Temperature and atmospheric pressure may be considered as predictors for the occurrence of bacillary dysentery in Guangzhou, Southern China

Introduction The control of bacillary dysentery (BD) remains a big challenge for China. Methods Negative binomial multivariable regression was used to study relationships between meteorological variables and the occurrence of BD during the period of 2006-2012. Results Each 1°C rise of temperature corresponded to an increase of 3.60% (95%CI, 3.03% to 4.18%) in the monthly number of BD cases, whereas a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of BD cases by 2.85% (95%CI = 3.34% to 2.37% decrease). Conclusions Temperature and atmospheric pressure may be considered as predictors for the occurrence of BD in Guangzhou.

Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Introduction Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. Methods We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. Results After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.

Influence of physical exercise and sodium intake on arterial pressure and cardiac hypertrophy in rats

Evidence shows that cardiac hypertrophy (CH) is a risk factor for many cardiovascular diseases. Several stimuli may cause CH-like manifestations and promote volume or pressure overload. Exercise-induced cardiac hypertrophy is an expected adaptation to regular exercise training. Salt intake has been shown to be the most important determinant of blood pressure in different populations. The purpose of the present work was to verify the influence of physical exercise and sodium intake on the blood pressure and myocardium. The study was performed on 36 rats divided into six groups: Group I (diet without salt overload), Group II (diet without salt overload and swimming), Group III (diet with 2.5% NaCl solution and swimming), Group IV (diet with 5% NaCl solution and swimming), Group V (diet with 2.5% NaCl solution without exercise), Group VI (diet with 5% NaCl solution without exercise). The arterial pressure was significantly lower in Group I when compared with Group IV. The ratio of cardiac mass/body mass was increased in Groups III and IV. In conclusion, there was evidence that exercise training and NaCl intake promotes arterial hypertension and cardiac hypertrophy.

Pressure sores among malnourished necropsied adults - preliminary data

Pressure sores are common among bedridden, elderly, or malnourished patients, and may occur in terminal ill patients because of impaired mobility, fecal or urinary incontinence, and decreased healing capacity. The aim of this study was to compare frequency of pressure sores between malnourished and non-malnourished necropsied adults. METHOD: All (n = 201) adults (age ³ 18 years) autopsied between 1986 and 1996 at the Teaching Hospital of Triangulo Mineiro Medical School (Uberaba) were eligible for the study. Gender, race, weight, height and main diagnoses were recorded. Ninety-six cases were excluded because of probable body water retention (congestive heart failure, hepatic insufficiency, nephrotic syndrome) or pressure sores secondary to peripheral vascular ischemia. Body mass index (BMI) was used to define malnourished (BMI < 18.5 kg/m²) and non-malnourished (BMI > 18.5kg/m²) groups. RESULTS: Except for weight (42.5kg; range: 28-57 vs. 60; 36-134.5kg) and BMI (16.9; range: 12.4-18.5 vs. 22.7; range: 18.5-54.6kg/m²), respectively, there were no statistical differences among 43 malnourished and 62 non-malnourished cases in relation to age (54.9 ± 20.4 vs. 52.9 ± 17.9 years), percentage of white persons (74.4 vs. 64.5%), male gender (76.7 vs. 69.3%) and main diagnoses. Five malnourished (11.6%) and 7 (11.5%) non-malnourished cases had pressure sores (p=0.89). CONCLUSION: Pressure sores were equally common findings in necropsied persons with protein-energy malnutrition, as assessed by body mass index.

Low coronary perfusion pressure is associated with endocardial fibrosis in a rat model of volume overload cardiac hypertrophy

