Hipertensão arterial na cidade de São Paulo: prevalência referida por contato telefônico

FUNDAMENTO: Pouco se conhece sobre a prevalência da hipertensão arterial na cidade de São Paulo, SP, Brasil. OBJETIVO: Identificar a prevalência da hipertensão referida na cidade de São Paulo. MÉTODOS: Realizaram-se 613 entrevistas por telefone, a partir das listas residenciais do sistema de telefonia fixa. A amostra foi calculada com prevalência estimada de hipertensão em 20,0%. RESULTADOS: A prevalência referida de hipertensão foi de 23,0% e 9,0% dos entrevistados referiram que o valor de sua última medida da pressão foi maior que 140/90 mmHg, porém não tinham conhecimento de que eram hipertensos, totalizando uma prevalência de 32,0%. Os hipertensos referiram que: 89,0% fazem tratamento e 35,2% estavam controlados; 27,0% faltam às consultas; 16,2% deixam de tomar os remédios; 14,8% apresentam história de acidente vascular encefálico, 27,8% cardiopatia e 38,7% hipercolesterolemia; 71,2% receberam orientação para diminuir sal, 64,6% para realizar atividade física, 60,0% para perder peso e 26,2% para controlar estresse; e 78,9% mediam a pressão regularmente. Houve relação estatisticamente significante (p < 0,05) para: 1) faltar às consultas com maior tempo de tratamento e acompanhamento irregular de saúde; 2) deixar de tomar os remédios com tabagismo, etilismo e a não realização de acompanhamento de saúde; 3) realizar tratamento para hipertensão com dislipidemia, idade mais elevada e maior tempo de uso de anticoncepcional, no caso das mulheres; e 4) índice de massa corporal alterado com presença de diabete, hipercolesterolemia, pressão sistólica não controlada e uso de mais de um anti-hipertensivo. CONCLUSÃO: A prevalência referida de hipertensão na cidade de São Paulo assemelha-se à prevalência identificada em outros estudos.

Desfechos clínicos por região geográfica em pacientes com implante de stent eluidor de Zotarolimus

FUNDAMENTO: Diferenças entre regiões geográficas em relação à características de pacientes e desfechos, particularmente em síndromes coronarianas agudas, tem sido demonstradas em testes clínicos. Os desfechos clínicos após intervenções coronarianas percutâneas com o stent eluidor de Zotarolimus em uma população real foram analisados com o tempo. OBJETIVO: A influência da localização geográfica sobre os desfechos clínicos com o stent eluidor de Zotarolimus foi avaliada em três regiões: Pacífico Asiático, Europa e América Latina. MÉTODOS: Um total de 8.314 pacientes (6.572 da Europa, 1.522 do Pacífico Asiático e 220 da América Latina) foram acompanhados por 1 ano; 2.116 desses (1.613, 316, e 187, respectivamente) foram acompanhados por 2 anos. Características dos pacientes e lesões, terapia antiplaquetária dupla e desfechos clínicos foram comparados entre a América Latina e as outras duas regiões. RESULTADOS: Os pacientes da América Latina apresentavam a maior proporção de fatores de risco e infarto do miocárdio prévio. O uso da terapia antiplaquetária dupla declinou rapidamente na América Latina, de 44,9% em 6 meses para 22,5% em 1 ano e 7,8% em 2 anos (Europa: 87,4%, 61,5%, 19,7%; Pacífico Asiático: 82,4%, 67,0%, 45,7%, respectivamente). Não houve diferenças significantes entre a América Latina e a Europa ou Pacífico Asiático para qualquer desfecho em qualquer ponto do tempo. A incidência de trombose de stent provável e definitiva pelo Academic Research Consortium foi baixa (<1,2%) entre todos os pacientes em 1 ano e 2 anos. CONCLUSÃO: Os desfechos clínicos foram comparáveis entre os pacientes da América Latina e Europa, e América Latina e Pacífico Asiático, a despeito dos subgrupos clínicos menos favoráveis na América Latina, perfil de risco mais elevado e menor uso acentuado de terapia antiplaquetária dupla com o tempo.

