A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): Study protocol for a randomized double-blind controlled trial

Background: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted.Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution.Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil. Clinical trials registration number: ClinicalTrials.gov: NCT00971165. © 2011 Fuchs et al; licensee BioMed Central Ltd.

Cavas históricas de ouro do Jaraguá: o que resta para se preservar?

The Historical Jaraguá Gold Caves are vestiges of excavations in weathered rock, dating back to the Brazilian colonial times, situated NW of Jaraguá peak, in the São Paulo municipality (SP). The areas were investigated to support historical preservation innitiatives. The excavations have lateral steep slopes and a narrow fat bottom zone, occupied by dense vegetation. The trace of the excavations is sinuous, trending N40-50W, in accordance to a transition zone of Neoproterozoic rocks: metapelites and metapsamites by the SW side and calc-silicate rocks and amphybolites at NE. The structural control results from three successive deformation phases. Urban expansion and road construction, during the last 30 years, have strongly impacted the areas: (I) Base of Quebra-Pé hill; (II) Jardim Britânia; (III) Morro Doce; (IV) Nova Anhangüera Park. A 5 th site was disfgured by earthworks. The Jardim Britânia area is partly discharacterized by earthflls; this however does not impede further protection actions. This framework allows to recommend authorities: (1) to permit immediate preservation of these areas; (2) to develop programs to build an integrated site for scientifc diffusion or an educational center for exhibition of rocks, ores and mineral samples; (3) to support the interest of some owners to preserve the area called Morro Doce, (4) to put forward a few proposals for educational use of the excavations, by production of feld guides on the historic sites. The alternatives will help keeping alive the memory of mining in the São Paulo State.

Prevention of hypertension in patients with pre-hypertension: Protocol for the PREVER-prevention trial

Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial Registration: Clinical Trials NCT00970931. © 2011 Fuchs et al; licensee BioMed Central Ltd.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

Contaminação microbiana das soluções de processamento radiográfico: Risco de infecção cruzada

Objective: To evaluate the microbial contamination in samples of radiographic developing and fixing solutions, radiographic processing water, dental unit waterlines and dental office's external water supply. Methods: Samples of 50 private dental offices and 20 dental offices of the School of Dentistry de Araçatuba-UNESP were collected. The samples were subjected to neutralization of the residual inhibitory agents followed by pre-enrichment in peptone water and EVA broth and were inoculated in selective and non-selective culture media. The DNA of the samples was extracted and the presence of superinfectant microorganisms was evaluated by PCR. The differences in the prevalence of the microorganisms in the samples of the solutions were analyzed by repeated-measures analysis of variance for category data, while the Chi-Square and Mann-Whitney tests were used to evaluate the existence of associations between the total number of heterotrophic microorganisms and infection control protocols. The significance level was set at 5%. Results: Samples of radiographic fixing solution presented a remarkably less frequent contamination than radiographic developing solution and radiographic processing water. The latter exhibited microorganisms typically originated from the oral microbiota and human skin as well as microorganisms frequently found in dental unit waterlines. There was less contamination of radiographic processing water in the dental offices where the x-ray film packets were disinfected before processing or were covered by a plastic film. Additionally, all samples of dental office's external water supply were drinkable. Conclusion: Covering the x-ray film packets with a plastic film protection barrier was proven the best manner to reduce the contamination of the evaluated solutions.

Estimativa da evapotranspiração de referência com uso do Irrigâmetro em Vitória da conquista/BA

The Irrigameter is aevapotranspiration measuring device used in irrigation management to optimize water. However, its use requires a prior adjustment to weather conditions where it will be used. The objective of this study was identify the corresponding height of water level inside the evaporimeterIrrigameter that estimate reference evapotranspiration in climate of the plateau of Vitoria da Conquista - BA, in different seasons. The experiment was a completely randomized design with five treatments and three replications. For each treatment was determined an average coefficient for the Irrigameter called K I, calculated as the ratio of estimated evapotranspiration in Irrigameter (ET I) and reference evapotranspiration (ET 0). The ET 0 was obtained by the Penman-Monteith - FAO 56. The results showed that the coefficients of Irrigameter increased exponentially with increasing water level inside the evaporimeter, and the equipment must be operated with the water level equal to 5.2 cm for better estimation of ET 0. The remaining heights observed in different seasons showed no significant difference when compared to annual average used as a reference in this study.

