Prevalence of hypertension in the urban population of Catanduva, in the State of São Paulo, Brazil

OBJECTIVE: To study the prevalence of systemic hypertension and its control in the population of Catanduva, in the state of São Paulo, Brazil. METHODS: We carried out a randomized cross-sectional population-based study of the urban population of Catanduva with individuals above 18 years of age (688 individuals accounting for 0.9% of the referred population). We interviewed study participants to analyze the major qualitative and quantitative variables that could influence the hypertensive scenario and the risk for systemic hypertension. Blood pressure was measured through the indirect method according to the III Consenso Brasileiro de Hipertensão (III Brazilian Consensus on Hypertension), which established blood pressure levels > or = 140/90 mm Hg as hypertensive. RESULTS: The prevalence of systemic hypertension was higher in individuals with: (1) history of hypertension (p<0.0001); (2) diabetes mellitus (p=0.05); (3) body mass index (B. M. I) > or = 25 kg/m² (p<0.001); (4) low educational level (p<0.0001); (5) familial income ranging from 1 to 5 minimum wages (p<0.05); (6) unmarried status (divorced/separated and widow(er)s) (p<0.0001). Of the interviewed individuals, 27.6% (p=0.05) had blood pressure levels under control. CONCLUSION: Our study showed that the prevalence of systemic hypertension was 31.5%, and that 27.6% of the individuals interviewed had blood pressure levels under control at the time of the interview.

Validation study of an automated wrist monitor, omron model HEM-608, compared with the standard methods for blood pressure measurement

OBJECTIVE - The aim of our study was to assess the profile of a wrist monitor, the Omron Model HEM-608, compared with the indirect method for blood pressure measurement. METHODS - Our study population consisted of 100 subjects, 29 being normotensive and 71 being hypertensive. Participants had their blood pressure checked 8 times with alternate techniques, 4 by the indirect method and 4 with the Omron wrist monitor. The validation criteria used to test this device were based on the internationally recognized protocols. RESULTS - Our data showed that the Omron HEM-608 reached a classification B for systolic and A for diastolic blood pressure, according to the one protocol. The mean differences between blood pressure values obtained with each of the methods were -2.3 +7.9mmHg for systolic and 0.97+5.5mmHg for diastolic blood pressure. Therefore, we considered this type of device approved according to the criteria selected. CONCLUSION - Our study leads us to conclude that this wrist monitor is not only easy to use, but also produces results very similar to those obtained by the standard indirect method.

Echocardiographic Assessment of the Pulmonary Venous Flow: An Indicator of Increased Pulmonary Flow in Congenital Cardiac Malformations

OBJECTIVE: To identify the left inferior pulmonary vein as an indirect marker of increased pulmonary flow in congenital heart diseases.METHODS: We carried out a prospective consecutive study on 40 patients divided into 2 groups as follows: G1 - 20 patients diagnosed with congenital heart disease and increased pulmonary flow; G2 (control group) - 20 patients who were either healthy or had congenital heart disease with decreased or normal pulmonary flow. We obtained the velocity-time integral of the left inferior pulmonary vein flow, excluding the "reverse A" wave, with pulsed Doppler echocardiography.RESULTS: In G1, 19 out of the 20 patients had well-identified dilation of the left inferior pulmonary vein. No G2 patient had dilation of the left inferior pulmonary vein. Dilation of the left inferior pulmonary vein in conditions of increased pulmonary flow had sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 95% (1 false-negative case). The integral of time and velocity of the pulmonary venous flow obtained with pulsed Doppler echocardiography was greater in the G1 patients (G1=25.0±4.6 cm versus G2=14.8±2.1 cm, p=0.0001).CONCLUSION: The identification of dilation of the left inferior pulmonary vein suggests the presence of congenital heart disease with increased pulmonary flow. This may be used as an indirect sign of increased flow, mainly in malformations of difficult diagnosis, such as atrial septal defects of the venous sinus or coronary sinus type.

