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Cardiovascular autonomic neuropathy in diabetes:Pathophysiology,clinical assessment and implications

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World Journal of Diabetes 2021年第6期12卷 855-867页

作者： Alice Duque Mauro felippe Felix Mediano Andrea De Lorenzo luiz Fernando Rodrigues Jr Education and Research Department Instituto Nacional de CardiologiaRio de Janeiro 22240006RJBrazil Laboratory of Clinical Research on Chagas Disease Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationRio de Janeiro 21040360RJBrazil Department of Physiological Sciences Biomedical InstituteFederal University of the State of Rio de JaneiroRio de Janeiro 22240006RJBrazil

Cardiovascular autonomic neuropathy(CAN)is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier,even before diabetes is *** is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers,which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic *** entire mechanism is still not elucidated,but several aspects of the pathophysiology of CAN have already been described,such as the production of advanced glycation end products,reactive oxygen species,nuclear factor kappa B,and pro-inflammatory *** microvascular complication is an important risk factor for silent myocardial ischemia,chronic kidney disease,myocardial dysfunction,major cardiovascular events,cardiac arrhythmias,and sudden *** has also been suggested that,compared to other traditional cardiovascular risk factors,CAN progression may have a greater impact on cardiovascular disease ***,CAN might be subclinical for several years,and a late diagnosis increases the mortality *** duration of the transition period from the subclinical to clinical stage remains unknown,but the progression of CAN is associated with a poor *** tests can be used for CAN diagnosis,such as heart rate variability(HRV),cardiovascular autonomic reflex tests,and myocardial ***,it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV,which is a non-invasive test with a lower operating ***,considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes,the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

关键词： Cardiovascular autonomic neuropathy Cardiac autonomic neuropathy Diabetes mellitus Heart rate variability Sympathetic autonomic nervous system Parasym-pathetic autonomic nervous system

Mayaro virus infection, the next epidemic wave after Zika?Evolutionary and structural analysis

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Asian Pacific Journal of Tropical Medicine 2018年第3期11卷 194-201页

作者： Eleonora Cella Marta Giovanetti Teresa Milano Marta Fogolari Francesco Garilli Ivailo Alexiev Riccardo Bazzardi Marco salemi luiz Carlos Junior Alcantara Silvia Angeletti Stefano Pascarella Massimo Ciccozzi Public Health and Infectious Diseases Sapienza University Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Fundao Oswaldo Cruz University of Rome"Tor Vergata" Dipartimento di Scienze Biochimiche"A.Rossi Fanelli" Universita La Sapienza Department of Medicine University Campus Bio-Medico of Rome National Reference Laboratory of HIV National Center of Infectious and Parasitic Diseases Department of Food Hygiene Experimental Zooprophylactic Institute of Sardinia Emerging Pathogens Institute Unirersity of Florida

Objective: To evaluate the evolution of the pathogen Mayaro virus, causing Mayaro fever(a mosquito-borne disease) and to perform selective pressure analysis and homology ***: Nine different datasets were built, one for each protein(from protein C to non-structural protein 4) and the last one for the complete genome. Selective pressure and homology modelling analyses were applied. Results: Two main clades(A and B) were pointed in the maximum likelihood tree. The clade A included five Brazilian sequences sampled from 1955 to 2015. The Brazilian sequence sampled in 2014 significantly clustered with the Haitian sequence sampled in 2015. The clade B included the remaining 27 sequences sampled in the Central and Southern America from 1957 to 2013. Selective pressure analysis revealed several sites under episodic diversifying selection in envelope surface glycoprotein El, non-structural protein 1 and nonstructural protein 3 with a posterior probability P≤0.01. Homology modelling showed different sites modified by selective pressure and some protein-protein interaction sites at high interaction propensity. Conclusion: Maximum likelihood analysis confirmed the Mayaro virus previous circulation in Haiti and the successful spread to the Caribbean and USA. Selective pressure analysis revealed a strong presence of negatively selected sites, suggesting a probable purging of deleterious polymorphisms in functional genes. Homology model showed the position 31, under selective pressure, located in the edge of the ADP-ribose binding site predicting to possess a high potential of protein-protein interaction and suggesting the possible chance for a protective vaccine,thus preventing Mayaro virus urbanization as with Chikungunya virus.

关键词： Mayaro virus Proteins Evolutionary analysis

Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

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World Journal of Hepatology 2019年第4期11卷 402-408页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus felippe Jorge luiz Gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Gabriela de Campos Araujo Amanda de Castro Machado Department of Liver Transplantation Instituto de Cardiologia do Distrito Federal Curso de Medicina Universidade Catolica de Brasilia

BACKGROUND Infection by the hepatitis C virus(HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver *** SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid *** biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1 A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the *** This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.

关键词： Hepatitis C Liver transplantation Leukocytoclastic vasculitis Immunosuppression Direct-acting antivirals Case report

Chagas heart disease:An overview of diagnosis,manifestations,treatment,and care

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World Journal of Cardiology 2021年第12期13卷 654-675页

作者： Roberto M Saraiva Mauro felippe F Mediano Fernanda SNS Mendes Gilberto Marcelo Sperandio da Silva Henrique H Veloso luiz Henrique C Sangenis Paula Simplício da Silva Flavia Mazzoli-Rocha Andréa S Sousa Marcelo T Holanda Alejandro M Hasslocher-Moreno Evandro Chagas National Institute of Infectious Diseases Oswaldo Cruz FoundationRio de Janeiro 21040-900RJBrazil

Chagas heart disease(CHD)affects approximately 30%of patients chronically infected with the protozoa Trypanosoma *** is classified into four stages of increasing severity according to electrocardiographic,echocardiographic,and clinical *** presents with a myriad of clinical manifestations,but its main complications are sudden cardiac death,heart failure,and ***,CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies,and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other *** patients with CHD,approximately 90%of deaths can be attributed to complications of Chagas *** cardiac death is the most common cause of death(55%–60%),followed by heart failure(25%–30%)and stroke(10%–15%).The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents ***,the management of CHD is challenging,and in this review,we present the most updated available data to help clinicians and cardiologists in the care of these *** describe the clinical manifestations,diagnosis and classification criteria,risk stratification,and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.

关键词： Chagas disease Diagnosis Treatment Heart failure Arrhythmia Stroke