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.

Epworth's sleepiness scale in outpatients with different values of arterial blood pressure

OBJECTIVE: To compare sleepiness scores of the Epworth scale in patients with different levels of arterial pressure when undergoing outpatient monitoring within the context of clinical evaluation. METHODS: A total of 157 patients selected for outpatient monitoring of arterial pressure during hypertension evaluation were divided into 3 groups: group 1 - normotensive; group 2 - hypertensive; group 3 - resistant hypertensive. For analysis, values > or = 11 were considered as associated with respiratory disturbances during sleep. RESULTS: Seventeen (10.8%) patients in group 1, 112 (71.3%) in group 2, and 28 (17.8%) in group 3, which was composed of aged, more severely hypertensive individuals, were analyzed. Groups were similar relative to sex and body mass index, but different in relation to systolic and diastolic pressure levels and age. Despite an absolute difference, no statistically significant difference occurred between Epworth scores and in the proportion of patients with values > or = 11 (5.9% vs. 18.8% vs. 212.4%; P=0.37). Despite the positive association between degree of sleepiness measured with the scale and the severity of the hypertension, no statistical significance occurred following control by age (p=0.18). CONCLUSION: A positive correlation exists between degree of sleepiness and hypertension severity. The absence of a statistical significance shown in the present study could be due to a beta type of error. Instruments that render this complaint into an objective finding could help in the pursuit of an investigation of respiratory disturbances during sleep in more severely hypertensive patients, and should therefore be studied better.

Correlations Between the Collagen Content of the Human Left Ventricular Myocardium, Measured by Biochemical and Morphometric Methods

OBJECTIVE: To assess, in myocardium specimens obtained from necropsies, the correlation between the concentration of hydroxyproline, measured with the photocolorimetric method, and the intensity of fibrosis, determined with the morphometric method. METHODS: Left ventricle myocardium samples were obtained from 45 patients who had undergone necropsy, some of them with a variety of cardiopathies and others without any heart disease. The concentrations of hydroxyproline were determined with the photocolorimetric method. In the histologic sections from each heart, the myocardial fibrosis was quantified by using a light microscope with an integrating ocular lens. RESULTS: A median of, respectively, 4.5 and 4.3 mug of hydroxyproline/mg of dry weight was found in fixed and nonfixed left ventricle myocardium fragments. A positive correlation occurred between the hydroxyproline concentrations and the intensity of fibrosis, both in the fixed (Sr=+0.25; p=0.099) and in the nonfixed (Sr=+0.32; p=0.03) specimens. CONCLUSION: The biochemical methodology was proven to be adequate, and manual morphometry was shown to have limitations that may interfere with the statistical significance of correlations for the estimate of fibrosis intensity in the human myocardium.

Correlation between turbidimetric and nephelometric methods of measuring C-reactive protein in patients with unstable angina or non-ST elevation acute myocardial infarction

OBJECTIVE: To evaluate the performance of the turbidimetric method of C-reactive protein (CRP) as a measure of low-grade inflammation in patients admitted with non-ST elevation acute coronary syndromes (ACS). METHODS: Serum samples obtained at hospital arrival from 68 patients (66±11 years, 40 men), admitted with unstable angina or non-ST elevation acute myocardial infarction were used to measure CRP by the methods of nephelometry and turbidimetry. RESULTS: The medians of C-reactive protein by the turbidimetric and nephelometric methods were 0.5 mg/dL and 0.47 mg/dL, respectively. A strong linear association existed between the 2 methods, according to the regression coefficient (b=0.75; 95% C.I.=0.70-0.80) and correlation coefficient (r=0.96; P<0.001). The mean difference between the nephelometric and turbidimetric CRP was 0.02 ± 0.91 mg/dL, and 100% agreement between the methods in the detection of high CRP was observed. CONCLUSION: In patients with non-ST elevation ACS, CRP values obtained by turbidimetry show a strong linear association with the method of nephelometry and perfect agreement in the detection of high CRP.