Prevalence of Cardiac Arrhythmias During and After Pregnancy in Women with Chagas' Disease without Apparent Heart Disease

OBJECTIVE: To evaluate cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease using dynamic electrocardiography. METHODS: Twenty pregnant women with Chagas' disease without apparent heart disease aged 19 to 42 years (26.96 ± 3.6) and a control group of 20 non-chagasic pregnant patients aged 16 to 34 years (22.5 ± 4.8). The patients were submitted to passive hemagglutination and indirect immunofluorescence for the detection of Trypanosoma cruzi evaluation, and electrocardiography, echocardiography and 24-h dynamic electrocardiography. RESULTS: Supraventricular premature depolarizations were observed in 18 (90%) patients and ventricular premature depolarization in 11 (55%) patients of both groups during pregnancy. After delivery, supraventricular premature depolarizations were present in 13 (60%) chagasic patients and in 16 (89.4%) control patients (P<=0.05). Ventricular premature depolarization were observed in 9 (45%) chagasic patients and 11 (57.8%) control patients. CONCLUSION: The prevalence of ventricular premature depolarization was similar for the chagasic and control groups during and after pregnancy. The incidence of supraventricular premature depolarizations was similar in the two groups during pregnancy, while after delivery a predominance was observed in the control group compared to the chagasic group.

Unsupervised Rehabilitation: effects of Exercise Training over the Long Run

OBJECTIVE: To assess the safety and efficacy of unsupervised rehabilitation (USR) in the long run in low-risk patients with coronary artery disease. METHODS: We carried out a retrospective study with 30 patients divided into: group I (GI) - 15 patients from private clinics undergoing unsupervised rehabilitation; group II (GII) - control group, 15 patients from ambulatory clinic basis, paired by age, sex, and clinical findings. GI was stimulated to exercise under indirect supervision (jogging, treadmill, and sports). GII received the usual clinical treatment. RESULTS: The pre- and postobservation values in GI were, respectively: VO2peak (mL/kg/min), 24±5 and 31± 9; VO2 peak/peak HR: 0.18±0.05 and 0.28±0.13; peak double product (DP peak):26,800±7,000 and 29,000 ± 6,500; % peak HR/predicted HRmax: 89.5±9 and 89.3±9. The pre- and post- values in GII were: VO2 peak (mL/kg/min), 27± 7 and 28±5; VO2 peak/peak HR: 0.2±0.06 and 0.2± 0.05; DP peak: 24,900±8,000 and 25,600± 8,000, and % peak HR/predicted HRmax: 91.3±9 and 91.1± 11. The following values were significant: preobservation VO2peak versus postobservation VO2peak in GI (p=0.0 063); postobservation VO2peak in GI versus postobservation VO2peak in GII (p=0.0045); postobservation VO2 peak/peak HR GI versus postobservation peak VO2/peak HR in GII (p=0.0000). The follow-up periods in GI and GII were, respectively, 41.33± 20.19 months and 20.60±8.16 months (p<0.05). No difference between the groups was observed in coronary risk factors, therapeutic management, or evolution of ischemia. No cardiovascular events secondary to USR were observed in 620 patient-months. CONCLUSION: USR was safe and efficient, in low-risk patients with coronary artery disease and provided benefits at the peripheral level.

Network Meta-analysis to Synthesize Evidence for Decision Making in Cardiovascular Research

Abstract Clinical decision-making requires synthesis of evidence from literature reviews focused on a specific theme. Evidence synthesis is performed with qualitative assessments and systematic reviews of randomized clinical trials, typically covering statistical pooling with pairwise meta-analyses. These methods include adjusted indirect comparison meta-analysis, network meta-analysis, and mixed-treatment comparison. These tools allow synthesis of evidence and comparison of effectiveness in cardiovascular research.

Mamíferos carnívoros e sua relação com a diversidade de hábitats no Parque Nacional dos Aparados da Serra, sul do Brasil

