Adesão ao tratamento e controle da pressão arterial por meio da monitoração ambulatorial de 24 horas

FUNDAMENTO: A hipertensão arterial sistêmica (HAS) é um importante fator de risco cardiovascular, no entanto os níveis de controle pressórico persistem inadequados. A avaliação da adesão ao tratamento anti-hipertensivo com a utilização da monitoração ambulatorial da pressão arterial (MAPA) de 24 horas pode representar um importante auxílio na busca de metas de controle da HAS. OBJETIVO: Avaliar a adesão ao tratamento anti-hipertensivo e a sua relação com os valores de PA obtidos pela MAPA de 24 horas entre pacientes hipertensos de centros de atenção primária à saúde (APS). MÉTODOS: Estudo transversal com 143 pacientes hipertensos de amostra representativa de serviço de APS do município de Antônio Prado, RS. Foi realizada aplicação do teste de Morisky e Green para avaliar a aderência ao tratamento e a verificação do número de medicamentos utilizados, seguida pela aplicação da MAPA de 24 horas. RESULTADOS: Observou-se que 65,7% da amostra foram considerados aderentes ao tratamento proposto, 20,3% eram moderadamente aderentes, enquanto somente 14% foram classificados como não aderentes. Do total de 143 pacientes avaliados, 79 (55,2%) foram identificados como HAS controlada (<130/80 mmHg) pelas medidas da MAPA de 24 horas, 64 (44,8%) não estavam controlados (>130/80 mmHg), 103 (72%) apresentaram ausência de descenso noturno da PA e 60 (41,9%) não estavam controlados durante o período de vigília. CONCLUSÃO: Verificamos, no presente estudo, que não há um controle adequado da HAS, com consequente perda de oportunidade dos profissionais envolvidos na APS de ajuste adequado das metas de PA preconizados. Esse fato ocorre a despeito de apropriada adesão ao tratamento anti-hipertensivo dos pacientes vinculados ao ambulatório de APS.

Hemodynamic Effect of Laser Therapy in Spontaneously Hypertensive Rats

Systemic arterial hypertension (SAH) is considered to be the greatest risk factor for the development of neuro-cardiovascular pathologies, thus constituting a severe Public Health issue in the world. The Low-Level Laser Therapy (LLLT), or laser therapy, activates components of the cellular structure, therefore converting luminous energy into photochemical energy and leading to biophysical and biochemical reactions in the mitochondrial respiratory chain. The LLLT promotes cellular and tissue photobiomodulation by means of changes in metabolism, leading to molecular, cellular and systemic changes. The objective of this study was to analyze the action of low-level laser in the hemodynamic modulation of spontaneously hypertensive rats, in the long term. Animals (n = 16) were randomly divided into the Laser Group (n = 8), which received three weekly LLLT irradiations for seven weeks, and into the Sham Group (n = 8), which received three weekly simulations of laser for seven weeks, accounting for 21 applications in each group. After seven weeks, animals were cannulated by the implantation of a catheter in the left carotid artery. On the following day, the systemic arterial pressure was recorded. The Laser Group showed reduced levels of mean blood pressure, with statistically significant reduction (169 ± 4 mmHg* vs. 182 ± 4 mmHg from the Sham Group) and reduced levels of diastolic pressure (143 ± 4 mmHg* vs. 157 ± 3 mmHg from the Sham Group), revealing a 13 and 14 mmHg decrease, respectively. Besides, there was a concomitant important decline in heart rate (312 ± 14 bpm vs. 361 ± 13 bpm from the Sham Group). Therefore, laser therapy was able to produce hemodynamic changes, thus reducing pressure levels in spontaneously hypertensive rats.

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Abstract Background: More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. Objectives: To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Methods: Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. Results: After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters. Conclusion: Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

Acumulação diferencial de nutrientes por cinco cultivares de milho (Zea mays L.): I - acumulação de macronutrientes

