Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective: Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results: We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE

AbstractBackground:Risk scores for cardiac surgery cannot continue to be neglected.Objective:To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.Methods:A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.Results:Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).Conclusion:Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0)

Potential Utility of the SYNTAX Score 2 in Patients Undergoing Left Main Angioplasty

Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

First- Versus Second-Generation Drug-Eluting Stents in Acute Coronary Syndromes (Katowice-Zabrze Registry)

Abstract Background: There are sparse data on the performance of different types of drug-eluting stents (DES) in acute and real-life setting. Objective: The aim of the study was to compare the safety and efficacy of first- versus second-generation DES in patients with acute coronary syndromes (ACS). Methods: This all-comer registry enrolled consecutive patients diagnosed with ACS and treated with percutaneous coronary intervention with the implantation of first- or second-generation DES in one-year follow-up. The primary efficacy endpoint was defined as major adverse cardiac and cerebrovascular event (MACCE), a composite of all-cause death, nonfatal myocardial infarction, target-vessel revascularization and stroke. The primary safety outcome was definite stent thrombosis (ST) at one year. Results: From the total of 1916 patients enrolled into the registry, 1328 patients were diagnosed with ACS. Of them, 426 were treated with first- and 902 with second-generation DES. There was no significant difference in the incidence of MACCE between two types of DES at one year. The rate of acute and subacute ST was higher in first- vs. second-generation DES (1.6% vs. 0.1%, p < 0.001, and 1.2% vs. 0.2%, p = 0.025, respectively), but there was no difference regarding late ST (0.7% vs. 0.2%, respectively, p = 0.18) and gastrointestinal bleeding (2.1% vs. 1.1%, p = 0.21). In Cox regression, first-generation DES was an independent predictor for cumulative ST (HR 3.29 [1.30-8.31], p = 0.01). Conclusions: In an all-comer registry of ACS, the one-year rate of MACCE was comparable in groups treated with first- and second-generation DES. The use of first-generation DES was associated with higher rates of acute and subacute ST and was an independent predictor of cumulative ST.

Fatôres que afetam a determinação da vitamina C na goiaba (Psidium guajava L.)

In the present paper the authors deal with the content of ascorbic acid in guavas (Psidium guajava L.) and the methods of sampling used. Ascorbic acid was determined directly in the photoeletric colorimeter (EEL), after extraction with a 4 per cent solution of oxalic acid. Guavas from various parts of State of S.Paulo were used and the general mean found was around 100 mgm of ascorbic acid per 100 gm fresh weight of the material used for extraction. It was found that there is great variation in the ascorbic acid content according to the condition of the fruit: Ascorbic acid Condition content in Mean mgm/100 gm Green and hard 93,36 - 119,54 102,43 Small green 57,34 - 92,30 83,40 Firm ripe 71,28 - 115,98 90,32 Overripe 63,22 - 85,98 77,36 Of the diferent parts of the fruit, the skin has the highest content; the pulp between the skin and the parts containing the seeds, the "inner pulp" contains little and finallw the central parts, formed by the pulp between seeds, the "inter pulp" a engligible amount. The proportion of ascorbic acid found in the skin, inner pulp and inter pulp may be as high as 1.6: 1: 0. Furthermore, the section near the peduncule and the sepals are richer than equatorial crossections. It was proved that the amount and intensity of sun-light is at least one important factant factor determining differences in the ascorbic acid content of the fruit, which is higer in the parts which have received more light. A sharp decrease was found in the vitamin C content of ripe fruite stored in a home refrigerator. The periods of the preservation were 12-24-48-96 hours and the decrease of the ascorbic acid content m per cent was 23.4 - 42.0 - 66.8 - 76.4 of the initial content of 144.28 mgm/100 gm. The following five different methods of sampling in the determination of the amount of vitamin C were tested, with extraction in a Waring blendor: 1) whole fruit; 2,) sample taken form fruits cut into many small pieces; 3) half of a fruit divided by a crossection at equal distance from both ends; 4) half of fruit divided lenghtwise; 5) a transversal slice of about 1 cm. It was found that the two first methods geve the most reliable results.

