Assessing Strategies for Heart Failure with Preserved Ejection Fraction at the Outpatient Clinic

Background: Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice. Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF. Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women). The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1), tissue Doppler echocardiography (TDE) and electrocardiography (ECG) were used; in strategy 2 (S2), B-type natriuretic peptide (BNP) measurement was included. Results: In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%); GII, E/E'8 to 15 (n = 79; 48%); and GIII, E/E'< 8 (n = 71; 43%). HFPEF was confirmed in GI and excluded in GIII. In GII, TDE [left atrial volume index (LAVI) ≥ 40 mL/m2; left ventricular mass index LVMI) > 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation) parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%). In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL) consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL) consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL) consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8%) with HFPEF as compared with those identified in S1. Conclusion: The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in identifying patients whose diagnosis of HF had been previously excluded based only on TDE findings.

Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

Background:Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs.Objectives:To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years.Methods:All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05.Results:The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05).Conclusion:In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.

Electrophysiological Studies and Radiofrequency Ablations in Children and Adolescents with Arrhythmia

Background:Radiofrequency ablation is the standard non-pharmacological treatment for arrhythmias in pediatric patients. However, arrhythmias and their associated causes have particular features in this population.Objective:To analyze the epidemiological characteristics and findings of electrophysiological diagnostic studies and radiofrequency ablations in pediatric patients referred to the Electrophysiology Unit at Instituto de Cardiologia do Rio Grande do Sul, in order to characterize the particularities of this population.Methods:Cross-sectional study with 330 electrophysiological procedures performed in patients aged less than 20 years between June 1997 and August 2013.Results:In total, 330 procedures (9.6% of the overall procedures) were performed in patients aged less than 20 years (14.33 ± 3.25 years, age range 3 months to 19 years), 201 of which were males (60.9%). A total of 108 (32.7%) electrophysiological diagnostic studies were performed and of these, 48.1% showed abnormal findings. Overall, 219 radiofrequency ablations were performed (66.3%) with a success rate of 84.8%. The presence of an accessory pathway was the most prevalent finding, occurring in 158 cases (72.1%), followed by atrioventricular nodal reentrant tachycardia (16.8%), typical atrial flutter (3.1%) and extrasystoles originating from the right ventricular outflow tract (2.7%). Three patients developed complications during ablation (1.4%). Among congenital heart diseases, which occurred in 51 (15.4%) patients, atrial sept defect was the most frequent (27.4%), followed by ventricular sept defect (25.4%) and Ebstein's anomaly (17.6%).Conclusion:Electrophysiological study and radiofrequency ablation are effective tools for diagnosis and treatment of arrhythmias in the pediatric population.

Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Meiose em Tripsacum australe Cutler e Anderson (T. dactyhides subsp. hispidum Hitchcock)

Depois de uma breve introdução, mostrando a importância que o gênero Tripsacum desempenha hoje nos problemas da origem do milho, fizemos um estudo detalhado da meiose na nova espécie Tripsacum australe, descrita recentemente por CUTLER e ANDERSON (3) e espécie esta encontrada em estado selvagem na América do Sul. Todas as fases da meiose mostraram-se normais e o número cte cromosômios, facilmente determinado nas fases diacinese, metáfase I, metáfase II, é de 18 para a fase haplóide. Esta espécie não difere, quanto ao número de cromosômios, da forma diplóide Tripsacum dactyloide e da espécie Tripsacum floridanum, estudadas por LONGLEY (5). Segundo MANGELSDORF e REEVES (10) as formas de Tripsacum encontradas na América Central têm 72 cromosômios e são consideradas como autotetraplóides. Entretanto, no que se refere à presença de "knobs" nos cromosômios, esta espécie parece diferir da espécie estudada por LONGLEY (5). Tripsacum australe não apresenta "knobs" nas extremidades dos cromosômios e provavelmente também nas outras regiões pois as figuras que puderam ser examinadas não mostraram essa estrutura. Segundo MANGELSDORF e REEVES (10) os "knobs" presentes no milho teriam vindo de Tripsacum, por meio de cruzamento entre estes dois gêneros. Assim sendo, os tipos de milho cultivados próximos ao centro de distribuição das espécies de Tripsacum até então conhecidas, e que é a região da América Central, principalmente o México, deveriam se apresentar bastante contaminados por este gênero e apresentariam mais "knobs" do que aqueles tipos de milho cultivados ionge da referida região. Observações de vários autores (6, 7, 9, 20, 11 e 12) confirmam esta hipótese, inclusive aquelas realizadas por um dos autores deste trabalho (Graner, não publicado) em material sul-americano. Tendo sido encontrada agora esta nova espécie de Tripsacum na América do Sul, aparentemente sem "knobs", torna-se interessante verificar se ela não poderia ter contribuido para o estabelecimento das formas de milho sem "knobs" encontradas na América do Sul. Cruzamentos entre milho e Tripsacum australe foram realizados por um dos autores (Addison), não lendo porém produzido sementes. Outras pesuisas tornam-se então necessárias afim de que se possa tirar conclusões a respeito de tão importante assunto.