Correlação dos escores de risco com a anatomia coronária na síndrome coronária aguda sem supra-ST

FUNDAMENTO:Há poucas publicações sobre a correlação entre escores de risco e anatomia coronária na síndrome coronária aguda (SCA). OBJETIVO: Correlacionar os escores de risco com a gravidade da lesão coronária na SCA sem supra-ST. MÉTODOS: Foram analisados 582 pacientes entre julho de 2004 e outubro de 2006. Avaliou-se a correlação entre os escores de risco TIMI, GRACE hospitalar e em seis meses com lesão coronária > 50%, por método não paramétrico de Spearman. Modelo de regressão logística múltipla foi realizado para determinar a habilidade preditiva dos escores em discriminar quem terá ou não lesão coronária > 50%. RESULTADOS: Foram 319 (54,8%) homens e a média de idade era 59,9 (± 10,6) anos. Correlação positiva foi observada entre a pontuação dos escores de risco e lesão coronária > 50% (escore de risco TIMI r = 0,363 [p < 0,0001]; escore GRACE hospitalar r = 0,255 [p < 0,0001]; escore GRACE em seis meses r = 0,209 [< 0,0001]). A área sob a curva ROC de cada escore para discriminar quem terá ou não lesão coronária > 50% foi: TIMI = 0,704 [IC95% 0,656-0,752; p <0,0001]; GRACE hospitalar = 0,623 [IC 95% 0,573-0,673; p < 0,0001]; GRACE em seis meses = 0,562 [IC95% 0,510-0,613; p = 0,0255]. Na comparação entre as áreas sob a curva ROC, tem-se: TIMI versus GRACE hospitalar: p = 0,01; TIMI versus GRACE em seis meses: p < 0,0001; GRACE hospitalar versus GRACE em seis meses: p = 0,0461. CONCLUSÃO: Os escores de risco se correlacionam com a gravidade das lesões coronárias, sendo o escore de risco TIMI o que demonstrou melhor habilidade preditiva

Functional Capacity of Patients with Pacemaker Due to Isolated Congenital Atrioventricular Block

Background:Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation.Objectives:To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling.Methods:This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%.Results:A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0)Conclusions:The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.

Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure

Introduction: Although diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF. Objective: The aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome. Results: A total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): −2.65 to −0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = −0.25 mg/dL; 95% CI: −0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64–1.56; p = 0.993). Conclusion: Compared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality was observed.

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas

Abstract Background: Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. Objective: To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. Methods: Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. Results: We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. Conclusion: Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.

Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase of isolates from the Amazon Region of Brazil

Since the late 1970s pyrimethamine-sulfadoxine (PS; FansidarTM Hoffman-LaRoche, Basel) has been used as first line therapy for uncomplicated malaria in the Amazon basin. Unfortunately, resistance has developed over the last ten years in many regions of the Amazon and PS is no longer recommended for use in Brazil. In vitro resistance to pyrimethamine and cycloguanil (the active metabolite of proguanil) is caused by specific point mutations in Plasmodium falciparum dihydrofolate reductase (DHFR), and in vitro resistance to sulfadoxine has been associated with mutations in dihydropteroate synthase (DHPS). In association with a proguanil-sulfamethoxazole clinical trial in Brazil, we performed a nested mutation-specific polymerase chain reaction to measure the prevalence of DHFR mutations at codons 50, 51, 59, 108 and 164 and DHPS mutations at codons 436, 437, 540, 581 and 613 at three sites in the Brazilian Amazon. Samples from two isolated towns showed a high degree of homogeneity, with the DHFR Arg-50/Ile-51/Asn-108 and DHPS Gly-437/Glu-540/Gly-581 mutant genotype accounting for all infections in Peixoto de Azevedo (n = 15) and 60% of infections in Apiacás (n = 10), State of Mato Grosso. The remaining infections in Apiacás differed from this predominant genotype only by the addition of the Bolivia repeat at codon 30 and the Leu-164 mutation in DHFR. By contrast, 17 samples from Porto Velho, capital city of the State of Rondônia, with much in- and out-migration, showed a wide variety of DHFR and DHPS genotypes.