Left ventricular hypertrophy following volume overload is regarded as an example of cardiac remodeling without increased fibrosis accumulation. However, infarction is associated with increased fibrosis within the noninfarcted, hypertrophied myocardium, particularly in the subendocardial regions. It is conceivable to suppose that, as also occurs postinfarction, low coronary driving pressure may also interfere with accumulation of myocardial fibrosis following aortocaval fistula. PURPOSE: To investigate the role of acute hemodynamic changes in subsequent deposition of cardiac fibrosis in response to aortocaval fistula. METHOD: Aortocaval fistula were created in 4 groups of Wistar rats that were followed over 4 and 8 weeks: aortocaval fistula 4 and aortocaval fistula 8 (10 rats each) and their respective controls (sham-operated controls - Sh), Sh4 and Sh8 (8 rats each). Hemodynamic measurements were performed 1 week after surgery. Hypertrophy and fibrosis were quantified by myocyte diameter and collagen volume fraction at the end of follow up. RESULT: Compared with Sh4 and Sh8, pulse pressure, left ventricular end-diastolic pressure, and +dP/dt were higher in aortocaval fistula 4 and aortocaval fistula 8, but -dP/dt was similar. Coronary driving pressure (mm Hg), used as an estimate of perfusion pressure, was lower in aortocaval fistula 8 (52.6 ± 4.1) than in Sh8 (100.8 ± 1.3), but comparable between aortocaval fistula 4 (50.0 ± 8.9) and Sh4 (84.8 ± 2.3). Myocyte diameter was greater in aortocaval fistula 8, whereas interstitial and subendocardial fibrosis were greater in aortocaval fistula 4 and aortocaval fistula 8. Coronary driving pressure correlated inversely and independently with subendocardial fibrosis (r² = .86, P <.001), whereas left ventricular systolic pressure (r² = 0.73, P = .004) and end-diastolic pressure (r² = 0.55, P = 012) correlated positively and independently with interstitial fibrosis. CONCLUSION: Coronary driving pressure falls and ventricular pressures increase early after aortocaval fistula and are associated with subsequent myocardial fibrosis deposition.

Mapeamento do uso e cobertura da terra a partir da segmentação e classificação de imagens-fração solo, sombra e vegetação derivadas do modelo linear de mistura aplicado a dados do sensor TM/Landsat5, na região do reservatório de Tucuruí - PA

Técnicas de sensoriamento remoto são fundamentais para o monitoramento das mudanças de uso da terra, principalmente em áreas extensas como a Amazônia. O mapeamento de uso da terra, geralmente é realizado por métodos de classificação manual ou digital pixel a pixel, os quais consomem muito tempo. Este estudo aborda a aplicação do modelo linear de mistura em uma imagem Landsat-TM segmentada para o mapeamento das classes de uso da terra na região do reservatório de Tucuruí-PA para os anos de 1996 e 2001.

Detecção de cicatrizes de áreas queimadas baseada no modelo linear de mistura espectral e imagens índice de vegetação utilizando dados multitemporais do sensor MODIS/TERRA no estado do Mato Grosso, Amazônia brasileira

O objetivo desta pesquisa foi avaliar os dados do sensor MODIS para detectar e monitorar cicatrizes de áreas recém queimadas. Utilizamos imagens da reflectância de superfície do sensor MODIS: produto MOD09 (dia 5 de outubro) e produto MOD13A1 (meses de outubro e novembro). Foi avaliada também uma série temporal de um ano dos índices de vegetação (IV) EVI e NDVI (produto MOD13A1). Uma imagem do sensor ETM+ (dia 5 de outubro) foi utilizada como base para a delimitação dos polígonos amostrais e avaliação dos dados MODIS devido a sua melhor resolução espacial. A metodologia focou na aplicação do modelo linear de mistura espectral nas imagens reflectância para a geração das imagens fração sombra. Análises de regressão foram efetuadas para comparação entre o percentual de sombra derivado da imagem ETM+ e das imagens MODIS. As alterações multitemporais nas imagens IV foram avaliadas com base no teste de Tukey. Os resultados mostraram que a imagem fração sombra gerada a partir do produto MOD09 apresentou um R² = 0,66 (p < 0,01) em relação aos dados ETM+. Para as imagens do produto MOD13A1 não foram identificadas relações significativas. Os IV dentro dos mesmos polígonos apresentaram uma variação sazonal durante o ano. No entanto, não houve uma diminuição significativa dos valores destes índices nos meses onde foram observadas as cicatrizes de áreas recém queimadas. Portanto, o produto MOD09 mostrou-se mais eficiente que o produto MOD13A1 para a detecção de cicatrizes de áreas recém queimadas. A análise multitemporal dos IV sugeriu que não foi possível detectar este mesmo padrão na área de estudo.

Mapeamento da antiga cobertura vegetal de várzea do Baixo Amazonas a partir de imagens históricas (1975-1981) do Sensor MSS-Landsat