No presente trabalho, os autores apresentam os resultados de um ensaio de campo empregando os cultivares Agroceres 256, Agroceres 504, Centralmex, H-7974 e Piranão no sentido de aquilatar diferenças no crescimento, produção e acumulação e exportação de nutrientes. O ensaio foi conduzido num regossol de fertilidade mediana, exceto em relação ao K que é baixo, situado no Município de Piracicaba, SP. O delineamento experimental utilizado foi de blocos ao acaso com 4 repetições. Foram seguidas as práticas culturais comuns, e a adubação constituiu de 83 g da fórmula 30-120-70 por metro linear por ocasião do plantio e 33 g por metro linear da fórmula 50-0-4, em cobertura 22 dias após a germinação. Plantas foram coletadas a partir dos 20 dias após a germinação, em intervalos de 20 dias até os 120 dias. As plantas foram divididas em "colmo + folhas", pendão e espiga e analisadas para N, P, K, Ca, Mg e S. Concluíram os autores que diferenças entre cultivares na acumulação de matéria seca na parte vegetativa não se traduzem, necessariamente, por um aumento de peso da matéria seca na espiga. Os cultivares atingem o máximo da quantidade de nutrientes nas seguintes épocas, em dias: N (89-100); P (101-120); K (58-66); Ca (74-94); Mg (100-120); S (93-95). Verificaram, ainda, que as quantidades máximas extraídas em mg/planta são: N (3169-3878); P (541-642); K (3850-4693); Ca (582-782); Mg (654-943); S (444-799). Finalmente, a exportação de nutrientes nas espigas por hectare (50.000 plantas) colhidas é: N (111-143 kg); P (22-30 kg); Ca (0,7-1,1 kg); Mg (10-12kg); S(9-13kg).

Desenvolvimento e produtividade de algodoeiros sob efeito de reguladores vegetais

Neste trabalho efetuaram-se estudos para determinar os efeitos de reguladores vegetais em algodoeiro Gossypium hirsutum L. cv. IAC-17, através da análise de crescimento e produtividade em plantas submetidas a diferentes dosagens e épocas de aplicação de reguladores vegetais. Para conhecimento do desenvolvimento, produção, características agronômicas dos algodoeiros e características tecnológicas das fibras, sob ação de reguladores vegetais, realizou-se em Piracicaba (SP) na safra 1978/79 um experimento sob condições de campo, em uma área de 1700 m², onde foi implantada a cultura. Trataram-se os algodoeiros com: cloreto -1,1 - dimetil piperidíneo (DPC) nas concentrações de 84, 167 e 250 ppm; cloreto (2-cloroetil) trimetilamônio (CCC) nas concentrações de 250, 350 e 450 ppm e ácido (2 - cloroetil) fosfônico (CEPA) nas concentrações 1670, 3340 e 6680 ppm, sendo cada substância aplicada a 51, 65 e 143 dias após a germinação, respectivamente. Realizaram-se os tratos culturais normais recomendados para a cultura. Os resultados indicam que DPC e CCC tendem a reduzir a altura das plantas e o diâmetro da copa. Aplicações de DPC não afetaram os parâmetros da análise de crescimento do algodoeiro, sendo que CCC 25O ppm reduziu a área foliar e o peso da matéria seca. O índice de área foliar foi diminuído por 28 dias com aplicações de CCC 250 e 350 ppm, sendo que a menor concentração reduziu a eficiência fotossintética nas plantas e as concentrações mais elevadas de CEPA e CCC tenderam a diminuir o número de capulhos e o peso de algodão em caroço. CCC 350 ppm aparentemente aumentou o peso médio do algodão por capulho, enquanto CEPA 6680 ppm tendeu a reduzi-lo. Em cada tratamento, o peso das sementes e a porcentagem de fibras amostradas em 50 g de algodão em caroço,bem como o peso de 100 sementes, não foram afetados pela aplicação de CCC, DPC e CEPA. Também as características tecnológicas das fibras não foram afetadas pela aplicação dos reguladores vegetais.

Diet of the South American frog Leptodactylus ocellatus (Anura, Leptodactylidae) in Uruguay

The diet of Leptodactylus ocellatus (L., 1758) was studied in specimens collected at Maldonado Department (Uruguay), where monthly surveys were made between August 1998 and March 2000. A total of 143 frogs were collected, measured, sexed, and dissected, to assess stomach contents. The anurans were grouped into three age classes and four categories (considering sex and capture date). The trophic amplitude for each age class and sex-season category was quantified using Shannon-Weaver Index, and the trophic niche overlap between ages and categories by using the Pianka Index. Comparisons among treatments were made by G-tests. The most important prey items were coleopterans (IRI = 2547), and significant correlations were found between predator and prey sizes. The major differences on diet composition were found between extreme age classes (froglets and adults). Significant differences were also detected between sexes in the cold season but not in the warm season. Any of these changes in diet may be related with the availability of prey.