Initial diagnostic errors in children suspected of having heart disease: prevalence and long-term consequences

OBJECTIVE: To access the incidence of diagnostic errors in the initial evaluation of children with cardiac murmurs. METHODS: We evaluated our 7-years of experience in a public pediatric cardiology outpatient clinic. Of 3692 patients who were sent to the hospital, 2603 presented with a heart murmur and were investigated. Patients for whom a disagreement existed between the initial and final diagnoses were divided into the following 2 groups: G1 (n=17) with an initial diagnosis of an innocent murmur and a final diagnosis of cardiopathy, and G2 (n=161) with an initial diagnosis of cardiopathy and a final diagnosis of a normal heart. RESULTS: In G1, the great majority of patients had cardiac defects with mild hemodynamic repercussions, such as small ventricular septal defect and mild pulmonary stenosis. In G2, the great majority of structural defects were interventricular communication, atrial septal defect and pulmonary valve stenosis. CONCLUSION: A global analysis demonstrated that diagnostic error in the initial evaluation of children with cardiac murmurs is real, reaching approximately 6% of cases. The majority of these misdiagnoses were in patients with an initial diagnosis of cardiopathy, which was not confirmed through later complementary examinations. Clinical cardiovascular examination is an excellent resource in the evaluation of children suspected of having cardiopathy. Immediate outpatient discharge of children with an initial diagnosis of an innocent heart murmur seems to be a suitable approach.

Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes

Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.

Comparison of Postprandial Lipemia between Women who are on Oral Contraceptive Methods and Those who are not

Background: Postprandial Lipemia (PPL) is a physiological process that reflects the ability of the body to metabolize lipids. Even though the influence of oral contraceptives (OC) on PPL is not known, it is a known fact that their use increases fasting lipid values. Objective: To compare the PPL between women who are on OC and those who are not. Methods: A prospective analytical study which assessed eutrophic women, aged between 18 and 28 years old, who were irregularly active and with fasting triglycerides ≤150 mg/dL. They were divided into two groups: oral contraceptive group (COG) and non-oral contraceptive group (NCOG). Volunteers were submitted to the PPL test, in which blood samples were collected in time 0 (12-hour fasting) and after the intake of lipids in times 180 and 240 minutes. In order to compare the triglyceride deltas, which reflect PPL, the two-tailed Mann-Whitney test was used for independent samples between fasting collections and 180 minutes (Δ1) and between fasting and 240 minutes (Δ2). Results: Forty women were assessed and equally divided between groups. In the fasting lipid profile, it was observed that HDL did not present significant differences and that triglycerides in COG were twice as high in comparison to NCOG. Medians of Δ1 and Δ2 presented significant differences in both comparisons (p ≤0.05). Conclusion: The results point out that women who are irregularly active and use OC present more PPL in relation to those who do not use OC, which suggests that in this population, its chronic use increases the risk of heart conditions.

