Effects of PDE type 5 inhibitors on Left Ventricular Diastolic Dysfunction in Resistant Hypertension

Resistant hypertension (RHTN) is a multifactorial disease characterized by blood pressure (BP) levels above goal (140/90 mmHg) in spite of the concurrent use of three or more antihypertensive drugs of different classes. Moreover, it is well known that RHTN subjects have high prevalence of left ventricular diastolic dysfunction (LVDD), which leads to increased risk of heart failure progression. This review gathers data from studies evaluating the effects of phosphodiesterase-5 (PDE-5) inhibitors (administration of acute sildenafil and short-term tadalafil) on diastolic function, biochemical and hemodynamic parameters in patients with RHTN. Acute study with sildenafil treatment found that inhibition of PDE-5 improved hemodynamic parameters and diastolic relaxation. In addition, short-term study with the use of tadalafil demonstrated improvement of LVDD, cGMP and BNP-32 levels, regardless of BP reduction. No endothelial function changes were observed in the studies. The findings of acute and short-term studies revealed potential therapeutic effects of IPDE-5 drugs on LVDD in RHTN patients.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Sombreamento dos cafezais: III - Resultados do 5º biênio (1961/1962)

This paper deals with data obtained in 1961 and 1962 in shaded and unshaded coffee plots at Piracicaba, São Paulo, Brazil. The results can be summarized as follows: a - the production, in shaded and unshaded plots, did not show differences statistically significant; b - the percentage of coffee berry borer infestation was higher in shaded plots as compared with unshaded ones; c - coffee fruits brought from the field in the harvest time yielding up in sunshaded plots as compared with shaded ones.

Untitled 5 Detail B

Detail of Untitled 5, 2010, pastel on paper.

Untitled 5 Detail A

Detail of Untitled 5, 2010, pastel on paper.

Untitled 5

Untitled, 2010, pastel on paper, 10.5' x 6'.

Desenvolvimento das gônadas de Dermatobia hominis (Diptera: Cuterebridae)

O trabalho descreve o desenvolvimento das gônadas do berne (D. hominis) durante o período pupal. As pupas desenvolvidas de larvas com peso superior a 650 mg, deram imagos fêmeas, enquanto que as desenvolvidas daquelas pesando entre 500 e 650 mg deram macho, tendo havido um erro ao redor de 5%. Até o oitavo dia de pupação os testículos crescem mais que os ovários; a partir daí diminui o desenvolvimento, parando de crescer entre o vigésimo e vigésimo quinto dias. A espermatogênese inicia por volta do sétimo dia de pupa quando é grande o número de espermatócitos. No décimo dia alguns testículos apresentam considerável número de espermátides e os espermatozóides começam a aparecer por volta do vigésimo dia. A espermiogênese desenvolve-se sem interrupção e ao final da pupação quase toda loja testicular está repleta de espermatózóides. Os machos começam a nascer dois dias antes das fêmeas. Nessas, os ovaríolos aparecem formados por volta do oitavo dia de pupa; os folículos se individualizam por volta do vigésimo dia de pupa onde se distingue os trofócitos com núcleos politênicos e citoplasmas bem basófilos, enquanto o ovócito tem citoplasma mais acidófilo e núcleo com cromatina bastante frouxa. A vitelogênese tem início ao redor do vigésimo quinto dia de pupa e se completa ao nascimento da imago. A ligação das gônadas com suas respectivas estruturas somáticas acontece ao redor do décimo terceiro dia de pupação.

Aspectos ecológicos da leishmaniose tegumentar americana: 5. Estratificação da atividade espacial e estacional de Phlebotominae (Diptera, Psychodidae) em áreas de cultura agrícola da região do Vale do Ribeira, Estado de São Paulo, Brasil

A composição e estratificação da atividade Phlebotominae desenvolvida numa mata residual e área aberta com intensa atividade agrícola, tomam parte desta investigação. O emprego da armadilha CDC tornou acessivo determinar a fauna local. Treze espécies e um número global de 5.423 indivíduos foram capturados. Os pontos situados no ecótono foram os que apresentaram maiores rendimentos, com destaque para P. intermedius, L. migonei e L. fischeri. Desse modo, os resultados levam acreditar serem portadoras de hábito acrodendrófilo. Por outro lado, quando o resultado global foi agrupado segundo o sexo masculino e feminino, o primeiro foi predominante. A análise da distruição estacional dessas espécies citadas revelou claramente picos de atividades mais elevados, bi e tri-modal, para diferentes estações. Na estação outono, P. intermedius teve atividade quase exclusivamente ao nível do solo. Esta exclusividade praticamente se estendeu aos locais de coleta situados em campo aberto.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for the Seychelles

Tobacco control has been recognized as a main public health concern in Seychelles for the past two decades. Tobacco advertising, sponsoring and promotion has been banned for years, tobacco products are submitted to high taxes, high-profile awareness programs are organized regularly, and several other control measures have been implemented. The Republic of Seychelles was the first country to ratify the WHO Framework Convention on Tobacco Control (FCTC) in the African region. Three population-based surveys have been conducted in adults in Seychelles and results showed a substantial decrease in the prevalence of smoking among adults between 1989 and 2004. A first survey in adolescents was conducted in Seychelles in 2002 (the Global Youth Tobacco Survey, GYTS) in a representative sample of 1321 girls and boys aged 13-15 years. The results show that approximately half of students had tried smoking and a quarter of both boys and girls had smoked at least one cigarette during the past 30 days. Although "current smoking" is defined differently in adolescents (>or=1 cigarette during the past 30 days) and in adults (>or=1 cigarette per day), which precludes direct comparison, the high smoking prevalence in youth in Seychelles likely predicts an increasing prevalence of tobacco use in the next adult generation, particularly in women. GYTS 2002 also provides important data on a wide range of specific individual and societal factors influencing tobacco use. Hence, GYTS can be a powerful tool for monitoring the situation of tobacco use in adolescents, for highlighting the need for new policy and programs, and for evaluating the impact of current and future programs.