Devices and Techniques for Blood Pressure Measurement and Criteria for Hypertension Adopted by Brazilian Physicians: Exploratory Study

OBJECTIVE: To determine technical procedures and criteria used by Brazilian physicians for measuring blood pressure and diagnosing hypertension. METHODS: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25,606 physicians in all Brazilian regions through a mailing list. The responses were compared with the recommendations of a specific consensus and descriptive analysis. RESULTS: Of the 3,621 (14.1%) responses obtained, 57% were from the southeastern region of Brazil. The following items were reported: use of an aneroid device by 67.8%; use of a mercury column device by 14.6%; 11.9% of the participants never calibrated the devices; 35.7% calibrated the devices at intervals < 1 year; 85.8% measured blood pressure in 100% of the medical visits; 86.9% measured blood pressure more than once and on more than one occasion. For hypertension diagnosis, 55.7% considered the patient's age, and only 1/3 relied on consensus statements. CONCLUSION: Despite the adequate frequency of both practices, it was far from that expected, and some contradictions between the diagnostic criterion for hypertension and the number of blood pressure measurements were found. The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals.

Assessment of the DIXTAL DX-2710 Automated Oscillometric Device for Blood Pressure Measurement with the Validation Protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)

OBJECTIVE: To assess the Dixtal DX2710 automated oscillometric device used for blood pressure measurement according to the protocols of the BHS and the AAMI. METHODS: Three blood pressure measurements were taken in 94 patients (53 females 15 to 80 years). The measurements were taken randomly by 2 observers trained to measure blood pressure with a mercury column device connected with an automated device. The device was classified according to the protocols of the BHS and AAMI. RESULT: The mean of blood pressure levels obtained by the observers was 148±38/93±25 mmHg and that obtained with the device was 148±37/89±26 mmHg. Considering the differences between the measurements obtained by the observer and those obtained with the automated device according to the criteria of the BHS, the following classification was adopted: "A" for systolic pressure (69% of the differences < 5; 90% < 10; and 97% < 15 mmHg); and "B" for diastolic pressure (63% of the differences < 5; 83% < 10; and 93% < 15 mmHg). The mean and standard deviation of the differences were 0±6.27 mmHg for systolic pressure and 3.82±6.21 mmHg for diastolic pressure. CONCLUSION: The Dixtal DX2710 device was approved according to the international recommendations.

Evolution of Cardiovascular Diseases Mortality in the Counties of the State of Rio de Janeiro from 1979 to 2010

Background: Cardiovascular Diseases (CVD) are the leading cause of death in Brazil. Objective: To estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010. Methods: The counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979–1989, 1990–1999, and 2000–2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period. Results: There was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000–2010). The drop in CBVD mortality was greater than that in IHD mortality. Conclusion: Mortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population.

Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

Cardiac Sympathetic Hyperactivity after Chemotherapy: Early Sign of Cardiotoxicity?

Background:Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 (123I-mIBG) seems to precede the drop in left ventricular ejection fraction.Objective:To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline.Methods:Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of 123I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2).Results:Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of 123I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of 123I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of 123I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of 123I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02).Conclusion:In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with 123I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.

Contribuição ao estudo do «vermelhão» do algodoeiro (Gossipium herbaceum)