Análise estatística da distribuição de Poisson

The general properties of POISSON distributions and their relations to the binomial distribuitions are discussed. Two methods of statistical analysis are dealt with in detail: X2-test. In order to carry out the X2-test, the mean frequency and the theoretical frequencies for all classes are calculated. Than the observed and the calculated frequencies are compared, using the well nown formula: f(obs) - f(esp) 2; i(esp). When the expected frequencies are small, one must not forget that the value of X2 may only be calculated, if the expected frequencies are biger than 5. If smaller values should occur, the frequencies of neighboroughing classes must ge pooled. As a second test reintroduced by BRIEGER, consists in comparing the observed and expected error standard of the series. The observed error is calculated by the general formula: δ + Σ f . VK n-1 where n represents the number of cases. The theoretical error of a POISSON series with mean frequency m is always ± Vm. These two values may be compared either by dividing the observed by the theoretical error and using BRIEGER's tables for # or by dividing the respective variances and using SNEDECOR's tables for F. The degree of freedom for the observed error is one less the number of cases studied, and that of the theoretical error is always infinite. In carrying out these tests, one important point must never be overlloked. The values for the first class, even if no concrete cases of the type were observed, must always be zero, an dthe value of the subsequent classes must be 1, 2, 3, etc.. This is easily seen in some of the classical experiments. For instance in BORKEWITZ example of accidents in Prussian armee corps, the classes are: no, one, two, etc., accidents. When counting the frequency of bacteria, these values are: no, one, two, etc., bacteria or cultures of bacteria. Ins studies of plant diseases equally the frequencies are : no, one, two, etc., plants deseased. Howewer more complicated cases may occur. For instance, when analising the degree of polyembriony, frequently the case of "no polyembryony" corresponds to the occurrence of one embryo per each seed. Thus the classes are not: no, one, etc., embryo per seed, but they are: no additional embryo, one additional embryo, etc., per seed with at least one embryo. Another interestin case was found by BRIEGER in genetic studies on the number os rows in maize. Here the minimum number is of course not: no rows, but: no additional beyond eight rows. The next class is not: nine rows, but: 10 rows, since the row number varies always in pairs of rows. Thus the value of successive classes are: no additional pair of rows beyond 8, one additional pair (or 10 rows), two additional pairs (or 12 rows) etc.. The application of the methods is finally shown on the hand of three examples : the number of seeds per fruit in the oranges M Natal" and "Coco" and in "Calamondin". As shown in the text and the tables, the agreement with a POISSON series is very satisfactory in the first two cases. In the third case BRIEGER's error test indicated a significant reduction of variability, and the X2 test showed that there were two many fruits with 4 or 5 seeds and too few with more or with less seeds. Howewer the fact that no fruit was found without seed, may be taken to indicate that in Calamondin fruits are not fully parthenocarpic and may develop only with one seed at the least. Thus a new analysis was carried out, on another class basis. As value for the first class the following value was accepted: no additional seed beyond the indispensable minimum number of one seed, and for the later classes the values were: one, two, etc., additional seeds. Using this new basis for all calculations, a complete agreement of the observed and expected frequencies, of the correspondig POISSON series was obtained, thus proving that our hypothesis of the impossibility of obtaining fruits without any seed was correct for Calamondin while the other two oranges were completely parthenocarpic and fruits without seeds did occur.

Riqueza em óleo nas sementes, amêndoas e cascas das bagas de mamona

This paper is a joined publication of the Depts. of Genetics and of Technology, of the E. S. A. "Luiz de Queiroz", Universidade de São Paulo, and deals with the variation of the percentage oil content in the whole seeds, the embryos and the seed-coat of 28 varieties of castor-beans (Ricinus communis, L.). Primarily, the authors, as a justification of this paper, make reference to the applications which castor-oil has in industry, medicine, etc. In accordance with the weight of 100 seeds, the varieties of castor-beans were classified into 3 classes : small seeds (100 seeds less than 30 g), medium seeds (100 seeds between 30 g and 60) and large seeds (100 seeds more than 60 g). The percentage of oil in the seed, embryo and seed-coat, the dimensions of the seeds and the weight of 100 seeds are given for every variety in table 1. In order to obtain an estimate of the variability for the methods of determination of the oil percentage, in the 3 differents parts of the seeds and also in the 3 groups of seeds, the coefficient of variability was calculate (table 2). It is showed that the variation in the seed and embryo is low and that in the seed-coat is very high. The analysis of variance, with regard to the difference among the 3 types of seeds (small, medium and large), among the 3 parts of the seed (whole seed, embryo and seed-coat) and residual error, is given in table 3. Only, the oil content of whole seeds among types of seeds was significant at the 5% level. The t test among the correspondent means is not significant for the difference between medium and large seeds is significant between both these types (medium and large) and small seeds. The fiducial limits in relation to the mean of the oil percentage in the 3 differents types of seed, show that there is one variety (n. 1013-2), which has a percentage of oil, in the medium type of seed, significantly at the 5% level (table 4), higher than the general mean. Since the distribution of the percentage of oil in the seedcoat is discontinuous, 5 groups were established (table 5). All the differences between groups are significant (table 6). For practical purposes, when we have to remove the seed coat, one should eliminate those varieties which loose at least 3% of oil by this procedure. There is a significant linear correlation at 5% level between the percentage of oil in the seed and in the embryo, of the smali and medium type of seeds (table 7), and also, when taking the 3 types together (lower part of table 7), one finds that the same is true. Also, the correlation between the percentages of oil in the embryo and in the seed-coat of the 3 types together is significant at 5% level. According to the results obtained in relation to the percentage in 28 varieties studied, it can be recommended, for breeding purposes, to work only with those varieties which belong to the medium and the large types of seeds.

