Correlação entre medidas ecocardiográficas e hemodinâmicas na avaliação do átrio direito e ventrículo direito em pacientes com hipertensão pulmonar / Correlation between echocardiographic and hemodynamic measurements in right atrium and right ventricle assessments of patients with pulmonary hypertension

Introdução: Hipertensão Pulmonar (HP), uma condição clínica grave, pode levar à disfunção sistólica do ventrículo direto (DSVD), com implicações prognósticas. Pacientes com suspeita de HP devem ser submetidos ao ecocardiograma transtorácico (ECOTT) para diagnóstico e avaliação, colocando-o como o principal exame de triagem e acompanhamento. Objetivo: Verificar a associação e a concordância das medidas referentes à pressão média no átrio direito (AD) e à disfunção sistólica do ventrículo direto (DSVD) ao (ECOTT) e ao cateterismo de câmaras direitas (CCD) em pacientes com (HP). Métodos: Foram incluídos indivíduos com diagnóstico de (HP). Todos os pacientes foram submetidos ao ECOTT e CCD. Avaliou-se pelo ECOTT: área do átrio direito (AAD), pressão média do átrio direito (AD) através por meio do diâmetro e da colapsabilidade da veia cava inferior (PMADECOTT ), strain AD (SAD), TAPSE (excursão sistólica do plano anular tricúspide), MAF (mudança da área fracional), SPLVD (strain da parede livre do VD) e onda s´ tricuspídea. Pelo CCD avaliaram-se pressão média do (PMADCCD ) e índice cardíaco (IC). Resultados: Dos 16 pacientes, 13 eram do sexo feminino. A idade média foi de 44,4 anos (±14,9). Constataram-se associação entre pressão média do átrio direito PMADCCD com área do átrio direito, PMADECOTT pressão média do átrio direito e SAD strain do átrio direito (r=0,845, r=0,621 e r=-0,523, respectivamente; p< 0,05). Verificou-se associação entre as categorias de risco de mortalidade, mensuradas pelas medidas AAD da área do átrio direito e pressão média do átrio direito PMADCCD (X2=10,42; p=0,003), com concordância moderada (k=0,44; p=0,012). DSVD A disfunção sistólica do ventrículo direto estava presente em dez pacientes. Houve associação entre disfunção sistólica do ventrículo direto DSVD (presente ou ausente) e índice cardíaco IC (r=0,522; p=0,04), com concordância moderada (k=0,43; p=0,037). Conclusão: As medidas do ecocardiograma transtorácico (ECOTT) e cateterismo de câmara direita (CCD) demostraram associação na avaliação da pressão média do átrio direito com melhor associação entre área do átrio direito AAD e pressão média do átrio direito (PMADCCD) . Houve associação com concordância moderada quanto à disfunção sistólica do ventrículo direto (DSVD) entre métodos. (AU)

Introduction: Pulmonary hypertension (PH), a serious clinical condition, can lead to right ventricular systolic dysfunction (RVSD) with prognostic implications. Patients with suspected PH should undergo transthoracic echocardiography (TTE) for diagnosis and evaluation as the main screening and follow-up exam. Objective: To verify the associations of and agreement between measurements of mean pressure in the right atrium (RA) and RVSD with TTE Method: Individuals diagnosed with PH were included. All patients underwent TTE and RCC. The following were evaluated by TTE: right atrial area (RAA), mean right atrial pressure through the diameter and collapsibility of the inferior vena cava (RMAPTTE), RA strain (RAS), tricuspid annular plane systolic excursion, fractional area change, RV free wall strain, and tricuspid s' wave. Mean RA pressure (RMAPRCC) and cardiac index (CI) were evaluated through the RCC. Results: Of the 16 patients, 13 were female. The mean patient age was 44.4 (±14.9) years. An association was found between RMAPRCC and AAD, RMAPTTE, and RAS (r=0.845, r=0.621, and r=-0.523, respectively; p<0.05). There was an association between the mortality risk categories measured by the RAA and RMAPRCC measures (X2=10.42; p=0.003), with moderate agreement (k=0.44; p=0.012). RVSDJ was present in 10 patients. There was an association between RVSD (present or absent) and CI (r=0.522; p=0.04) with moderate agreement (k=0.43; p=0.037). Conclusion: The TTE and RCC measurements showed an association in the assessment of mean right atrial pressure, especially between RAA and RMAPRCC. An association with RVSD and moderate agreement between methods were also noted. (AU)

Noise level in neonatal incubators: A comparative study of three models.