Erarbeitung von Richtwerten für das Ferritin im Serum durch Auswertung der in einer Laborarztpraxis gemessenen Konzentrationen männlicher und weiblicher Personen im Alter von 0 bis 20 Jahren : Vergleich mit den verfügbaren Referenzbereichen

Magdeburg, Univ. Med. Fak., Diss., 2011

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.

Medien, Bildung, Schule : Dokumentation der ersten Netzwerktagung Medienkompetenz Sachsen-Anhalt, Halle (Saale), 19. und 20. September 2011

Johannes Fromme (Hrsg.)

Abgasanalyse der Brennwertzentrale CGW 20/120

[s.c.]

Avaliação da exigência de calcário do solo

Foram estudados quatro métodos de avaliação da exigência de calcário de diversos solos, pertencendo a maioria a séries bem caracterizadas do Município de Piracicaba, Estado de São Paulo. Serviu como referência o método de incubação, segundo o qual 20 amostras foram tratadas com cinco doses de carbonato de cálcio puro, perfazendo um total de 100 amostras. Verificou-se que o método baseado na extração de hidrogênio ou prótons dos diversos componentes da acidez do solo, com solução 1 N de acetato de cálcio, pH = 7,0, é o mais simples, rápido e sensível, e forneceu um coeficiente de correlação r = 0,92, quando comparado com o método de incubação. O método que emprega a solução tampão SMP, e que também extrai hidrogênio ou prótons dos diversos componentes da acidez do solo, também foi eficiente (r = 0,90). O método baseado na elevação da saturação em bases a 85%, calculando-se a capacidade de troca de cátions CTC ou t, levando-se em conta o hidrogênio extraído com solução 1 N de acetato de cálcio, pH = 7,0, apresentou o coeficiente de correlação mais elevado (r = 0,96). Finalmente, o método baseado na extração do alumínio trocável com solução 1 N de KCl, relacionado à exigência de calcário para atingir o pH = 5,7, determinada por incubação, apresentou um coeficiente de correlação r = 0,72.

AUFBAU UND INBETRIEBNAHME EINER 20-L-EXPLOSIONSAPPARATUR

[s.c.]

Nutrição mineral de hortaliças: XXXII. marcha de absorção dos nutrientes pelo tomateiro (Lycopersicon esculentum Mill,) destinado ao processamento industrial

