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Background: The aim of this study is to report early and long-term results of elective endovascular aneurysm repair (EVAR) in a tertiary low-volume hospital in Brazil., Methods: Between October 2006 and May 2017, 120 patients underwent elective EVAR for infrarenal aortic aneurysm. The interventions were reviewed retrospectively, focusing on 30-day mortality, long-term survival, and freedom from reintervention. Late outcomes were assessed by the Kaplan-Meier method and Cox regression., Results: The follow-up's median and interquartile range was 3 (1-5) years. Overall, most patients were males (75%) and the median age was 74 years. Mostly patients were at a high risk for intervention (79.1%) and the majority was classified as American Society of Anesthesiologists III (53.3%). Preoperative aneurysm diameter median was 60 mm, interquartile range was 52.7-69. As per the postoperative aneurysm sac evolution, the number of patients with a reduction, stabilization, or an increase was 93 (77.5%), 18 (15%), and 9 (7.5%), respectively. The 30-day mortality was 6.6% and no late aneurysm-related deaths were identified. The overall incidence of late endoleaks was 24.1%, with the predominance of type II (23.3%), followed by type IA (0.8 %). Secondary interventions were necessary for 9 patients (7.5%). The 6-year analyses revealed freedom from reintervention and overall survival of 87.9% and 57.7%, respectively. The Cox regression analyses identified age > 75 years as an adverse factor for overall survival (hazard ratio = 2.5; P = 0.021)., Conclusions: In the present study, EVAR in a low-volume center was associated with high 30-day mortality, but satisfactory long-term results were identified., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: We aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection., Methods: This case-control study, we recruited mother-infant pairs between May 2015 and October 2017 in a pediatric infectious disease clinic in Rio de Janeiro. Inclusion criteria required either that the mother reported Zika infection symptoms during pregnancy or that the infant presented with clinical or imaging features of the CZS. Exclusion criteria included detection of an alternative cause for the patient's presentation or negative polymerase chain reaction assays for Zika in all specimens tested within 12 days from the beginning of maternal symptoms. Infants with CZS (CDC definition) were selected as cases and infants without CZS, but with probable maternal Zika virus infection during pregnancy, were selected as controls. Maternal and pregnancy-related informations were collected and their relationship to the presence of congenital anomalies due to CZS was assessed by Fisher exact or Mann-Whitney test., Results: Out of the 42 included neonates, 24 (57.1%) were diagnosed with CZS (cases). The mean maternal age at the birth was 21 years old. The early occurrence of maternal symptoms during pregnancy was the only variable associated with CZS (odds ratio = 0.87, 95% CI: 0.78-0.97). Case's mothers presented symptoms until the 25th week of gestational age (GA), while control's mothers presented until 36th weeks of GA. Income; illicit drug, alcohol, or tobacco use during pregnancy; other infections during pregnancy (including previous dengue infection) were not associated with CZS., Conclusions: Our study corroborates the hypothesis that Zika virus infection earlier in pregnancy is a risk factor to the occurrence of congenital anomalies in their fetuses.

Prognostic stratification in acute myeloid leukemia (AML) relies, mostly, on cytogenetics and molecular features of leukemic blasts. The LeukemiaNet prognostic scoring system has been proposed as a standardized way of evaluating prognosis in AML. We have analysed outcomes in 65 AML cases (median age of 54 years, range 18-82) treated at five hematology centers in Brazil stritified according to the European Leukemia Net (ELN) recommendations for cytogenetic and molecular analysis. We classified patients as favorable (N = 13), intermediate-1 (N = 25), intermediate-2 (N = 15), or adverse risk (N = 9). Bone marrow transplantation (BMT) was performed in 13 patients (21%). Median follow-up was 12 months. The median overall survival (OS) for all patients was 12.4 months. Median OS was 19.8, 12.4, 10.1, and 10.4 months (p = 0.24) for patients in the favorable, intermediate-1, intermediate-2, and adverse groups, respectively. Among patients receiving BMT, median OS was 26.8 months. The ELN is a valuable tool for prognostic stratification of AML patients treated in Brazil. Nevertheless, its usefulness is limited when compared to data from developed countries.

Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.

This paper aimed to evaluate the influence of seasonality on the chemical composition of oysters (Crassostrea rhizophorae). Samples were collected during summer and winter from the estuary and lagoon complex of the municipality of Barra de São Miguel, Alagoas, Brazil. Statistical differences (p<0.05) between summer and winter were observed in relation to chemical composition. The oysters cultivated in the winter presented some nutritional advantages because of the higher levels of proteins and functional nutrients, such as the eicosapentaenoic-docosahexaenoic acid combination and percentages of polyunsaturated fatty acids (n-3 and n-6), and the lower levels of saturated fatty acids. Therefore, the animals in winter presented a higher content of cholesterol oxides. The levels of cholesterol oxides found in these products during winter may encourage researchers to investigate the composition of oysters cultivated in different climates all over the world., (Copyright © 2012. Published by Elsevier Ltd.)

