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Obesity impacts the quality of life (HRQL). Studies about the effects of a possible interaction between gender and body mass are rare. The objective of the present paper is to estimate the biological interaction between gender and obesity on HRQL. This was a cross-sectional study based on data from CAMELIA study with population assisted by the Family Doctor Program of Niteroi visited between June 2006 and December 2007. HRQL was assessed by the SF-36. The exposure categories were: obese women, non-obese women, obese men and non-obese men, the reference category. Obese women showed higher percentages of low overall, physical and mental quality of life with the largest associations in the physical component. The excess risk due to interaction was statistically significant in physical dimension: RERI = 1.97 (0.40-3.52) and RERIa = 1,97 (0.40-1.7). Among the Brazilian population aged 20–64 years, obesity was independently associated with low HRQL. This association differed by gender, being significant for women. The possibility of the combined effect takes greater importance in the context of increasing incidence of obesity globally. Healthcare professionals in primary care settings should pay attention to gender differences in the impact of obesity on HRQL.

Background Planning strategies to prevent heart failure (HF) in developing countries require epidemiologic data in primary care. The purpose of this study was to estimate the prevalence of HF stages and their phenotypes, HF with preserved ejection fraction (HFPEF), and HF with reduced EF (HFREF) and to determine B-type natriuretic peptide (BNP) levels to identify HF in the adult population. Methods and Results This is a cross-sectional study including 633 individuals, aged ≥45 years, who were randomly selected and registered in a primary care program of a medium-sized city in Brazil. All participants were underwent clinical evaluations, BNP measurements, electrocardiograms, and tissue Doppler echocardiography in a single day. The participants were classified as stage 0 (healthy, 11.7%), stage A (risk factors, 36.6%), stage B (structural abnormalities, 42.7%), or stage C (symptomatic HF, 9.3%). Among patients with HF, 59% presented with HFPEF and 41% presented with HFREF. The mean BNP levels were 20 pg/mL−1 in stage 0, 20 pg/mL−1 in stage A, 24 pg/mL−1 in stage B, 93 pg/mL−1 in HFPEF, and 266 pg/mL−1 in HFREF. The cutoff BNP level with optimal sensitivity (92%) and specificity (91%) to identify HF was 42 pg/mL−1. Conclusion The present study demonstrated a high prevalence of individuals at risk for HF and the predominance of HFPEF in a primary care setting. The clinical examination, along with BNP and tissue Doppler echocardiography, may facilitate early detection of stages A and B HF and allow implementation of interventions aimed at preventing progression to symptomatic HF.

Smell has traditionally been considered a less important sense when compared to sight or hearing, but recent research has unraveled important features inherent to the sense of smell. Once considered just a chemical sensor for sampling the environment, data from animal models and human studies currently imply numerous and complex effects of smell on behavior, mood, and on the immune response. In this review we discuss a possible inter-relationship between olfactory impairment, autoimmunity and neurological/psychiatric symptoms in several diseases affecting the central nervous system (CNS) such as Parkinson, Alzheimer's disease, autism, schizophrenia, multiple sclerosis and neuropsychiatric lupus erythematosus. We suggest that common manifestations are not mere coincidences. Current data from animal models show that neuropsychiatric manifestations are intimately associated with smell impairment, and autoimmune dysregulation, via autoantibodies (anti-NMDAR, anti-ribosomal P) or other mechanisms. From clues of pathological manifestations, we propose a novel approach to the understanding of the interactions between the CNS, the smell and the immune system.

Guidelines from medical societies suggest recommendations for the appropriate request of tests. In 2009, the Brazilian Society of Cardiology (BSC) published new guidelines for transthoracic echocardiography (TTE) request.To evaluate the prevalence of Class III requests for TTE, as defined by the BSC Guidelines and analyze these requests profile comparing a public university hospital (PUH) with a private cardiology hospital (PCH).We prospectively evaluated 779 consecutive outpatient TTE requests: 391 from the PCH and 388 from the PUH between December 2009 and May 2010. The indications studied were classified accordingly to the BSC guidelines. Request distribution was compared by Chi-square test. Statistical significance was set at p0.05.Of the 779 requests, 61 (7.8%) were considered Class III. Of these 14 were from the public and 47 from the private hospital. The distribution of requests was statistically different between institutions (p0.001). Check-up in asymptomatic patients was the main inadequate indication, with 37 cases (33 in the private institution- 89.18%), followed by evaluation after angioplasty in 9 cases (8 in the private institution - 88.88%); ventricular function monitoring in patients with stable heart failure in 6 cases (4 in the public institution - 66.66%), post-bypass surgery in 5 cases (4 in the private institution- 80%), and evaluation of nonspecific electrocardiographic abnormalities in 4 cases (4 in the public institution - 100%).Asymptomatic patients' assessment was the main cause of inadequate TTE requests, which differs between institutions: routine check-up in the private and heart failure in the public hospital.