Homologies of the flower and inflorescence in the early-divergent grass anomochloa (poaceae)

Premise of the study: The grass subfamily Anomochlooideae is phylogenetically significant as the sister group to all other grasses. Thus, comparison of their structure with that of other grasses could provide clues to the evolutionary origin of these characters. Methods: We describe the structure, embryology, and development of the flower and partial inflorescence of the monotypic Brazilian grass Anomochloa marantoidea. We compare these features with those of other early-divergent grasses such as Pharus and Streptochaeta and closely related Poales such as Ecdeiocolea. Key results: Anomochloa possesses several features that are characteristic of Poaceae, notably a scutellum, a solid style, reduced stamen number, and an ovary with a single ovule that develops into a single indehiscent fruit. Interpretation of floral patterning in Anomochloa is problematic because the ramification pattern of the florets places the bracts and axes in unusual positions relative to the primary inflorescence axis. Our study indicates that there is a single abaxial carpel in Anomochloa, probably due to a cryptic type of pseudomonomery in Anomochloa that resembles the pseudomonomery of other grasses. On the other hand, the Anomochloa flower differs from the typical grass flower in lacking lodicules and possessing four stamens, in contrast with the tristaminate condition that characterizes many other grasses. Conclusions: Using the median part of the innermost bract as a locator, we tentatively homologize the inner bract of the Anomochloa partial inflorescence with the palea of other grasses. In this interpretation, the pattern of monosymmetry due to stamen suppression differs from that of Ecdeiocolea. © 2012 Botanical Society of America.

Fator de crescimento nervoso em cola de fibrina no reparo término-lateral de nervos em ratos

Purpose: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. Methods: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. Results: All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). Conclusion: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.

Mastigação simulada e digestão ácido-enzimática de sementes de leguminosas forrageiras tropicais

This study aimed to evaluate the effect of simulated chewing in the laboratory on the survival of seeds of four tropical forage legumes (butterfly pea, Clitorea ternatea; estilosantes, Stylosanthes capitata/S. macrocephala 'Campo Grande; archer, Macrotyloma axillare and perennial soybean, Neonotonia wightii) submitted to different periods of acid enzymatic digestion in vitro. Three trials were conducted to observe the percentage of destroyed seeds by the mastication; to compare the germination of the seeds (intact seeds, simulated mastication, scarification with sandpaper, mastication and scarification with sandpaper). And, finally the seeds were incubated at 39oC with hydrochloric acid and pepsin for: 0, 2, 4, 8, 12 and 24 hours. The percentages of not destroyed seeds in mastication (archer, 91,5; perennial soybean, 88.0; butterfly pea, 82.1, and estilo, 81.1), associated with the beneficial effects of scarification on germination (64.7, 60.0, 92.0 e 87.3%, respectively) and the effects of time of acid-enzymatic digestion (75% higher if they stay 24 hours in HCl + pepsin) associated to the hard and not permeable coats of legume seeds, allow a high potential for resistance, and to pass intact through the digestive tract of cattle, being able to germinate when defecated in the pastures. However, estilo should not be included in the feeding of cattle for this purpose, because it do not resists the acid-enzyme digestion.