Chagas disease in Mexico: an analysis of geographical distribution during the past 76 years - A review

Literature from 1928 through 2004 was compiled from different document sources published in Mexico or elsewhere. From these 907 publications, we found 19 different topics of Chagas disease study in Mexico. The publications were arranged by decade and also by state. This information was used to construct maps describing the distribution of Chagas disease according to different criteria: the disease, vectors, reservoirs, and strains. One of the major problems confronting study of this zoonotic disease is the great biodiversity of the vector species; there are 30 different species, with at least 10 playing a major role in human infection. The high variability of climates and biogeographic regions further complicate study and understanding of the dynamics of this disease in each region of the country. We used a desktop Genetic Algorithm for Rule-Set Prediction procedure to provide ecological models of organism niches, offering improved flexibility for choosing predictive environmental and ecological data. This approach may help to identify regions at risk of disease, plan vector-control programs, and explore parasitic reservoir association. With this collected information, we have constructed a data base: CHAGMEX, available online in html format.

Species composition and seasonal abundance of sandflies (Diptera: Psychodidae: Phlebotominae) in coffee agroecosystems

The composition and seasonal occurrence of sandflies were investigated in coffee agroecosystems in the Soconusco region of Chiapas, Mexico. Insect sampling was performed on three plantations located at different altitudes: Finca Guadalupe Zajú [1,000 m above sea level (a.s.l.)], Finca Argovia (613 m a.s.l.) and Teotihuacán del Valle (429 m a.s.l.). Sandflies were sampled monthly from August 2007-July 2008 using three sampling methods: Shannon traps, CDC miniature light traps and Disney traps. Sampling was conducted for 3 h during three consecutive nights, beginning at sunset. A total of 4,387 sandflies were collected during the course of the study: 2,718 individuals in Finca Guadalupe Zajú, 605 in Finca Argovia and 1,064 in Teotihuacán del Valle. The Shannon traps captured 94.3% of the total sandflies, while the CDC light traps and Disney traps captured 4.9% and 0.8%, respectively. More females than males were collected at all sites. While the number of sandflies captured was positively correlated with temperature and relative humidity, a negative correlation was observed between sandfly numbers and rainfall. Five species of sandflies were captured: Lutzomyia cruciata , Lutzomyia texana , Lutzomyia ovallesi , Lutzomyia cratifer / undulata and Brumptomyia sp. Lu. cruciata , constituting 98.8% of the total, was the most abundant species. None of the captured sandflies was infected with Leishmaniaspp.

An analysis of the influence of discount sales promotion in consumer buying intent and the moderating effects of attractiveness

ABSTRACT The purpose of this paper is to analyze the influence of discount sales promotion in the purchase intention and the moderating effects of attractiveness in the relationship between intention to purchase a discounted product and the impulsiveness, hedonic perception and financial risk. Thus, an experiment involving 613 students was conducted. The hypotheses predicted that a product with discount promotion would relate positively with impulsivity, as well as with a hedonic perception about the good offered, and negatively with the perception of financial risk associated with the product offered with discount. A positive moderation was expected of the perceived attractiveness of the announced discount promotion on the intentions of behaviors. The results confirmed the hypothesis, indicating positive effects of impulsivity and hedonic perception by purchasing the discounted products, in addition to the negative link between the intention of purchasing discounted products and the perception of a financial risk. The moderating effects were not confirmed. Final considerations conclude the work.

Time standards of nursing in Primary Health Care: an observational study

Abstract OBJECTIVE To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU) in Brazil to substantiate the calculation of work force. METHOD This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique. RESULTS A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control. CONCLUSION The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized.

Year-round poultry litter decomposition and N, P, K and Ca release

Poultry litter is an important nutrient source in agriculture, although little information is available regarding its decomposition rate and nutrient release. To evaluate these processes, poultry litter (PL) was applied to the soil to supply 100, 200 and 300 kg ha-1 N contained in 4,953, 9,907 and 14,860 kg ha-1 PL, respectively. The litter bag technique was used to monitor the process of decomposition and nutrient release from the litter. These bags were left on the soil surface and collected periodically (after 15, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, and 365 days). The dry matter (DM) loss was highest (35 %) after the first 30 days of field incubation. The highest nutrient release occurred in the first 60 days on the field, when 40, 34, 91, and 39 %, respectively, of N, P, K, and Ca of the initial PL dry matter (4,860 kg ha-1) was already released to the soil. In absolute terms, these percentages represent 40, 23, 134, and 69 kg ha-1 of N, P, K, and Ca and these values doubled and tripled as the PL fertilization rates increased to 9,907 and 14,860 kg ha-1, respectively. After one year of field incubation, the residual contents in the litter were 27, 15, 18 and 30 % of the initial DM , and N, P and Ca, respectively. The release rate of K was the fastest and 91 % of the K had been released from the PL after 30 days of field incubation.