FUNDAMENTO: A associacao da ativacao autonomica, fracao de ejecao do ventriculo esquerdo (FEVE) e classe funcional da insuficiencia cardiaca e mal compreendida. Objetivo: Nosso objetivo foi correlacionar a gravidade dos sintomas com a atividade simpatica cardiaca, atraves do uso de iodo-123-metaiodobenzilguanidina (123I-MIBG); e com FEVE em pacientes com insuficiencia cardiaca (IC) sistolica sem tratamento previo com betabloqueador. METODOS: Trinta e um pacientes com IC sistolica, classe I a IV da New York Heart Association (NYHA), sem tratamento previo com betabloqueador, foram inscritos e submetidos a cintilografia com 123I-MIBG e ventriculografia radioisotopica para determinacao da FEVE. A relacao precoce e tardia coracao/mediastino (H/M) e a taxa de washout (WO) foram medidas. RESULTADOS: De acordo com a gravidade dos sintomas, os pacientes foram divididos em grupo A, com 13 pacientes em classe funcional NYHA I/II, e grupo B, com 18 pacientes em classe funcional NYHA III/ IV. Em comparacao com os pacientes do grupo B, o grupo A apresentou uma FEVE significativamente maior (25% ± 12% para o grupo B vs. 32% ± 7% no grupo A, p = 0,04). As relacoes precoces e tardias H/M do Grupo B foram menores do que as do grupo A (H/M precoce 1,49 ± 0,15 vs. 1,64 ± 0,14, p = 0,02; H/M tardia 1,39 ± 0,13 vs. 1,58 ± 0,16, p = 0,001, respectivamente). A taxa de WO foi significativamente maior no grupo B (36% ± 17% vs. 30% ± 12%, p = 0,04). A variavel que mostrou a melhor correlacao com a NYHA foi a relacao H/M tardia (r = -0,585, p = 0,001), ajustada para idade e sexo. CONCLUSAO: Esse estudo mostrou que o 123I-MIBG cardiaco se correlaciona melhor do que a fracao de ejecao com a gravidade dos sintomas em pacientes com insuficiencia cardiaca sistolica sem tratamento previo com beta-bloqueador.

Blacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications.The study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c.The study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment.We compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p0.20) as higher levels of HbA1c (p0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively.Those results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.

Recent revelations of immune alterations in Parkinson’s disease have led to the convergence that an autoimmune mechanism may play a role in the etiopathogenesis of this neurodegenerative disease. In the current study, 77 Parkinson’s disease patients and 77 matched healthy controls were analyzed for the presence of seven autoantibodies previously found to be associated with central nervous system manifestations namely: antineuronal-cells, anti-brain lysate, anti-dsDNA, anti-phosphatidylserine, anti-cardiolipin, anti-serotonin, and anti-melanocytes antibodies. Patients underwent systematic assessments of demographics, clinical, and biochemical manifestations. Three autoantibodies were found to be more prevalent among Parkinson’s disease patients (antineuronal cells10.3% vs. 1.3%, p = 0.017; anti-brain lysate 9.1% vs. 1.3%, p = 0.032; anti-dsDNA 10.3% vs. 2.6%, p = 0.049). Clinical manifestations of Parkinson’s disease, particularly dyskinesia and depression, were found to be associated with the presence of these autoantibodies.

Heart failure (HF) is an important public health concern in Brazil due to its high prevalence. Our objective was to study the performance of primary care physicians of the public health system in the management of heart failure in the city of Niterói, Rio de Janeiro state, comparing their practice to that recommended by the Brazilian Society of Cardiology (BSC) guidelines.In a cross-sectional study, 167 patients aged over 18, with a primary diagnosis of heart failure (HF), were studied at the university hospital by questionnaire, physical exam, electrocardiogram (ECG), chest X-ray, and echocardiogram (echo) as the gold standard exam.HF was not confirmed by echo criteria in 56 cases (33.5%). Sixty-nine patients (40.6%) had not previously undergone any diagnostic exam. Mean age was 61 years (+/- 13.3) and 57% were women. The main divergences from the guidelines were underuse of echo (11.4%), angiotensin-converting enzyme inhibitors (ACEIs) (64.1%) and beta-blockers (BBs) (26.0%), and the most often prescribed of the latter were those without benefits in morbidity and mortality --propranolol (15.6%) and atenolol (6.6%). The association of ACEIs and BBs was used in 25% of patients. Diuretics were the most prescribed (64.7%) and spironolactone was used in 9.0% of cases.There is a significant divergence between primary practice and the BSC guidelines. In this setting, the limited availability of echo and of the recommended drugs, combined with a lack of information, restricts their use. A program to improve adherence to the guidelines and to an evidence-based approach, through continuous medical training, should be implemented to improve the quality of primary care.

Throughout human evolution, smell lost its important role to be replaced by other senses. Although, it retained a "role"in several "healing" practices. The aim of this review was to analyze the possible roles and influences of olfaction on higher brain functions, like mood and memory, and in contrast heightened the influence of pathologies such as Alzheimer's disease and schizophrenia on the olfactory function, based on recent animal and human data. In this neuro-psychiatric approach, the immune system could have a central role.