Flutuação de Diptera em granja avícola, Pelotas, Rio Grande do Sul, Brasil

In order to investigate the population fluctuation of Diptera in a poultry house in Pelotas, Rio Grande do Sul, Brazil, six collection methods were utilized: 1 (0 to 7 day-old feces from chickens), 2 (7 to 14 day-old feces), 3 (14 to 21 day-old feces), 4 (0 to 21 day-old feces), 5 (accumulated feces) and 6 (tube trap). Analyses of polynomial regression were accomplished independent of the collection method. The survey was conducted from August 1998 to July 1999 in chicken houses at the Conjunto Agrotécnico Visconde da Graça. A total of 28,720 Diptera were collected, including the following species: Coproica sp. and Telomerina flavipes (Meigen, 1830) (15,640); Drosophila repleta Wollaston, 1858 (9,229); Dohrniphora cornuta (Bigot, 1857) (2,539); Ischiolepta scabricula (Haliday, 1833) (544); Lestodiplosis sp. (320); Muscina stabulans (Fallen, 1817) (159); Musca domestica L., 1758 (143); Drosophila melanogaster Meigen, 1830 (95); Telmatoscopus albipunctatus Williston, 1893 (21); Rhegmoclema sp. (14); Fannia canicularis (L., 1761) (7); Stomoxys calcitrans (L., 1758) (2); and unidentified species of Psychodidae (6) and Muscidae (1). The greatest number of species occurred in October, November and December and the fewest in August, September and April. The greatest abundance of Diptera was recorded in October (9,092), while the lowest index of capture was noted in April (658). The population fluctuation was estimated for Coproica sp. and T. flavipes, D. repleta, D. cornuta, I. scabricula and Lestodiplosis sp.

Composition and diversity of Trichoptera (Insecta) larvae communities in the middle section of the Jacuí river and some tributaries, State of Rio Grande do Sul, Brazil

The taxonomic composition and diversity of Trichoptera larvae communities were studied in four lotic sites in central region of State of Rio Grande do Sul. Sampling was done monthly from June, 2001 to May, 2002 in four sites located at the middle section of Jacuí River (Point 4) and in three tributaries (Carijinho River - Point 1; Lajeado da Gringa - Point 2 and Lajeado do Gringo - Point 3), with a Surber sampler. The total number of larvae collected was 29,143, belonging to 25 genera distributed in nine families; twenty of these genera are new records for the State. The highest abundance was found at Point 2 (n = 12,547). The highest standardized richness, for a 1,177 specimens sample chosen by chance, was recorded at Point 1, followed by Point 4 (17.7 and 16 genera, respectively). The highest diversity was found at Point 1, and the lowest at Point 3 (H' = 1.31 and H' = 0.77, respectively). Point 1 had the lowest anthropic influence and the best preserved riparian vegetation, while Point 3 presented the highest anthropic impact, and a very reduced riparian vegetation. The diversity of Trichoptera observed in this study is low, compared to the estimated maximum theoretical diversity. Low diversity values are related to the low evenness, since the richness was relatively high. The Trichoptera larvae communities seem to be related to the food availability and physical features (riparian vegetation and anthropic influence) of the study sites.

Inquérito sôbre a doença de Chagas no hospital da Santa Casa de Misericórdia de Belo Horizonte (Minas Gerais, Brasil)