Estudos sôbre a alimentação mineral do cafeeiro, X: extração de macronutrientes na colheita pelas variedades "Mundo Novo", "Caturra" e "Bourbon Amarelo"

This paper deals with the determination of the content of macronutrients in pulp and beans of three coffee varieties, namely 'Mundo Novo', 'Caturra Amarelo' and 'Bourbon Amarelo'. Samples were collected in plantations located in the three types of soils herein most of S. Paulo, Brazil, coffee is grown, that is, "terra roxa legítima" (Ribeirão Preto), "massapé-salmourão" (Mocóca), and "arenito de Bauru" (Pindorama). The following main conclusions were drawn after statistical analysis of data obtained hereby. There is no statistical difference among the three varieties . Average contents of macronutrients, as per cent of the dry matter, are the following: N P K Ca Mg S bean 1,71 0,10 1,53 0,27 0,15 0,12 pulps 1.78 0,14 3,75 0,41 0,13 0,15 Samples collected in Mocóca ("massapé-salmourão") had lower N and K contents, probably due to lack of availability of these elements in the soil, as suggested by its analysis. Results obtained in this work are in good agreement with data described elsewhere. Out of the total of elements contained in the whole fruit the following proportions are exported as clean coffee: N - 2/3, P and K - 1/2, Ca, Mg and S - 1/3. It is clear therefore that a substantial amount of elements absorbed from the soil remains in the pulp or in the dry hulls which result from processing. From this fact raises the interest of using these residues as fertilizer in the coffee plantations.

A maturação do abacaxi

In the present work it was sougth to correlate the coloration of the fruit of Ananas comosus variety Perola with the pulp quality, aiming at the orientation of the fruit grower to the correct time of harvest. Pineapple fruit was chosen in 5 stages of maturation recognized by its external characteristics, principally its color. The fruits of each stage of maturation were analysed, determining the. weight, the percentage of soluble solids, and relation of acid to soluble solids. At the same time a test was made classifying the fruits as acid, regular, good, excellent, and spoiled. A correlation was found between the external coloration of the fruit and the degree of maturation. Concluding from this that the best time to harvest the variety Perola is in the third stage in the regions closest to the market and in the second stage in the regions which are farther away. For the cannery industry the fruit should be harvest in the first stage.

Osteopatologias e alterações dentárias em Otaria byronia (Pinnipedia, Otariidae) da costa do Rio Grande do Sul, Brasil

Bone diseases and tooth alterations in 47 specimens of Otaria byronia (Blainville, 1820), from southern Brazilian coast, were analized. Tooth wear and the associated bone pathologies were determined, as well as their percentuals. The main infection was osteomyelitis associated with tooth alterations, such as fractures and attrition, both of them exposing the pulp chamber. Tooth attrition increases with age, favoring fractures and their complications, including osteomyelitis, causing a high frequency of them in specimens presenting more pronounced tooth wear. In one specimen tuberculosis was found in the maxilla, perhaps primarily pulmonary. The high frequency of enamel hypoplasia might reflect cyclic food deficit. Infections and tooth fractures might be related to behaviour, such as fishermen interaction, territorial fighting, and accidents during food capture.

The influence of prior experience with artificial fruits on the ovipositioning behavior of Anastrepha fraterculus (Diptera, Tephritidae)

The South American fruit fly, Anastrepha fraterculus (Wiedemann, 1830) (Diptera, Tephritidae), is a leading pest of Brazilian fruit crops. This study evaluated how prior experience with artificial fruits containing peach and/or guabiroba pulp influenced the ovipositing behavior of A. fraterculus. Insects 15-21 days old were exposed to four treatments: 1) experience with guabiroba, Campomanesia xanthocarpa O. Berg (Myrtaceae); 2) experience with peach, Prunus persica (L.) Batsch (Chimarrita cultivar; Rosaceae); 3) experience with both fruits; and 4) no experience (naive). Naive females and females experienced with guabiroba pulp and with both fruits (peach and guabiroba) oviposited and showed dragging and puncturing behavior on substrates containing guabiroba, but females that were only exposed to peach pulp did not show a preference for any substrate. The study shows that prior experience with substrate influences ovipositing behavior in A. fraterculus.

Serum laminin in hepatosplenic human schistosomiasis

Serum laminin level was measured in chronic schistosomiasis. A significant increase in the mean serum laminin levels was observed in patients with hepatosplenic (HS) schistosomiasis (2,57 ± 0,83U/ml), as compared to those in patients with the hepatointestinal (HI) form of the disease (1,38 ± 0,45-U/ml) and in the control group (1,15 ± 0,31 U/ml). In the HS patients there was a significant direct relatiom between serum laminin and percutaneous splenic pulp pressure (r = 0,68). These findigs are compatible with an increased production of lamin in hepatosplenic schistosomiasis with may be related to the observed enlarged liver and spleen basement membranes in such disease.

Pathology of the spleen in hepatosplenic schistosomiasis. Morphometric evaluation and extracellular matrix changes

Histological, ultrastructural, morphometric and immunohistochemical data obtained from the study of spleens removed by splenectomy from 34 patients with advanced hepatosplenic schistosomiasis revealed that the main alterations were congestive dilatation of the venous sinuses and diffuse thickening of the splenic cords. Splenic cord thickening was due to an increase of its matrix components, especially type IV collagen and laminin, with the conspicuous absence of interstitial collagens, either of type I or type III. Deposition of interstitial collagens (types I and III) occurred in scattered, small focal areas of the red pulp, but in the outside of the walls of the venous sinuses, in lymph follicles, marginal zone, in the vicinity of fibrous trabeculae and in sidero-sclerotic nodules. However, fibrosis was not a prominent change in schistosomal splenomegaly and thus the designation "fibro-congestive splenomegaly" seems inadequate. Lymph follicles exhibited variable degrees of atrophy, hyperplasia and fibrous replacement, sometimes all of them seen in different follicles of the same spleen and even in the same examined section. Changes in white pulp did not seem to greatly contribute to increasing spleen size and weight, when compared to the much more significant red pulp enlargement.