A survey of carnivore mammals was accomplished in Aparados da Serra National Park from February 1998 to March 2000. The park has 10,250 ha and is considered a biodiversity core area of the Atlantic Forest Biosphere Reserve in the Rio Grande do Sul State, Brazil. The landscape is characterized by relatively well preserved relicts of Araucaria angustifolia (Bertol.) Kuntze forest, grasslands and Atlantic Forest, which have contributed for the survival of endangered carnivore mammals. The National Park was divided in a grid of 16 km² cells using a 1:50,000 scale map. The animals were recorded using indirect methods, by identifying signs (scats, tracks) and direct observation in 2.5 km long and 5 m wide transects, with 10 replicates in each grid cell. Interviews with local people were also used to confirm the animal presence. A total of 13 species was recorded: Procyon cancrivorus (Cuvier, 1798), Pseudalopex gymnocercus (G. Fischer, 1814), Leopardus pardalis (Linnaeus, 1758) and Cerdocyon thous (Linnaeus, 1766) were the most frequent species registered. Nasua nasua (Linnaeus 1766), Herpailurus yaguarondi (Lacépède, 1809), Chrysocyon brachyurus (Illiger, 1815), Eira barbara (Linnaeus, 1758), Leopardus sp., Puma concolor (Linnaeus, 1771), Galictis cuja (Molina, 1782), Conepatus chinga (Molina, 1892) and Lontra longicaudis (Olfers, 1818) showed lower frequencies. The Park presented areas with significant differences (Mantel Test, P< 0.05) in species richness and composition related to habitat classes. Areas with high habitat richness presented high species richness. The Araucaria forest was the habitat that presented the higher carnivore richness. The border areas of the Park are influenced by several environmental degradation factors that could be affecting the distribution of carnivores.

Um método de análise de populações vegetais

In a rpevious paper it was shown that the ecolocogical succession phenomenon is correlated with the phylogenetic progression. Also, in "indifferent genera", following well stablished evolutionary trends, it was found that the species of generalized morphology pertain to the pioneer's habitants, while the more differentiated species are confined to more stabilized habitats (DIRECT METHOD). Among the "characteristic genera", it was also found that the monotopics occur with higher relative frequency in the final stages of the succession, while those genera with a dispersion area covering more than one biogeographical realm have a higher relative frequency in the pioneer stages. Taking the monotopic genera, with exepcion of the occasional very rare relics, as modern ones, and the polytopics as the older genera, the above mentioned correlation is again indicated. (INDIRECT METHOD). In the present paper the use of the "indirect method" as applied to plant populations has been demonstrated.

Os anofelinos do sub-gênero kerteszia em relação à distribuição das bromeliáceas em comunidades florestais do município de Brusque, Estado de Santa Catarina

The present work is part of the studies realized under the authority of the National Service of Malaria (Brazil), with the collaboration of scientists of the Oswaldo Cruz Institute, in some forests of the southern part of Brazil.This is the first of a series and its subject is the development of the Anopheles mosquitoes of the kerteszia in water collected in Bromeliaceae leaves. The ecology of Bromeliaceae was studied in a previous work. The botanical material was classified by specialists from several botanical institutions from Europe and the United States of America. The most important ecological relations of the “bromeliad-kerteszia” problem were presented through four indices: 1st Positivity index – Relative frequency of bromeliad with watery forms in the bromeliad examined. 2nd Larval index – Mean number of watery forms in the positive bromeliad. 3rd Ovoposition index – Product of the Positivy index by the Larval index. 4th MK index – Product of the Ovoposition index by the total number of bromeliad, positive or not, in a unity of area (1.000 m²). The capture of flying forms in relation to the relative humidity was also studied. From the several forests of the Brusque region we have selected one community of each type, which were the most representative forests in Southern Brazil. Conclusions on the “bromeliad-kerteszia” problem – From a general point of view only a few factors are really important and these are listed below: 1°) The volum of water on the bromeliad. 2°) The level where the bromeliad is fixed. 3°) The number of bromeliad in unity of area. The distribution of microclimas in the forest through the considered levels has a direct influence on the species of subgenus Kerteszia (qualitative influence) and an indirect influence through the ecological distribution of the more frequent bromeliad with best qualities as biotope for the watery forms (qualitative influence). The MK index is roughly proportional to the square of half the total number of Bromeliaceae in a certain type of forest. Then the MK index would be a certain function of the ecological type of the forest and of the total number of bromeliad in a unity of area. MK approximately α x (x/10)² . x = n° of bromeliad in a unity of área (1.000 m²); α = qualitative factor. It would be interesting to see if this proportion is maintained when we have examined a greater number of forests of different types.