During the years 1948, 1949 and 1951 a disease occurred in the cotton crops of the state of S. Paulo Brazil (S. Am.), which caused a severe drop in yields. The abnormality was characterized by a typical reddish - purple color of the leaves, being by this reason, called "vermelhão", that is, reddening of the cotton plant. The disease was associated with a dry season. Among the several hypotheses raised to explain the causes of the disease were: insect attack, potassium deficiency - where from the name "potash hunger" was also given -, and magnesium deficiency: In order to study the problem the Department of Agricultural Chemistry of the College of Agriculture of the University of São Paulo, at Piracicaba, carried out a series of experiments as follows: 1. pot experiments in which soil of one of the affected regions was used ("terra roxa", a red-brownish soil derived from basalt); 2. pot-soil experiments varying the moisture supplied; 3. sand culture experiments omitting certain elements from the nutrient solutions; 4. field plot experiments, conducted on a sandy soil; three different varieties were employed: Texas, Express, and I.A. 817; magnesium was applied either as sulfate or dolomitic limestone. All the experiments were completed with suitable chemical analyses. The results can be summarized as follows: 1. in the first trial, the not properly manured pots (minus Mg), symptoms were registered which were similar to the symptoms observed in the field; it was possible to establish some differences among three different types of reddening: due to lack of K in the mixed fertilizers used, the characteristic cotton rust made its appearance, the red color in the leaves of the minus Mg plants was all alike that described in the current literature as a symptom of Mg-deficiency; in all the treatments ocurred a yellow-reddish color in the leaves associated with the latest stages of maturity; 2. in the second experiment it was verified that when the plants in the pots with soil were kept 75 per cent of the water holding capacity, no symptom of deficiency showed up; was true even for the plants not receiving neither K nor Mg; however, plants supplied with only 25 per cent of the water holding capacity showed, respectively, cotton rust in the minus K treatment and the red purplish color in the minus Mg series; 3. the sand culture experiment confirmed lack of Mg as the cause of "vermelhão", being potash deficiency the responsible for cotton rust; 4. in the field experiment, variety LA. 817 revealed to be the most sensitive to "vermelhão" when Mg was omitted from the fertilizers; symptoms of K deficiency appeared when no K was supplied; both magnesium sulfate and dolomitic limestone proved to be equally effective in the control of "vermelhão"; 5. the analyses of material collected both in the field as well in the pots revealed that leaf petiole in the most reliable part to indicate the K and Mg status of the plant; the variation in Mg content suffered by the plants showing different stages of "vermelhão was, quantitatively, at least as large as that in K content, however when one deals with K deficient plants, that is, plants showing the typical rust, no variation occurred in the Mg content, whereas K in the dry mater dropped from more than 1 per cent to less than half per cent. Then, the following general conclusions can be drawn: 1. Mg deficiency is the cause of "vermelhão" of cotton crops; 2. K deficiency also occurred, but in a lesser degree; 3. the climate conditions - especially the lack of rain influenced the soil dynamic of K, and especially Mg, bringing a severe reduction in their assimilability; 4. the "vermelhão" disease can be easily controlled upon additions either of magnesium sulfate or dolomitic limestone.

Estudos sôbre a alimentação mineral da mandioca (Manihot utilissima Pohl.)