Extrato de própolis no controle de helmintoses em bezerros

The use of conventional anthelmintic has been a growing concern among consumers who have become more and stricter toward drug residues in products of animal origin. Thus, this research aimed to evaluate the anthelmintic effect of alcoholic extract of propolis, at 30% of concentration, in naturally infected calves. Twelve calves weighting 60 kg and aging 90 days old were used. The treatments were performed by direct oral administration of 10 mL of EAP. The calves received the extract at every 8 h intervals, for five consecutive days. The results were evaluated comprising the detection of light and heavy eggs counted per gram of feces (EPG), immediately before and after treatment, calculating the percentage of reduction. For the statistical analysis, the results were evaluated by Wilcoxon unilateral test of signed points at 5% probability. Trichostrongylus sp. and Strongyloides sp. were found. After treatment, 83% of animals showed an average decrease of 48.48% per counting of EPG. Therefore, propolis may represent an important adjunctive therapy to control helminthiasis in cattle. It was particularly important in ecological organic and biological-dynamic systems of production, whose use of chemicals is prohibitive and limiting factor for certification.

Própolis no controle da mastite bovina

Bovine mastitis is considered the main disease causing great economic losses in dairy herds. It is usually treated by antimicrobial chemicals that promote drug resistance, residues in food and environmental contamination. However, consumers in different countries requires more natural foods and with higher quality. Thus, the objective was to check the activities of propolis in controlling bovine mastitis. Seventy-two Holstein cows were used. The mastitis was identified by the California Mastitis Test, somatic cell counts and microbiological examination of milk. Four treatments were held: in group EAP1 10ml of a 30% alcoholic propolis extract (EAP) were given orally for seven consecutive days; in group EAP2 the same procedure described for the first group was used, in addition EAP was used for immersion of the teats before and after milking; in group CA alcohol was used for immersion of the teats before and after milking; and in group CT animals were subjected to soaking and disinfection, procedures routinely used by the property. The results were analyzed by the non-parametric variance model for repeated measures complemented by independent groups in multiple comparisons. There was a decrease of the somatic cell count in all groups. The biological activities of propolis provide great prospects; however, under the conditions evaluated, it was not possible to observe differences between treatments. The great diversity in its chemical composition and the complexity of multiple synergistic mechanisms involved in its biological activity require additional clinical trials.

Comparative study of the healing process when using Vicryl®, Vicryl Rapid®, Vicryl Plus®, and Monocryl® sutures in the rat dermal tissue

Introduction: Various types of sutures are available in the market with different constitutions. However, there is a lack of research to assess and quantify the behavior of these materials. Resources and materials: This study comes benchmark wires polyglactin 910 (Vicryl ®), irradiated polyglactin 910 (Vicryl Rapid ®), polyglactin 910 treated with triclosan (Vicryl Plus ®), and poliglecaprone 25 (Monocryl ®). For this, we used 40 rats that were divided into two groups, underwent two skin incisions longitudinal 2-cm long. In Group A, simple interrupted sutures using irradiated polyglactin 910 on the right and left side of polyglactin 910, and in group B, polyglactin 910 with triclosan on the right and the left poliglecaprone 25 were made. At 2, 7, 14, and 28 days after surgery, the ten animals were killed per period, and the samples were processed for histomorphologic and histometric analysis. Conclusions: The results demonstrated that the wire poliglecaprone 25 showed better biological response, with less inflammatory infiltrates and rapid organization of connective tissue. © 2012 Springer-Verlag Berlin Heidelberg.

Analysis of HCV quasispecies dynamic under selective pressure of combined therapy

Background: The quasispecies composition of Hepatitis C virus (HCV) could have important implications with regard to viral persistence and response to interferon-based therapy. The complete NS5A was analyzed to evaluate whether the composition of NS5A quasispecies of HCV 1a/1b is related to responsiveness to combined interferon pegylated (PEG-IFN) and ribavirin therapy.Methods: Viral RNA was isolated from serum samples collected before, during and after treatment from virological sustained responder (SVR), non-responder (NR) and the end-of-treatment responder patients (ETR). NS5A region was amplified, cloned and sequenced. Six hundred and ninety full-length NS5A sequences were analyzed.Results: This study provides evidence that lower nucleotide diversity of the NS5A region pre-therapy is associated with viral clearance. Analysis of samples of NRs and the ETRs time points showed that genetic diversity of populations tend to decrease over time. Post-therapy population of ETRs presented higher genetic distance from baseline probably due to the bottleneck phenomenon observed for those patients in the end of treatment. The viral effective population of those patients also showed a strong decrease after therapy. Otherwise, NRs demonstrated a continuous variation or stability of effective populations and genetic diversity over time that did not seem to be related to therapy. Phylogenetic relationships concerning complete NS5A sequences obtained from patients did not demonstrate clustering associated with specific response patterns. However, distinctive clustering of pre/post-therapy sequences was observed. In addition, the evolution of quasispecies over time was subjected to purifying or relaxed purifying selection. Codons 157 (P03), 182 and 440 (P42), 62 and 404 (P44) were found to be under positive selective pressure but it failed to be related to the therapy.Conclusion: These results confirm the hypothesis that a relationship exists between NS5A heterogeneity and response to therapy in patients infected with chronic hepatitis C. © 2013 Jardim et al.; licensee BioMed Central Ltd.