São relatados os resultados de um inquérito sôbre doença de Chagas realizado na Santa Casa de Misericórdia de Belo Horizonte (Minas Gerais, Brasil), com a finalidade de verificar a incidência desta moléstia e especialmente de sua forma cardíaca crônica entre os doentes ali internados. Foram examinados 181 pacientes adultos não selecionados, adotando-se os seguintes métodos: a) exame clínico geral e exame minucioso do aparelho circulatório; b) eletrocardiograma; c) reação de fixação do complemento para a doença de Chagas (antígeno de cultura do Schizotrypanum cruzi); d) reação de Wassermann; e) xenodiagnóstico e radiografia dos pacientes com reação de fixação do complemento (Guerreiro & Machado) positiva e de portadores de outras cardiopatias. Dos 181 pacientes examinados, 37 (20,44%) tinham provas de laboratório positivas para foença de Chagas. 49 (27,07%) eram portadores de cardiopatias, com as seguintes etiologias: doença de Chagas (18 casos); arteriosclerose (13 casos); hipertensão arterial (12 casos); sífilis (casos); febre reumática (3 casos); cardiopatia congênita (1 caso); cor pulmonale crônico (1 caso). De 34 pacientes com doença de Chagas, 18 (52,95%) apresentavam evidências eletrocardiográficas de comportamento miocárdico. As alterações eletrocardiográficas mais freqüentes foram: bloqueio do ramo direito, extra-sístoles ventriculares, alterações de QRS (isoladas ou associadas a alterações de T), bloqueios auriculo-ventriculares. Estes achados são semelhantes aos já descritos na cardiopatia chagásica crônica por Laranja e cols. (13,26). As alterações eletrocardiográficas mais frequentes no grupo de pacientes com provas de laboratório negativas para doença de Chagas foram: curvas de hipertrofia ventricular esquerda (strain) alteralçoes primárias de T e extra-sístoles vemtriculares. A idade de 50,0% dos pacientes com miocardite chagásica crônica não ultrapassou os 30 enquanto que 83,33% dos pacientes portafores de outras cardiopatias eram maiores de 30 anos. A reação de fixação do complemento (antígeno de cultura do Schizotrypanum cruzi), devido à sua especificidade e sensibilidade, mostrou ser muito util para o diagnóstico de laboratório da doença de Chagas em sua fase crônica. O xenodiagnóstico foi positivo em 8 casos (25,8%) de 31 pacientes com reação de Guerreiro & Machado positiva. Foi discutidoo problema da etiologia do megaesôfago e do megacolon, admitindo os Autores que adoença de Chagas possivelmente desempenhe, em determinadas zonas, papel significativo no desenvolvimento destas afecções. Foi brevemente relatada a distribuição geográfica dos triatomídeos no Estado de Minas Gerais. Os principais vetores são Panstrongylus megistus, Triatoma infestans e Triatoma sordida, se bem que outras 12 espécies ocorrem neste Estado. Estes triatomídeos existem em 204 (64,55%) dos 316 municípios do Estado de Minas. Vetores infetados foram encontrados em 143 municípios (70,09%). Foram assinaladas as áreas infetadas mais importantes. Os Autores salientaram a importância médica da doença de Chagas, acreditando ser esta infecção um dos mais importantes fatores de cardiopatia em amplas zonas rurais do Estado de Minas Gerais.

The patterns of tungiasis in Araruama township, state of Rio de Janeiro, Brazil

This paper describes patterns of infestation with Tunga penetrans (L., 1758) within the poor community of Araruama municipality, State of Rio de Janeiro, Brazil, assessed by the number of persons and domestic animals parasitized. The overall prevalence of infestation was 49.2% (211 parasitized hosts) of the 429 examined. Humans (p < 0.01) and dogs (p < 0.01) were the most important hosts with 62.6% and 35.6% respectively. Dogs were considered as the potential infestation source to humans. Considering sex and age groups, both measures showed a significant difference (p < 0.01): female (62.2% infested of 143 examined) and male (43.9% infested of 98 examined). All age classes were found infested with significant difference (G = 42.5; p < 0.01) and most of the infestation occurred in children in the 0-9-year old category (27.3%). In contrast and based on mean of chigoe burden per person, the parasitic intensity was significantly higher on male than on female in all age categories, except for the 50+ (H = 27.1; p < 0.01) and decreasing with the increase of age (chi2 = 69.7, A = -124.6, p < 0.01). Growing urbanization, improved housing and sewage systems, use of appropriate footwear, examination of the feet principally in young children, antitetanus prophylaxis and reduction of stray dogs population are the major prophylactic methods recommended.

Hepatitis B virus screening in contacts of blood donors with antibodies against core protein (anti-HBc), but without surface antigen (HBsAg)

To increase blood safety Brazil introduced screening for anti-HBc among blood donors in 1993. There was a decrease in the hepatitis B virus (HBV) transmission, but this measure identified a great number of HBsAg-negative, anti-HBc-positive donors. Surveillance policy determines that contacts of HBV carriers should be screened to HBV markers, but there is no recommendation about how to guide contacts of HBsAg-negative, anti-HBc-positive donors. Aiming to evaluate whether the contacts of this group are at greater risk for HBV infection, a cross-sectional study was performed to compare prevalence of HBV infection between contacts of HBsAg-positive blood donors (group I) and contacts of HBsAg-negative, anti-HBc-positive donors (group II). Contacts were submitted to a questionnaire and blood tests for HBV markers. In group I (n = 143), 53 (37.1%) were anti-HBc-positive and 11 (7.7%) were HBsAg-positive. In group II (n = 111), there were 9 and 0.9%, respectively. HBV exposure was associated with group I, sexual activity, blood transfusion, being one of the donor's parents, and living for more than ten years with the donor. Regarding the families as sample units, it was more common to find at least one member with HBV markers (p < 0.05) among the families of group I compared to group II. Contacts of HBsAg-negative, anti-HBc-positive individuals presented a much lower risk of having already been exposed to HBV and there is no need to screen them for HBV in low to moderate prevalence populations.