1. The present work was carried out to study the effects of mineral nutrients in the yield as well as in the composition of cassava roots. The variety "Branca de Sta. Catarina" was grown by the sand culture method, the following treatments being used: N0 P0 K0, N0 P1 Kl, N1 P0 K1, N2 P1 K0, N2 P1 K1, N1 P2 K1, and N1 P1 K2, where the figures 0, 1, and 2 denote the relative proportion of a given element. The nutrients were given as follows: N = 35 grams of ammonium nitrate per pot loaded with 120 pounds of washed sand; P1 = 35 grams of monocalcium phosphate; Kl = 28 grams of sulfate of potash. Besides those fertilizers, each pot received 26 grams of magnesium sulfate and weekly doses of micronutrients as indicated by HOAGLAND and ARNON (1939). To apply the macronutrients the total doses were divided in three parts evenly distributed during the life cycle of cassava. 2. As far yield of roots and foliage are concerned, there are a few points to be considered: 2.1. the most striking effect on yield was verified when P was omitted from the fertilization; this treatment gave the poorest yields of the whole experiment; the need of that element for the phosphorylation of the starchy reserves explains such result; 2.2. phosphorus and nitrogen, under the experimental conditions, showed to be the most important nutrients for cassava; the effect of potassium in the weight of the roots produced was much less marked; it is noteworthy to mention, that in absence of potassium, the roots yield decreased whereas the foliage increased; as potassium is essential for the translocation of carbohydrates it is reasonable to admit that sugars produced in the leaves instead of going down and accumulate as starch in the roots were consumed in the production of more green matter. 3. Chemical analyses of roots revealed the following interesting points: 3.1. the lack of phosphorus brought about the most drastic reduction in the starch content of the roots; while the treatment N1 P1 K1 gave 32 per cent of starch, with NI PO Kl the amount found was 25 per cent; this result can be explained by the requirement of P for the enzymatic synthesis of starch; it has to be mentioned that the decrease in the starch content was associated with the remarkable drop in yield observed when P was omitted from the nutrient medium; 3.2. the double dosis of nitrogen in the treatment N2 P1 K1, gave the highest yields; however the increase in yield did not produce any industrial gain: whereas the treatment N1 P1 K1 gave 32 per cent of starch, by raising the N level to N2, the starch content fell to 24 per cent; now, considering the total amount of starch present in the roots, one can see, that the increase in roots yield did not compensate for the marked decrease in the starch content; that is, the amount of starch obtained with N1 P1 K1 does not differ statistically from the quantity obtained with N2 P1 K1; as far we know facts similar to this had been observed in sugar beets and sugar cane, as a result of the interaction between nitrogen and sugar produced; the biochemical aspect of the problem is very interesting: by raising the amount of assimilable nitrogen, instead of the carbohydrates polymerize to starch, they do combine to the amino groups to give proteinaceous materials; actually, it did happen that the protein content increased from 2.91 to 5.14 per cent.

Nota sobre ácaros (Acari) atacando fruteira-do-conde (Rollinia sp.)

The flowers of this orchard tree presents six fleshy petals, fused two by two, and disposed propeller like. In the center is a cavity which harbors the cone shaped reproductive organs. An eriophyid mite, described by H. H. Keifer as Aculops flechtmann Keifer, 1972, causes considerable bronzing to the petals (Fig. 1-A). Large numbers of this mite attacking the basis of the reproductive organs causes them to dry and drop. On the young fruits, which are squamous, this mite causes some rusting and small necrotic areas (Fig. 1-B). As the fruit grows these small areas remain dark and barky. Very often the necrotic areas are invaded by the false spider mite Brevipalpus phoenicis (Geijskes, 1939), which enlarges the damage. The false spider mite also attacks leaves and green stems; the epidermis of the latter then assumes a barky appearance.

Sobre o preparo dos parasitas da malária em distensões espessas, especialmente em amostras supersecas

I) the A. presents a method developed for the preparation of thick blood films, specially old desiccated smears. The observations are based on the experience of more than 53000 blood samples collected in the laboratory of the “Serviço de Malaria do Nordeste” as well as in the research department of the “Serviço de Malaria da Baixada Fluminenese”. II) As in introductory matter, he emphasizes the value of the obstacles presented by overdrying of the thick blood films occurring systematically in great malaria control organizations in which the laboratory receives materials from more or less remote localities, particularly in the Brazilian northeast, in regions invaded by Anopheles gambiae. III) An analysis of the causes of failure of the methods of Chorine and Knowles recorded in the literature for such purposes is given, as well as its adaptability for the simultaneous preparation of large numbers of samples. IV) The method is based the protective action of a previous fixation by a dilute solution of formalin, which, without preventing further dehemoglobinization, prevents morphological alterations in the parasites by the action of Knowles solution which is retained in this metod without modification. V) For washing out the acids of the dehemoglobinizating solution as well as for diluting the Giemsa stain, the A. proposes a very simple technique, extremely convenient for such purpose, which consists in adding acetic acid to the distilled water in the proportion of 1 drop for each 10cc of water, and then increasing the hydrogeni-on concentration to pH 7.2 with a 2% sol. of sodium carbonate. As indicator a 0.02% solution purple-bromcresol prepared in accordante to Medalia, is used. In this reaction there is the formation of the acetic acid ↔ sodium acetate, buffer system very suitable for giving a convenient pH and for preventing the precipitation of the dye, which can be used for two or three batches of 700 or 800 slides each, without changing the staining solution. VI) – The method can be summarized as follow: For a small number of samples, Coplin’s or any other staining jar can be used. Large number of slides must be placed in groups of 10 or 15 units each, the slides being separated by a piece of cardboard, according to Barber & Komp. A) Fix in dilute formalin (2%), during 5 minutes. b) Without washing, put in Knowles solution (see the formula in the text), no more than 20 minutes. c)Two successive washings in distilled water, buffered as explained above (which can be used several times). d) Dry and stain with Giemsa solution, prepared by using 1 drop of the stain for each c. c. of buffered distilled water. Time: 1 hour. E) Was in distilled water and dry.