Reveste-se de grande importância o conhecimento da marcha de absorção de nutrientes pelas culturas, principalmente visando uma aplicação racional dos fertilizantes. Utilizou-se no presente experimento a cultivar Roma VF, de porte determinado, que tem tido grande aceitação tanto pelos tomaticultores como pelas industrias processadoras. As amostras para analise foram coletadas no período junho a outubro de 1977, em uma área experimental instalada num solo representativo da região oeste do Estado de São Paulo (Latossol Vermelho Amarelo), no município de Narandiba (DIRA de Presidente Prudente)· A cultura recebeu uma adubação de 85--300-100 kg/ha de NPK, sendo 1/3 do N aplicado juntamente com todo o P e K no plantio e os 2/3 restantes aplicados em cobertura aos 30 e 35 dias após a germinação. A área foi de 1,25 x 0,30 m (26,666 covas/ha), com culturais foram os normalmente recomendados para a cultura na região. As amostras (4 repetições) foram coletadas aos 15, 30, 45, 60, 75, 90 e 105 dias após a germinação. As plantas foram separadas em folhas cotiledonares, folhas, caule e frutos. Determinou-se o peso de matéria seca e analisou-se para N, P, K, Ca, Mg, S, B, Cu, Fe, Mo e Zn. Os resultados analíticos obtidos revelaram um crescimento lento ate aos 30 dias, após o que houve um crescimento acelerado, com o peso da materia seca praticamente dobrando a cada quinzena no período dos 45 aos 75 dias, atingindo o máximo aos 105 dias (5.706,61 kg/ha). Quanto ao crescimento dos frutos, expresso em peso de materia seca, houve um aumento de cerca de 20 vezes no intervalo dos 45 aos 75 dias, praticamente duplicando o peso no período dos 75 aos 90 dias e estabilizando-se aos 105 dias (2.708,6 kg/ha). Na época de floração, as folhas apresentavam, em função da materia seca, 3,7% N; 0,50% P; 4,44% K; 3,24% Ca; 0,99% Mg; 0,46% S; 72 ppm B; 15 ppm Cu; 434 ppm Fe; 375 ppm Mn; 0,18 ppm Mo; 148 ppm Zn. A produção efetiva de 65 ton/ha obtida na área experimental, contem as seguintes quantidades de nutrientes nos frutos: 67,8 g N; 8,9 g P; 112,2g K; 7,7 g Ca; 6,0 g Mg; 3,1 g S; 93 g B; 45 g Cu; 547 g Fe; 163 g Mn; 485 mg Mo.

Exigências nutricionais do sorgo sacarino

As exigências nutricionais de dois cultivares de sorgo sacarino (Brandes e Rio) foram estudadas em condição de campo e em casa de vegetação com cultivo em solução nutritiva. O ensaio em casa de vegetação foi conduzido em bandejões de 40 1 de capacidade contendo solução nutritiva de Hoagland e Arnon, e no campo, foram amostradas plantas que receberam adubação com 150-200-100 kg/ha de N, P2O5 e K2O, respectivamente. A ordem decrescente de exigências em casa de vegetação foi: K, N, Ca, Mg, P, S e Fe, Mn, Cu, Zn. Considerando a colheita dos colmos e dos grãos, o cultivar Brandes exportou 55% do N, 41% do P, 68% do K, 16% do Ca, 38% do Mg, 47% do S, 6% do Fe, 55% do Cu, 10% do Mn e 14% do Zn absorvidos, e o cultivar Rio exportou 59% do N, 43% do P, 72% do K, 10% do Ca, 44% do Mg, 60% do S, 1% do Fe, 66% do Cu, 8% do Mn e 10% do Zn absorvidos, em casa de vegetação. Em condição de campo, as exigências para produzir 1 tonelada de colmo foram de 3,22 a 3,93 kg de N, de 0,40 a 0,45 kg de P, de 3,91 a 4,3i kg de K, de o,02 a 0,77 kg de Ca, de 0,86 a 0,54 kg de Mg; de 0,32 a 0,41 kg de S, de 68,82 a 36,71 g de Fe, de 3,48 a 2,94 kg de Cu, de 16,43 a 18,05 g de Mn, de 7,72 a 8,77 g de Zn e de 17,99 a 20,47g de B.

Konzentrationen der Androgene fertiler Frauen zwischen dem 20. und 45. Lebensjahr in Abhängigkeit vom Alter und Zyklustag

Magdeburg, Univ., Med. Fak., Diss., 2015