Infrared thermometry to schedule irrigation of common bean

The objective of this work was to determine the critical irrigation time for common bean (Phaseolus vulgaris L. cv. Carioca) using infrared thermometry. Five treatments were analyzed. Canopy temperature differences between plants and a well-watered control about 1, 2, 3, 4, and 5±0.5ºC were tested. Physiological variables and plant growth were analyzed to establish the best time to irrigate. There was a significant linear correlation between the index and stomatal resistance, transpiration rate, and leaf water potential. Although significant linear correlation between the index and mean values of total dry matter, absolute growth rate, and leaf area index was found, no correlation was found with other growth index like relative growth rate, net assimilation rate, and leaf area ratio. Plants irrigated when their canopy temperature was 3±0.5ºC above the control had their relative growth rate mean value increased up to 59.7%, yielding 2,260.2 kg ha-1, with a reduction of 38.0% in the amount of water used. Plants irrigated when their canopy temperature was 4±0.5ºC yielded 1,907.6 kg ha-1, although their relative growth rate mean value was 4.0% below the control. These results show that the best moment to irrigate common bean is when their canopy temperature is between 3ºC and 4±0.5ºC above the control.

Nitrogênio e potássio via água de irrigação nas características de produção da bananeira 'Grand Naine'

O objetivo deste trabalho foi avaliar o efeito do nitrogênio e do potássio, aplicados via água de irrigação por microaspersão, sobre as características de produção da bananeira, cv. Grand Naine. O delineamento utilizado foi o de blocos casualizados, com quatro repetições. Os tratamentos consistiram de 30, 180, 300, 420 e 570 kg ha-1 ano-1 de N e de 55, 330, 550, 770 e 1.045 kg ha-1 ano-1 de K2O, e testemunha, sem adubação, totalizando onze tratamentos, de acordo com o modelo da matriz experimental de Plan Puebla III. Foram avaliadas as características: massa média de fruto, massa média de cacho e produtividade, referentes ao primeiro e segundo ciclos de produção. No primeiro e segundo ciclos, a massa média de fruto, a massa média de cacho e a produtividade foram influenciadas apenas pelas doses de potássio. Os maiores valores de massa média de fruto (253,47 g), massa média de cacho (28 kg) e produtividade (55,42 t ha-1), no primeiro ciclo, foram obtidos com a aplicação de 938,31, 665,38 e 665,27 kg ha-1 de K2O, respectivamente. No segundo ciclo, os maiores valores em relação à massa média de fruto (174, 22 g), massa média de cacho (32,04 kg) e produtividade (60,08 t ha-1) foram alcançados com a aplicação de 725,50, 907,50 e 933,33 kg ha-1 de K2O, respectivamente. Não houve resposta das características avaliadas ao nitrogênio.

Grazing intensities and poultry litter fertilization levels on corn and black oat yield

The objective of this work was to assess the effect of poultry litter fertilization levels on corn and black oat yield using different grazing intensities, poultry litter levels (mixture of manure and bedding material) and a chemical fertilization level. The experimental design was a randomized complete block in a split-plot arrangement with four replicates. Black oat + ryegrass grazing intensities, characterized by different pasture sward management, with animal entrance at 25, 30 and 35-cm heights and exit at 5.0, 10 and 15-cm heights, were established at the main plots. After the grazing period, corn was grown at the subplots with four levels of poultry litter (0, 4,953, 9,907 and 14,860 kg ha-1), aiming to supply 0, 100, 200 and 300 kg ha-1 of nitrogen, and a treatment with chemical fertilizer, according to soil analysis. Grazing intensities had no effect on corn yield. Corn yield was 7,493, 8,458, 9,188, 10,247 and 11,028 kg ha-1, respectively, for the treatments without and with 4,953, 9,907 and 14,860 kg ha-1 of poultry litter, and the treatment with chemical fertilization. Poultry litter levels have a residual effect on the production of black oat grown in succession to corn.