Maternal periodontal disease in rats decreases insulin sensitivity and insulin signaling in adult offspring

Background: Periodontal disease during pregnancy has been recognized as one of the causes of preterm and lowbirth- weight (PLBW) babies. Several studies have demonstrated that PLBW babies are prone to developing insulin resistance as adults. Although there is controversy over the association between periodontal disease and PLBW, the phenomenon known as programming can translate any stimulus or aggression experienced during intrauterine growth into physiologic and metabolic alterations in adulthood. The purpose of the present study is to investigate whether the offspring of rats with periodontal disease develop insulin resistance in adulthood. Methods: Ten female Wistar rats were divided into periodontal disease (PED) and control (CN) groups. All rats were mated at 7 days after induction of periodontal disease. Male offspring were divided into two groups: 1) periodontal disease offspring (PEDO; n = 24); and 2) control offspring (CNO; n = 24). Offspring body weight was measured from birth until 75 days. When the offspring reached 75 days old, the following parameters were measured: 1) plasma concentrations of glucose, insulin, fructosamine, lipase, amylase, and tumor necrosis factor-α (TNF-α); 2) insulin sensitivity (IS); and 3) insulin signal transduction (IST) in insulin-sensitive tissues. Results: Low birth weight was not detected in the PEDO group. However, plasma concentrations of glucose, insulin, fructosamine, lipase, amylase, and TNF-α were increased and IS and IST were reduced (P <0.05) in the PEDO group compared with the CNO group. Conclusion: Maternal periodontal disease may induce insulin resistance and reduce IST in adult offspring, but such alterations are not attributable to low birth weight.

On Hepatitis C Virus Evolution: The Interaction between Virus and Host towards Treatment Outcome

Background:Hepatitis C is a disease spread throughout the world. Hepatitis C virus (HCV), the etiological agent of this disease, is a single-stranded positive RNA virus. Its genome encodes a single precursor protein that yields ten proteins after processing. NS5A, one of the non-structural viral proteins, is most associated with interferon-based therapy response, the approved treatment for hepatitis C in Brazil. HCV has a high mutation rate and therefore high variability, which may be important for evading the immune system and response to therapy. The aim of this study was to analyze the evolution of NS5A quasispecies before, during, and after treatment in patients infected with HCV genotype 3a who presented different therapy responses.Methods:Viral RNA was extracted, cDNA was synthesized, the NS5A region was amplified and cloned, and 15 clones from each time-point were sequenced. The sequences were analyzed for evolutionary history, genetic diversity and selection.Results:This analysis shows that the viral population that persists after treatment for most non-responder patients is present in before-treatment samples, suggesting it is adapted to evade treatment. In contrast, the population found in before treatment samples from most end-of-treatment responder patients either are selected out or appears in low frequency after relapse, therefore changing the population structure. The exceptions illustrate the uniqueness of the evolutionary process, and therefore the treatment resistance process, in each patient.Conclusion:Although evolutionary behavior throughout treatment showed that each patient presented different population dynamics unrelated to therapy outcome, it seems that the viral population from non-responders that resists the treatment already had strains that could evade therapy before it started. © 2013 Bittar et al.