR-CM and wtATTR-CM were related to heart failure and arrythmias. Regarding the therapeutic itinerary, 13% and 5% of hATTR-CM and wtATTR-CM received treatment with tafamidis meglumine, respectively, while 0% and 29% of hATTR-CM and wtATTR-CM were referred to heart transplant. Our findings may be useful to support the development of health guidelines and policies to improve diagnosis, treatment, and to cover unmet medical needs of patients with ATTR-CM in Brazil.

Primary microvascular angina (PMA) is a common clinical condition associated to negative impact on quality of life (QOL) and reduced physical capacity. This study aimed at evaluating the effects of aerobic physical training (APT) on myocardial perfusion, physical capacity, and QOL in patients with PMA. We investigated 12 patients (53.8 ± 9.7 years old; 7 women) with PMA, characterized by angina, angiographycally normal coronary arteries, and reversible perfusion defects (RPDs) detected on 99mTc-sestamibi-SPECT myocardial perfusion scintigraphy (MPS). At baseline and after 4 month of APT, the patients underwent MPS, cardiopulmonary test, and QOL questionnaire. Stress-rest MPS images were visually analyzed by attributing semi-quantitative scores (0 = normal; 4 = absent uptake), using a 17-segment left ventricular model. Summed stress, rest, and difference scores (SDS) were calculated. In comparison to the baseline, in the post-training we observed a significant increase in peak-VO2 (19.4 ± 4.8 and 22.1 ± 6.2 mL·kg−1·minute−1, respectively, P = .01), reduction of SDS (10.1 ± 8.8 and 2.8 ± 4.9, P = .008), and improvement in QOL scores. Physical training in patients with PMA is associated with reduction of myocardial perfusion abnormalities, increasing of physical capacity, and improvement in QOL. The findings of this hypothesis-generating study suggest that APT can be a valid therapeutic option for patients with PMA.