Estudo comparativo entre métodos de contrôle quantitativo da produção leiteira

This paper deals with the estimation of milk production by means of weekly, biweekly, bimonthly observations and also by method known as 6-5-8, where one observation is taken at the 6th week of lactation, another at 5th month and a third one at the 8th month. The data studied were obtained from 72 lactations of the Holstein Friesian breed of the "Escola Superior de Agricultura "Luiz de Queiroz" (Piracicaba), S. Paulo, Brazil), being 6 calvings on each month of year and also 12 first calvings, 12 second calvings, and so on, up to the sixth. The authors criticize the use of "maximum error" to be found in papers dealing with this subject, and also the use of mean deviation. The former is completely supersed and unadvisable and latter, although equivalent, to a certain extent, to the usual standard deviation, has only 87,6% of its efficiency, according to KENDALL (9, pp. 130-131, 10, pp. 6-7). The data obtained were compared with the actual production, obtained by daily control and the deviations observed were studied. Their means and standard deviations are given on the table IV. Inspite of BOX's recent results (11) showing that with equal numbers in all classes a certain inequality of varinces is not important, the autors separated the methods, before carrying out the analysis of variance, thus avoiding to put together methods with too different standard deviations. We compared the three first methods, to begin with (Table VI). Then we carried out the analysis with the four first methods. (Table VII). Finally we compared the two last methods. (Table VIII). These analysis of variance compare the arithmetic means of the deviations by the methods studied, and this is equivalent to compare their biases. So we conclude tht season of calving and order of calving do not effect the biases, and the methods themselves do not differ from this view point, with the exception of method 6-5-8. Another method of attack, maybe preferrable, would be to compare the estimates of the biases with their expected mean under the null hypothesis (zero) by the t-test. We have: 1) Weekley control: t = x - 0/c(x) = 8,59 - 0/ = 1,56 2) Biweekly control: t = 11,20 - 0/6,21= 1,80 3) Monthly control: t = 7,17 - 0/9,48 = 0,76 4) Bimonthly control: t = - 4,66 - 0/17,56 = -0,26 5) Method 6-5-8 t = 144,89 - 0/22,41 = 6,46*** We denote above by three asterisks, significance the 0,1% level of probability. In this way we should conclude that the weekly, biweekly, monthly and bimonthly methods of control may be assumed to be unbiased. The 6-5-8 method is proved to be positively biased, and here the bias equals 5,9% of the mean milk production. The precision of the methods studied may be judged by their standard deviations, or by intervals covering, with a certain probability (95% for example), the deviation x corresponding to an estimate obtained by cne of the methods studied. Since the difference x - x, where x is the mean of the 72 deviations obtained for each method, has a t distribution with mean zero and estimate of standard deviation. s(x - x) = √1+ 1/72 . s = 1.007. s , and the limit of t for the 5% probability, level with 71 degrees of freedom is 1.99, then the interval to be considered is given by x ± 1.99 x 1.007 s = x ± 2.00. s The intervals thus calculated are given on the table IX.