Este estudo apresenta um mapa da cobertura vegetal da planície de inundação do Rio Amazonas entre as cidades de Parintins (AM) e Almeirim (PA), com base em imagens Landsat-MSS adquiridas entre 1975 e 1981. O processamento digital dessas imagens envolveu a transformação para imagens-fração de vegetação, solo e água escura (sombra), seguido da aplicação de técnicas de segmentação e classificação por região. O mapa resultante da classificação foi organizado em quatro classes de cobertura do solo: floresta de várzea, vegetação não-florestal de várzea, solo exposto e água aberta. A precisão do mapa foi estimada a partir de dois tipos de informações coletadas em campo: 1) pontos de descrição: para validação das classes de cobertura não sujeitas a grandes alterações, como é o caso dos corpos d'água permanentes, e identificação de indicadores dos tipos de cobertura original presentes na paisagem na ocasião da obtenção das imagens (72 pontos); 2) entrevistas com moradores antigos para a recuperação da memória sobre a cobertura vegetal existente há 30 anos (44 questionários). Ao todo foram coletadas informações em 116 pontos distribuídos ao longo da área de estudo. Esses pontos foram utilizados para calcular o Índice Kappa de concordância entre os dados de campo e o mapa resultante da classificação automática, cujo valor (0,78) indica a boa qualidade do mapa de cobertura vegetal da várzea. Os resultados mostram que a região possuía uma cobertura florestal de várzea de aproximadamente 8.650 km2 no período de aquisição das imagens.

Land cover classification of Lago Grande de Curuai floodplain (Amazon, Brazil) using multi-sensor and image fusion techniques

Given the limitations of different types of remote sensing images, automated land-cover classifications of the Amazon várzea may yield poor accuracy indexes. One way to improve accuracy is through the combination of images from different sensors, by either image fusion or multi-sensor classifications. Therefore, the objective of this study was to determine which classification method is more efficient in improving land cover classification accuracies for the Amazon várzea and similar wetland environments - (a) synthetically fused optical and SAR images or (b) multi-sensor classification of paired SAR and optical images. Land cover classifications based on images from a single sensor (Landsat TM or Radarsat-2) are compared with multi-sensor and image fusion classifications. Object-based image analyses (OBIA) and the J.48 data-mining algorithm were used for automated classification, and classification accuracies were assessed using the kappa index of agreement and the recently proposed allocation and quantity disagreement measures. Overall, optical-based classifications had better accuracy than SAR-based classifications. Once both datasets were combined using the multi-sensor approach, there was a 2% decrease in allocation disagreement, as the method was able to overcome part of the limitations present in both images. Accuracy decreased when image fusion methods were used, however. We therefore concluded that the multi-sensor classification method is more appropriate for classifying land cover in the Amazon várzea.

Marcapasso com sensor de contratilidade regulado pelas variações do sistema nervoso autônomo na miocardiopatia chagásica crônica

OBJETIVO: Analisar o desempenho da estimulação cardíaca artificial com marcapasso do tipo VVIR cujo sensor é regulado pelas variações do sistema nervoso autônomo em pacientes chagásicos com distúrbio no sistema de condução. MÉTODOS: Estudados 47 chagásicos, 28 do sexo masculino, com idades entre 24 e 68 anos, 36 tinham bloqueio atrioventricular (AV) total; 8, bloqueio AV de 2º grau 2; e 3 doença do nódulo sinusal, e encontravam-se, de acordo com a NYHA, em classe I (4), II (15), III (16) e IV (12). Após o implante de marcapasso do tipo VVIR os pacientes foram acompanhados durante 12 meses. A resposta de freqüência foi registrada em gravações de Holter de 24h e divididos em dois grupos de acordo com a FC em repouso - grupo 1: >65bpm e grupo 2: <=65bpm, para estudo comparativo, considerando: 1) FC em exercício no período de pós-implante; 2) PA em repouso após o implante e 3) avaliação dos grupos de eletrodos identificados como TIR-60-UP e outros eletrodos. RESULTADOS: O grupo 1 teve em exercício menor variação entre seus valores, do que o grupo 2, indicando que esse tipo de sistema de estimulação permite controlar individualmente cada paciente. Os valores de PA em repouso e em exercício não foram diferentes entre os grupos. O eletrodo do tipo TIR-60-UP, comportou-se como os demais eletrodos. CONCLUSÃO: O marcapasso do tipo VVIR cujo sensor é regulado pelas variações do SNA propicia o restabelecimento dos mecanismos fisiológicos em chagásicos, sendo que 74% deles tiveram melhora de uma ou duas classes funcionais da NYHA.

Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP) in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3%) complained of high BP, and 61 (76.3%) received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%). One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5%) were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits). Currently, the therapeutic approach is not recommended, even in specialized clinics.