Background: Warfarin-dosing pharmacogenetic algorithms have presented different performances across ethnicities, and the impact in admixed populations is not fully known., Aims: To evaluate the CYP2C9 and VKORC1 polymorphisms and warfarin-predicted metabolic phenotypes according to both self-declared ethnicity and genetic ancestry in a Brazilian general population plus Amerindian groups., Methods: Two hundred twenty-two Amerindians (Tupinikin and Guarani) were enrolled and 1038 individuals from the Brazilian general population who were self-declared as White, Intermediate (Brown, Pardo in Portuguese), or Black. Samples of 274 Brazilian subjects from Sao Paulo were analyzed for genetic ancestry using an Affymetrix 6.0(®) genotyping platform. The CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910), and VKORC1 g.-1639G>A (rs9923231) polymorphisms were genotyped in all studied individuals., Results: The allelic frequency for the VKORC1 polymorphism was differently distributed according to self-declared ethnicity: White (50.5%), Intermediate (46.0%), Black (39.3%), Tupinikin (40.1%), and Guarani (37.3%) (p<0.001), respectively. The frequency of intermediate plus poor metabolizers (IM+PM) was higher in White (28.3%) than in Intermediate (22.7%), Black (20.5%), Tupinikin (12.9%), and Guarani (5.3%), (p<0.001). For the samples with determined ancestry, subjects carrying the GG genotype for the VKORC1 had higher African ancestry and lower European ancestry (0.14±0.02 and 0.62±0.02) than in subjects carrying AA (0.05±0.01 and 0.73±0.03) (p=0.009 and 0.03, respectively). Subjects classified as IM+PM had lower African ancestry (0.08±0.01) than extensive metabolizers (0.12±0.01) (p=0.02)., Conclusions: The CYP2C9 and VKORC1 polymorphisms are differently distributed according to self-declared ethnicity or genetic ancestry in the Brazilian general population plus Amerindians. This information is an initial step toward clinical pharmacogenetic implementation, and it could be very useful in strategic planning aiming at an individual therapeutic approach and an adverse drug effect profile prediction in an admixed population.

Background: Recent studies have reported the clinical importance of CYP2C19 and ABCB1 polymorphisms in an individualized approach to clopidogrel treatment. The aims of this study were to evaluate the frequencies of CYP2C19 and ABCB1 polymorphisms and to identify the clopidogrel-predicted metabolic phenotypes according to ethnic groups in a sample of individuals representative of a highly admixtured population., Methods: One hundred and eighty-three Amerindians and 1,029 subjects of the general population of 4 regions of the country were included. Genotypes for the ABCB1c.C3435T (rs1045642), CYP2C19*2 (rs4244285), CYP2C19*3 (rs4986893), CYP2C19*4 (rs28399504), CYP2C19*5 (rs56337013), and CYP2C19*17 (rs12248560) polymorphisms were detected by polymerase chain reaction followed by high resolution melting analysis. The CYP2C19*3, CYP2C19*4 and CYP2C19*5 variants were genotyped in a subsample of subjects (300 samples randomly selected)., Results: The CYP2C19*3 and CYP2C19*5 variant alleles were not detected and the CYP2C19*4 variant allele presented a frequency of 0.3%. The allelic frequencies for the ABCB1c.C3435T, CYP2C19*2 and CYP2C19*17 polymorphisms were differently distributed according to ethnicity: Amerindian (51.4%, 10.4%, 15.8%); Caucasian descent (43.2%, 16.9%, 18.0%); Mulatto (35.9%, 16.5%, 21.3%); and African descent (32.8%, 20.2%, 26.3%) individuals, respectively. As a result, self-referred ethnicity was able to predict significantly different clopidogrel-predicted metabolic phenotypes prevalence even for a highly admixtured population., Conclusion: Our findings indicate the existence of inter-ethnic differences in the ABCB1 and CYP2C19 variant allele frequencies in the Brazilian general population plus Amerindians. This information could help in stratifying individuals from this population regarding clopidogrel-predicted metabolic phenotypes and design more cost-effective programs towards individualization of clopidogrel therapy.

Screening HIV infection in pregnancy provides an ideal opportunity to make an early diagnosis in women in order to provide treatment to reduce vertical transmission to the newborn. The objectives were to describe the profile of HIV-infected pregnant women attending municipal hospitals in Vitória and to identify the causes associated with the lack of HIV therapeutic prophylaxis. Descriptive analysis of antenatal and HIV surveillance data of pregnant women in Vitória, Brazil from 1997 to 2001 was performed. HIV infection was reported in 208 pregnant women. Their median age was 23 years, antenatal care was reported in 96.2% and HIV infection was diagnosed during antenatal care in 60.1%. Zidovudine (ZDV) therapy was initiated in 88% of the cases, 57.9% of which started before 20 weeks of gestation. The remaining 12% of the total of pregnant women received no therapy. Factors associated with lack of mother to child transmission (MTCT) prevention were: test not available (14 cases), delay of test result (seven cases) and patient's refusal to take medication (four cases). After delivery, 8.2% of the newborn did not receive ZDV and 14 women breastfed. Among the 196 live births, 3.1% (95%CI 1.9-4.3) of MTCT was reported. These data from an area with comprehensive HIV and antenatal surveillance provide an opportunity to identify gaps in public health efforts to reduce MTCT.