Ripening of mango fruits. Competition of methods

Mangoes, cv. Imperial, were exposed, in post harvest, to the following methods of ripening: 1) sawdust burning; 2) alcohol vaporization; 3) calcium carbide (acetylene), 4) vapour of ethylene; and, 5) immersion in ethefon. All methods resulted in acceleration of ripening, when compared to controls. Calcium carbide, ethelene and ethefon were the best, methods. Alcohol vaporization also showed good results sawdust burning method showing low efficiency.

Doses and methods of distribution of potassium chloride on soybean crop (Glycine max (L.) Merrill) in a red latosol, affecting soil salinity, grain production and chemical composition of leaves

The present work deal t wi th an experiment under field conditions and a laboratory test of soil incubation the objectives were as follows: a. to study effects on soybean grain product ion and leaf composition of increasing doses of potassium chloride applied into the soil through two methods of distribution; b. to observe chemical modifications in the soils incubated with increasing doses of potassium chloride; and, c. to correlate field effects with chemical alterations observed in the incubation test, The field experiment was carried out in a Red Latosol (Haplustox) with soybean cultivar UFV - 1. Potassium chloride was distributed through two methods: banded (5 cm below and 5 cm aside of the seed line) and broadcasted and plowed-down. Doses used were: 0; 50; 100 and 200 kg/ha of K2O. Foliar samples were taken at flowering stage. Incubation test were made in plastic bags with 2 kg of air dried fine soil, taken from the arable layer of the field experiment, with the following doses of KC1 p,a. : 0; 50; 100; 200; 400; 800; 1,600; 3.200; 6,400 and 12,800 kg/ha of K(2)0. In the conditions observed during the present work, results allowed the following conclusions: A response by soybean grain production for doses of potassium chloride, applied in both ways, banded or broadcasted, was not observed. Leaf analysis did not show treatment influence over the leaf contents for N, P, K, Ca, Mg, and CI, Potassium chloride salinity effects in both methods of distribution for all the tested closes were not observed.

A comparative analysis of Cobb-Douglas model with additive and multiplicative error

This paper dis cusses the fitting of a Cobb-Doug las response curve Yi = αXβi, with additive error, Yi = αXβi + e i, instead of the usual multiplicative error Yi = αXβi (1 + e i). The estimation of the parameters A and B is discussed. An example is given with use of both types of error.

The interference of methods in the collection of teredinids (Mollusca, Bivalvia) in mangrove habitats

In the estuary of the Mamanguape River (Paraíba, Brazil), a new collection technique was developed and applied with virgin poles of mangrove trees Avicennia schaueriana (Verbenaceae), Rhizophora mangle (Rhizophoraceae), and Laguncularia racemosa (Combretaceae), taking into account wood preference, water salinity and depth influence during teredinid larval settlement. Sets of poles were vertically fixed in the riverbed at three sites along a decreasing salinity gradient, where they stayed for four months. The poles were collected and divided into upper, median, and lower segments, in agreement with different immersion regimes. An increase of 239% was obtained in the number of individuals when compared to a previous study in the same area using a different methodology. The species Teredo bartschi (Clapp, 1923), Nausitora fusticula (Jeffreys, 1860) and Bankia fimbriatula Moll & Roch, 1931 were registered in both studies, and the species Psiloteredo healdi (Bartsch, 1931) is here registered for the first time as occurring in that estuary. The species Neoteredo reynei (Bartsch, 1920), previously registered on tree branches of the mangrove habitat, was not found in the present work. Bankia fimbriatula, the most abundant species, did not show preference for any substratum but occurred significantly on the lower segment of the poles. N. fusticula, second in abundance, preferred to settle on poles of A. schaueriana and on any of the three segments. Aiming to assess the habitat variations, a more accurate study on teredinids diversity in mangrove ecosystems should be performed through a concomitant analysis from tree branches of the mangrove habitat, as well as from poles of mangrove trees or panels made of pine wood or mangrove trees wood. These collection devices should be maintained along a decreasing salinity gradient exposed to different tide levels.