Morfologia do Mycobacterium leprae hominis e do M. leprae muris: estudo baseado na microscopia electrônica e de contraste de fases

Hansen's Bacillus: By electron microscopy this bacillus shows membrane and halo, this being more visible when sorrounding the globi or bundles of bacilli; shows, also, free granules of various sizes which were before considered as dust of the dyes; shows external granules bound with the membrane and some times branching. By phases contrast microscopy examining leproma suspensions and subcataneous lymph at 400 x we saw many free granules with intense rotatory movement; granulated bacilli with screw, skip or stroke motion, producing slow progressive motion. All such elementes are surrounded by a halo, corresponding to the classical gloea. By a patient and delayed examination we were able to see that the internal granules are motile and help the progression of the bacilli, giving the impression that the cytoplasm is liquid. By a lasting observation we could see the larger granules form prolapse, like a pseudopode and abandon the bacilli and going in very rapid rotatory movement. There are branched bacilli; there are pedunculated fred granules like comets. The addition of a drop of formol at the preparation stops all movements. Stefansky's Bacillus: Repeated examination by RCA electron microscope, type EMU-25 of fresh suspensions of rat lepromas, led us to confirm the close relationship between human and murine leprosy agents. We examined also material from carabo (Lepra bubalorum) from Java, but due to fixation, the material was unsuitable for comparative studies. The Stefansky's bacilli showed also emmbranes and halos, internal or external granules (smaller than those of Hansen's bacillus). The bacilli shaded by chromium look thicker and shorter than those of Hansen. Due to electron bombardment both, Hansen's and Stefansky's baccilli suffer considerable alterations in their structure, showing black barrs of chromatin condensation at their extremities as also in their centers. By phase microscopy the Stefansky's bacilli showed elements with 1, 2 (bipolar), 3 or more internal small granules, developing identical movements as those of Hansen. The globi seem to be non-motile but the free bacilli appearing around the globi show intense movement. At 1000 x the examination is less satisfactory than at 400 x. The addition of formol solution in the preparation suppresses all movements, even the brownian, but the material becomes more suitable for the study of static morphology of the bacilli. CONCLUSION - The electron and phases contrast microscopy of leprous material from different types and phases of the disease may explain some of the unknown aspects of the biology and morphology of the bacilli.

Behavior of Biomphalaria glabrata, the intermediate host snail of Schistosoma mansoni, at different depths in water in laboratory conditions

Using three columns of different depths (1.10m, 8.40m and 10.40m), we investigated the possibility of Biomphalaria glabrata moving towards deep regions. In the 1.10m column, we noted that locomotion can occur in two manners: 1) when the foot is in contact with the substrate: a) sliding descent; b) sliding ascent; c) creeping descent; d) creeping ascent, 2) when the foot is not in contact with the substrate: a) sudden descent without emission of air bules; b) sudden descent with emission of air bules; c) sudden ascent. In the 8.40m column containing food on the bottom (experimental group), the snails remained longer at this depth when compared to those of the group which received no food (control). The sliding behavior was characteristic of locomotion occurring at 0 to 1m both in upward and downward directions. Creeping behavior was typical for the ascent of the snails that reached deeper levels. When the snails were creeping, the shell remained hanging as if it were heavier, a fact that may have been due to water entering the pulmonary chamber. In the 10.40m column, the snails slid downward to a depth of 4m or descended suddenly all the way to the bottom. Ascent occurred by creeping from the bottom to the surface. In the 8.40m and 10.40m columns, copulation, feeding and oviposition occurred at the deepest levels.

