Antihypertensive drug treatment changes in the general population: the CoLaus study.

BACKGROUND: Changes in antihypertensive drug treatment are paramount in the adequate management of patients with hypertension, still, there is little information regarding changes in antihypertensive drug treatment in Switzerland. Our aim was to assess those changes and associated factors in a population-based, prospective study. METHODS: Data from the population-based, CoLaus study, conducted among subjects initially aged 35-75 years and living in Lausanne, Switzerland. 772 hypertensive subjects (371 women) were followed for a median of 5.4 years. Data Subjects were defined as continuers (no change), switchers (one antihypertensive class replaced by another), combiners (one antihypertensive class added) and discontinuers (stopped treatment). The distribution and the factors associated with changes in antihypertensive drug treatment were assessed. RESULTS: During the study period, the prescription of diuretics decreased and of ARBs increased: at baseline, diuretics were taken by 46.9% of patients; angiotensin receptor blockers (ARB) by 44.7%, angiotensin converting enzyme inhibitors (ACEI) by 28.8%, beta-blockers (BB) by 28.0%, calcium channel blockers (CCB) by 18.9% and other antihypertensive drugs by 0.3%. At follow-up (approximately 5 years later), their corresponding percentages were 42.8%, 51.7%, 25.5%, 33.0% 20.7% and 1.0%. Among all participants, 54.4% (95% confidence interval: 50.8-58.0) were continuers, 26.9% (23.8-30.2) combiners, 12.7% (10.4-15.3) switchers and 6.0% (4.4-7.9) discontinuers. Combiners had higher systolic blood pressure values at baseline than the other groups (p < 0.05). Almost one third (30.6%) of switchers and 29.3% of combiners improved their blood pressure status at follow-up, versus 18.8% of continuers and 8.7% of discontinuers (p < 0.001). Conversely, almost one third (28.3%) of discontinuers became hypertensive (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), vs. 22.1% of continuers, 16.3% of switchers and 11.5% of combiners (p < 0.001). Multivariate analysis showed baseline uncontrolled hypertension, ARBs, drug regimen (monotherapy/polytherapy) and overweight/obesity to be associated with changes in antihypertensive therapy. CONCLUSION: In Switzerland, ARBs have replaced diuretics as the most commonly prescribed antihypertensive drug. Uncontrolled hypertension, ARBs, drug regimen (monotherapy or polytherapy) and overweight/obesity are associated with changes in antihypertensive treatment.

Hemodynamic effects of sodium bicarbonate in critically ill neonates.

OBJECTIVE: To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. DESIGN: Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration. SETTING: Neonatal intensive care unit, tertiary care center. PATIENTS: Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH < 7.25 in premature and < 7.30 in term infants, base deficit > -8). INTERVENTION: An 8.4% sodium bicarbonate solution diluted 1:1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula "base deficit x body weight (kg) x 1/3 x 1/2". MEASUREMENTS AND RESULTS: Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (-39.3%). Calculated systemic vascular resistance (SVR) (-10.7%) and diastolic BP (-11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline. CONCLUSION: Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.