Noctuidae moths occurring in grape orchards in Serra Gaúcha, Brazil and their relation to fruit-piercing

There is no study aiming to investigate if Noctuidae moths are responsible for piercing cultivated fruits in South America. This research aims to survey noctuid moths and list the species with mouth-parts (proboscis) morphology that suggest the capacity to cause damages to grape orchards in the state of Rio Grande do Sul, Brazil. Catches were carried out weekly from late November 2007 to late March 2008 (fructification period) using light traps and McPhail traps in three grape orchards in the region of Serra Gaúcha. The catches resulted in 187 taxa, with 149 identified at the specific level and 38 at genus level. The proboscises of representative taxa were removed and analyzed under stereomicroscope and scan electron microscope. It was verified that only Oraesia argyrosema (Hampson, 1926) and Gonodonta biarmata Guenée, 1852 show proboscis with suitable morphology for piercing rind and pulp of a grape berry. Achaea ablunaris (Guenée, 1852); Ascalapha odorata (Linnaeus, 1758); Letis mineis Geyer, 1827; Mocis latipes Hübner, 1823; Ophisma tropicalis Guenée, 1852, and Zale exhausta (Guenée, 1852) show proboscis only adapted to lacerate the pulp. The proboscis morphology of the remaining noctuid moths suggests lack of capacity to cause damage. Despite the presence of species capable of piercing grape berries, the populations of such species are very reduced and unable to cause damage of economic level.

Industrial and urban organic wastes increase soil microbial activity and biomass

Microbial processes have been used as indicators of soil quality, due to the high sensitivity to small changes in management to evaluate, e.g., the impact of applying organic residues to the soil. In an experiment in a completely randomized factorial design 6 x 13 + 4, (pot without soil and residue or absolute control) the effect of following organic wastes was evaluated: pulp mill sludge, petrochemical complex sludge, municipal sewage sludge, dairy factory sewage sludge, waste from pulp industry and control (soil without organic waste) after 2, 4, 6, 12, 14, 20, 28, 36, 44, 60, 74, 86, and 98 days of incubation on some soil microbial properties, with four replications. The soil microbial activity was highly sensitive to the carbon/nitrogen ratio of the organic wastes. The amount of mineralized carbon was proportional to the quantity of soil-applied carbon. The average carbon dioxide emanating from the soil with pulp mill sludge, corresponding to soil basal respiration, was 0.141 mg C-CO2 100 g-1 soil h-1. This value is 6.4 times higher than in the control, resulting in a significant increase in the metabolic quotient from 0.005 in the control to 0.025 mg C-CO2 g-1 Cmic h-1 in the soil with pulp mill sludge. The metabolic quotient in the other treatments did not differ from the control (p < 0.01), demonstrating that these organic wastes cause no disturbance in the microbial community.

Multivariate analysis applied to the study of the relationship between soil and plant properties in a peach orchard

In the State of Rio Grande do Sul, the municipality of Pelotas is responsible for 90 % of peach production due to its suitable climate and soil conditions. However, there is the need for new studies that aim at improved fruit quality and increased yield. The aim of this study was to evaluate the relationship that exists between soil physical properties and properties in the peach plant in the years 2010 and 2011 by the technique of multivariate canonical correlation. The experiment was conducted in a peach orchard located in the municipality of Morro Redondo, RS, Brazil, where an experimental grid of 101 plants was established. In a trench dug beside each one of the 101 plants, soil samples were collected to determine silt, clay, and sand contents, soil density, total porosity, macroporosity, microporosity, and volumetric water content in the 0.00-0.10 and 0.10-0.20 m layers, as well as the depth of the A horizon. In each plant and in each year, the following properties were assessed: trunk diameter, fruit size and number of fruits per plant, average weight of the fruit per plant, fruit pulp firmness, Brix content, and yield from the orchard. Exploratory analysis of the data was undertaken by descriptive statistics, and the relationships between the physical properties of the soil and of the plant were assessed by canonical correlation analysis. The results showed that the clay and microporosity variables were those that exhibited the highest coefficients of canonical cross-loading with the plant properties in the soil layers assessed, and that the variable of mean weight of the fruit per plant was that which had the highest coefficients of canonical loading within the plant group for the two years assessed.