A review of achievements of the national schistosomiasis control program in middle and upper Egypt areas

In Egypt the "national schistosomiasis control program" was formulated to control transmission by reduction of prevalence and intensity of current infections, and thereby achieve an acceptable level of schistosomiasis disease control. The program was implemented foremost in Middle Egypt (1977) and Upper Egypt (1980), collectively extending 800 km alongside of the River Nile and accommodate about 10.5 million people. Schistosoma haematobium has been essentially the prevailing species infection in both areas. The strategy of control entailed both area-wide mollusciciding with niclosamide, and selective population chemotherapy with metrifonate. Evaluation in 1986 showed that prevalence dropped from pre-control 29.4% in Middle Egypt and 26.3% in Upper Egypt to 6% and 7.8% respectively, together with a remarkable drop of infections among children. Also mean intensity attained low levels consistent of low grade infections. It is evident therefore that in these areas where an enhancement of schistosomiasis infections had been anticipated the employment of the twofold strategy effected a state of low-prevalence/low-intensity signifying a lowered reservoir of infection and a substantial interference with the potentials of transmission.

Efficacy of insecticide impregnated bed-nets to control malaria in a rural forested area in Southern Cameron

Due to current spreading of chemoresistant strains of Plasmodium falciparum malaria control must incorporate vector control programmes. Due to well known constraints house sprayings cannot be performed as before. Personal protection can be developed and a large scale use of insecticide treated bed-nets appeared to be very useful to reduce man-vector contact in Asia, South America and West and East Africa. No trial has done is forest Central Africa where transmission is permanent. We performed such a trial in the southern part of Cameroon (using deltamethrin, at 25mg/m*) and obtained similar data to those observed in the Gambia Burkina Faso and Tanzania with a noteworthy reduction of both transmission and high parasitaemia of P. falciparum (respectively 78% and 75%) meaning a drop of malaria morbidity.

A simple and economic slide micro-immunoenzymatic (Micro-SIA) test for epidemiological studies of toxoplasmosis

A slide micro-immunoenzymatic assay (micro-SIA) to detectantibodies to non-particulate Toxoplasma gondii antigens is described. This assay allows the diagnosis of toxoplasmosis infection in about 1 hr. Twenty-four determinations can be performed per slide. Five hundred ng of antigen and 5 or 10 µl drop of each reactive are necessary per well. The clear contrast of colours obtained for negative and positive sera after the test is finished, allows direct discrimination of the results. However, it is possible to quantify the results of the reaction using a minireader. Sera dilution cutoff value, determined as themost frequent titre for the general population, is 1:100. The toxoplasma micro-SIA correlates well with indirect immunofluorescence (IIF), its sensitivity is atleast three times as much as IIF. The test has an intra and inter assay variation coefficient of 5.46 per cent and of 6.24 per cent respectively. Sera obtained at random from argentinian people were analyzed and a 56 per cent of infection was found. The main features of the Toxoplasma micro-SIA are its simplicity, sensitivity, reproducibility, and the virtual absence of background making it very suitable for screening tests.

Comparison of polymerase chain reaction on fresh tissue samples and fecal drops on filter paper for detection of Trypanosoma cruzi in Rhodnius prolixus

PCR detection of Trypanosoma cruzi in Rhodnius prolixus using fresh tissue or fecal drops on filter paper showed comparable results: 38.7% infection rate using the fresh tissue sample and 37.9% by dried fecal drop.