Épocas de plantio da lentilha precoce em quatro regiões de Minas Gerais

Foram conduzidos cinco ensaios, todos irrigados, em quatro regiões de Minas Gerais: Viçosa, Leopoldina (Zona da Mata), Patos de Minas (Alto Paranaíba), Uberaba (Triângulo) e Janaúba (Norte), com o objetivo de determinar a melhor época de plantio da lentilha precoce. Em Viçosa, foram estudadas seis datas de plantio, de 15/3 a 30/5; em Leopoldina, quatro, de 7/4 a 10/6; em Uberaba e Patos de Minas, seis, de 17/2 a 2/6; e em Janaúba, cinco, de 16/5 a 3/8. O intervalo entre datas de plantio foi de, aproximadamente, 20 dias. No ensaio de Viçosa, foi utilizada a cultivar Precoz, plantada no espaçamento entre fileiras de 40 cm, com 30 sementes/m; nos outros ensaios, a Silvina, no espaçamento entre fileiras de 30 cm, com 50 sementes/m. Em geral, os maiores rendimentos foram alcançados quando o plantio foi feito em maio, principalmente na segunda quinzena. Em Viçosa, a lentilha também teve bom desempenho quando plantada na segunda quinzena de março. Em Leopoldina e Janaúba, os dois locais de temperaturas mais altas, o plantio no início de junho não prejudicou o rendimento, se comparado com o da segunda quinzena de maio. Nas épocas de plantio em que foram obtidos os maiores rendimentos, a lentilha precoce, após a emergência, levou entre 28 e 60 dias para iniciar o florescimento; e da emergência até a colheita, entre 92 e 112 dias. O maior rendimento médio foi alcançado em Leopoldina, quando o plantio foi realizado em 27/5: 1.644 kg/ha. O peso de 100 sementes da 'Silvina'variou de 5,5 a 6,3 gramas, quando o plantio foi feito em maio.

Estabelecimento de um protocolo regenerativo para a micropropagação do abacaxizeiro

No Laboratório de Fisiologia do Desenvolvimento e Genética Vegetal do CCA-UFSC, nos anos de 1993 a 1996, foram testadas 24 combinações de tratamentos envolvendo dois genótipos de abacaxizeiro (Ananas comosus (L.) Merr.), seis combinações dos fitorreguladores ácido naftalenoacético (ANA) e 6-benzilaminopurina (BAP), e os meios de cultura líquidos e geleificados, com o objetivo de estabelecer um protocolo regenerativo para a micropropagação do abacaxizeiro. A taxa de regeneração comportou-se de forma quadrática para a maioria das combinações testadas. O meio de cultura MS (Murashige & Skoog, 1962), líquido, adicionado de ANA (2,7 µM) e BAP (4,4 µM), proporcionou uma taxa média de regeneração de 19,7 brotos/explante. A magnitude do efeito genotípico exibido pelas cultivares utilizadas foi intermediária entre o efeito das combinações dos níveis de ANA e BAP (o maior) e o efeito da constituição física do meio de cultura. A melhor combinação de tratamentos foi testada em 17 acessos coletados no Estado de Santa Catarina, demonstrando-se a eficiência do protocolo regenerativo. A taxa média de regeneração foi de 15,3 brotos/explante, dos quais 40% apresentaram altura igual ou inferior a 3 cm. Brotos enraizados ou não, com altura igual ou superior a 3 cm, apresentaram valores médios de 95,5% de sobrevivência.

Voiko tieteenaloja verrata toisiinsa?

Kirjoitus perustuu alustukseen Suomen Kulttuurirahaston järjestämällä kulttuurinpuolustuskurssilla 14.-15.3. 2002

Résultats préliminaires de l'enclouage rétrograde de l'humérus [Preliminary results of retrograde nailing of the humerus]

A group of nine patients with a diaphyseal fracture of the humerus and treated with retrograde nailing were studied with a mean follow-up of 15.3 months. Six patients with a humeral fracture without neurological deficit showed a good shoulder and elbow mobility at the last visit. Three patients with neurological lesion preoperatively suffer from a diminished range of movement not related to the surgical procedure. During the operation and postoperatively we found no complication related to the implant and more precisely we could not find a iatrogenic fracture or nervous lesion except one intraoperative lesion of the radial nerve probably related to an important traction movement during reduction with complete remission. Consolidation has been achieved for all fractures but one. This patient suffers from a lesion of the brachial plexus with complete plegia of the arm and a vascular lesion. This patient had to be reoperated for an atrophic non-union by bone grafting and plate fixation. The retrograde nail is a good implant and must be considered in our treatment plans as much as conservative treatment or surgical treatment with plating, anterograde nailing or the use of an external fixator. Only then will we be able to give to the patient the most adapted treatment for his fracture.