Association of cytokine genetic polymorphism with hepatites B infection evolution in adult patients

The infection by the hepatitis B virus (HBV) has different forms of evolution, ranging from self-limited infection to chronic hepatic disease. The objective of this study was to evaluate the influence of cytokine genetic polymorphisms in the disease evolution. The patients were divided into two groups, one with chronic HBV (n = 30), and the other with self-limited infection (n = 41). The genotyping for TNF (-308), TGFB1 (+869, +915), IL-10 (1082, -819, and -592), IL-6 (-174), and IFNG (+874) was accomplished by the PCR-SSP (polymerase chain reaction with sequence specific primers technique using the One Lambda kit. Although no statistically significant differences were found between the groups, the combination of TNF -308GG and IFNG +874TA was found in a lower frequency in chronic patients than in individuals with self-limited infection (26.7 versus 46.3%; P = 0.079; OR = 0.40; IC95% = 0.14-1.11). In chronic patients with histological alterations it was not observed the genotype TGFB1+869 C/C, against 24.4% in the self limited infection group (100 versus 75.6%; P = 0.096; OR = 7.67; IC95% = 0.42-141.63). Further studies in other populations, and evaluation of a greater number of individuals could contribute for a better understanding of the cytokine genetic polymorphism influence in HBV infection evolution.

Polymorphisms of toll-like receptor 2 and 4 genes in Chagas disease

The aim of this study was to test the possible implication of toll-like receptor 2 (TLR2) and TLR4 gene polymorphisms in determining the susceptibility to Chagas' disease. Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism in 475 individuals from Colombia, 143 seropositive with chagasic cardiomyopathy, 132 seropositive asymptomatic and 200 seronegative. The TLR2 arginine to glutamine substitution at residue 753(Arg753Gln) polymorphism was absent in the groups analyzed. The TLR4 Asp299Gly and Thr399Ile polymorphisms are in linkage disequilibrium and we observed a very low frequency of these polymorphisms in our study population (2.6% and 1.8% respectively). The overall TLR2 and TLR4 alleles and genotype distribution in seronegative and seropositive were not significantly different. We compared the frequencies between asymptomatic patients and those with chagasic cardiomyopathy and we did not observe any significant differences in the distribution of alleles or genotypes. In summary, this study corroborates the low frequency of TLR2 and TLR4 polymorphisms observed in other populations and suggest that these do not play an important role in Chagas' disease. The validation of these findings in independent cohorts is needed to firmly establish a role for TLR2 and TLR4 variants in Chagas' disease.

Frequency and types of human papillomavirus among pregnant and non-pregnant women with human immunodeficiency virus infection in Recife determined by genotyping

Women with human immunodeficiency virus (HIV) infection present a higher risk of infection by the human papillomavirus (HPV) and cervical cancer. To determine HPV genotypes and frequencies among HIV-positive women, an analytical cross-sectional study was carried out on 147 women (51 were pregnant and HIV-positive, 45 pregnant and HIV-negative and 51 HIV-positive and not pregnant), who were attended at a maternity hospital in Recife between April 2006-May 2007. They answered a questionnaire and underwent a gynaecological examination, with samples collected for HPV investigation by PCR, hybrid capture II, oncotic colpocytology (Papanicolau) and colposcopy. The frequency of HPV DNA was 85.3% (122/143), with a high proportion of HPV types that have been identified as high risk for cervical cancer. Among HIV-positive pregnant women, there was an HPV prevalence of 96% (48/50), of whom 60.4% (29/48) were high-risk. HPV 16, 58, 18, 66 and 31 were the most frequent types. Colpocytological abnormalities were observed in 35.3% (18/51) of HIV-positive non-pregnant women, 21.6% (11/51) of HIV-positive pregnant women and 13.3% (6/45) of HIV-negative pregnant women with a predominance of low-level lesions. A high prevalence of HPV infection was identified, especially with the high-risk types 16, 58, 18 and 66. This study identified high-risk HPV types in all three groups examined (HIV-positive pregnant women, HIV-negative pregnant women and HIV-positive not pregnant), characterising its distribution in this setting.

Interobserver variability of ultrasound parameters in portal hypertension

The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (κ = 0.714-0.795) for portal vein thrombosis and perfect (κ = 1) for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869) and splenic index (r = 0.816-0.905) and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675), splenic (r = 0.573-0.913) and superior mesenteric (r = 0.525-0.607) veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.