Brazilian multicenter study on efficacy and tolerability of trandolapril in mild-to-moderate essential arterial hypertension. EMBATHE substudy with ambulatory blood pressure monitoring

OBJECTIVE: A double-blind, placebo-controlled multicenter study involving 34 centers from different Brazilian regions was performed to evaluate the antihypertensive efficacy and tolerability of trandolapril, an angiotensin I converting enzyme inhibitor, in the treatment of mild-to-moderate systemic arterial hypertension. METHODS: Of 262 patients enrolled in this study, 127 were treated with trandolapril 2 mg/day for 8 consecutive weeks, and the remaining 135 patients received placebo for the same period of time. Reduction in blood pressure (BP) and the occurrence of adverse events during this period were evaluated in both groups. RESULTS: Significant reductions in both systolic and diastolic pressures were observed in patients treated with trandolapril when compared with those on placebo. Antihypertensive efficacy was achieved in 57.5% of the patients on trandolapril and in 42% of these normal values of BP were obtained. The efficacy of trandolapril was similar in all centers, regardless of the area of the country. In a subset of 30 patients who underwent ABPM, responders showed a significant hypotensive effect to trandolapril throughout the 24 hour day. The adverse event profile was similar in both trandolapril and placebo groups. CONCLUSION: Our results demonstrate, for the first time in a large group of hypertensive patients from different regions in Brazil, good efficacy and tolerability of trandolapril during treatment of mild-to-moderate essential systemic hypertension.

Influence of the elevation of the left ventricular diastolic pressure on the values of the first temporal derivative of the ventricular pressure (dP/dt)

PURPOSE: To assess the effects of the elevation of the left ventricular end-diastolic pressure (LVEDP) on the value of the 1st temporal derivative of the ventricular pressure (dP/dt). METHODS: Nineteen anesthetized dogs were studied. The dogs were mechanically ventilated and underwent thoracotomy with parasympathetic nervous system block. The LVEDP was controlled with the use of a perfusion circuit connected to the left atrium and adjusted to the height of a reservoir. The elevation of the LVEDP was achieved by a sudden increase in the height of a reservoir filled with blood. Continuous recordings of the electrocardiogram, the aortic and ventricular pressures and the dP/dt were performed. RESULTS: Elevation of the LVEDP did not result in any variation of the heart rate (167±16.0bpm, before the procedure; 167±15.5bpm, after the procedure). All the other variables assessed, including systolic blood pressure (128±18.3mmHg and 150±21.5mmHg), diastolic blood pressure (98±16.9mmHg and 115±19.8mmHg), LVEDP (5.5±2.49 and 9.3±3.60mmHg), and dP/dt (4,855 ± 1,082 mmHg/s and 5,149±1,242mmHg/s) showed significant increases following the expansion of the ventricular cavity. Although the elevation of the dP/dt was statistically significant, 6 dogs curiously showed a decrease in the values of dP/dt. CONCLUSION: Sudden elevation of the LVEDP resulted in increased values of dP/dt; however, in some dogs, this response was not uniform.

Laboratory assessment of the hypertensive individual. Value of the main guidelines for high blood pressure

OBJECTIVE: To determine if abnormal laboratory findings are more common in individuals with hypertension and in those with other risk factors, such as obesity, smoking and alcohol ingestion. METHODS: A study was carried out in the general outpatient clinics of a university hospital (145 individuals without previous diagnosis of hypertension) and the following variables were assessed: high blood pressure (as defined by the VI Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure - VI JNC), obesity [calculated using body mass index (BMI)], tobacco use, and alcoholic ingestion. The laboratory examinations consisted of the following tests: hemogram, glycemia, uric acid, potassium, total/HDL-fraction cholesterol, triglycerides, calcium and creatinine. RESULTS: High blood pressure was not associated with a higher number of abnormal laboratory tests. Hypertensive individuals with a BMI > or = 25kg/m² or normotensive obese individuals, however, had a higher frequency of diabetes (12X), hypertriglyceridemia (3X), and hypercholesterolemia (2X), as compared with hypertensive individuals with BMI <25kg/m² and preobese/normal weight normotensive individuals. CONCLUSION: High blood pressure is not associated with a higher frequency of abnormal laboratory tests. The association of high blood pressure and obesity, however, increases the detection of diabetes and dyslipidemias.

The effect of siesta in parameters of cardiac structure and in interpretation of ambulatory arterial blood pressure monitoring

OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21% of the records indicated that the person had taken a siesta (263 woman, 52±14 years). The average duration of the siesta was 118±58 minutes. RESULTS: (average ± standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138±16/85±11 vs 139±16/86±11 mmHg, p<0.05); 2) pressure loads during wakefulness including the siesta, were less than those observed without the siesta); 3) the averages of nocturnal sleep blood pressures were similar to those of the siesta, 4) nocturnal sleep pressure drops were similar to those in the siesta including wakefulness with and without the siesta; 5) the averages of BP in men were higher (p<0.05) during wakefulness with and without the siesta, during the siesta and nocturnal sleep in relation to the average obtained in women; 6) patients with a reduction of 0- 5% during the siesta had thickening of the interventricular septum and a larger posterior wall than those with a reduction during the siesta >5%. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.