BACKGROUND: Preterm infants usually have to spend a long time in an incubator, excessive noise in which can have adverse physiological and psychological effects on neonates. In fact, incubator noise levels typically range from 45 to 70 dB but differences in this respect depend largely on the noise measuring method used. The primary aim of this work was to assess the extent to which noise in an incubator comes from its own fan and how efficiently the incubator can isolate external noise. METHODS: Three different incubator models were characterized for acoustic performance by measuring their internal noise levels in an anechoic chamber, and also for noise isolation efficiency by using a pink noise source in combination with an internal and an external microphone that were connected to an SVAN958 noise analyzer. RESULTS: The incubators studied produced continuous equivalent noise levels of 53.5-58 dB and reduced external noise by 5.2-10.4 dB. CONCLUSIONS: A preterm infant in an incubator is exposed to noise levels clearly exceeding international recommendations even though such levels usually comply with the limit set in the standard IEC60601-2-19: 2009 (60 dBA) under normal conditions of use.

Ocorrência de cochonilhas em espinheira-santa (Maytenus ilicifolia Mart. ex Reissek) / Occurrence of mealybugs in "espinheira-santa" (Maytenus ilicifolia Mart. ex Reissek)

Maytenus ilicifolia é uma espécie medicinal nativa do Brasil que vem sendo cultivada para atender a crescente demanda do mercado. Os fatores que interferem na produção, tal como a incidência de pragas e doenças, devem ser estudados para garantir o incremento na produtividade. O objetivo deste trabalho foi registrar a ocorrência e a identificação de cochonilhas associadas a 15 acessos de espinheira-santa (Maytenus ilicifolia) do Banco Ativo de Germoplasma da Embrapa Clima Temperado e do Instituto Federal Sul-rio-grandense. Foi registrada a quantidade de plantas infestadas em cada acesso e identificado, em laboratório, as espécies de cochonilhas infestantes. O número de plantas infestadas variou entre os acessos. Foram identificadas as cochonilhas Ceroplastes sp. e Saissetia oleae, família Coccidae. Dos 10 acessos infestados, 23 (11,3%) plantas apresentaram infestação com Ceroplastes sp. e, apenas uma (0,5%), com Saissetia oleae. O acesso 133 mostrou a maior incidência de Ceroplastes sp. (33,3%), seguido do acesso 130 (25,0%). O acesso 123 foi o que apresentou menor quantidade de plantas infestadas (4,8%). Saissetia oleae ocorreu em apenas uma planta, pertencente ao acesso 136 (5,6%).

Maytenus ilicifolia is a medicinal species native to Brazil which has been cultivated to meet the growing market demand. Factors that interfere with the production, such as the incidence of pests and diseases, should be studied to ensure increased productivity. The aim of this study was to record the occurrence and the identification of mealybugs associated with 15 "espinheira-santa" (Maytenus ilicifolia) accessions from the Active Germplasm Bank of "Embrapa Clima Temperado" and "Instituto Federal Sul-rio-grandense". The quantity of infested plants in each accession was recorded and the species of infested mealybugs were identified in the laboratory. The number of infested plants varied among accessions. The identified mealybugs were Ceroplastes sp. and Saissetia oleae, family Coccidae. Of 10 infested accessions, 23 plants (11.3%) showed infestation with Ceroplastes sp., and only one (0.5%) with Saissetia oleae. Accession 133 showed the highest incidence of Ceroplastes sp. (33.3%), followed by accession 130 (25.0%). Accession 123 had the least amount of infested plants (4.8%). Saissetia oleae occurred in only one plant, belonging to accession 136 (5.6%).

Tratamento de reestenose intrastent com o novo stent farmacológico firebird TM, limerador de sirolimus - Resultados angiográficos e ultrassonográficos de um ano de evolução / Treatment of in-stent restenosis with the new firebird TM sirolimus eluting stent - One year angiographic and intravascular ultrasound follow-up results

Introdução: A reestenose intrastent (RIS), resultante da excessiva resposta reparadora neointimal após o implante da prótese, é uma das principais limitações da intervenção coronária percutânea. A despeito da eficácia dos stents farmacológicos (SF) de primeira geração no tratamento da RIS, questões relacionadas à segurança e ao perfil de flexibilidade/navegabilidade dessas próteses estimularam o desenvolvimento de novas gerações de SF. O novo SF Firebird TM (Microport Co. Ltd., Xangai, China) combina uma plataforma de aço inoxidável (316 L) de hastes finas (0,0040 polegada), um potente agente antiproliferativo (sirolimus, na dose de 9 ug/mm2) e um revestimento que inclui três camadas de polímero durável, que controla a liberação do fármaco. Apesar de ser um dos SF mais utilizados na China, pouco se conhece sobre seu desempenho, sobretudo em subgrupos de maior complexidade. Método: Entre fevereiro e dezembro de 2009, pacientes portadores de lesão reestenótica única, de stents não-farmacológicos, foram submetidos a intervenão coronária percutânea com implante de stent Firebird TM. Avaliação com angiografia ultrassom intracoronário (USIC) foi programada para todos os pacientes...

BACKGROUND: In-stent restenosis (ISR), resulting from excessive neointimal hyperplasia, is a major limitation of percutaneous coronary intervention. Despite the efficacy of first generation drug-eluting stents (DES) in the treatment of ISR, issues related to the safety and flexibility/navigability profile have encouraged the development of new generations of DES. The new FirebirdTM DES (Microport Co. Ltd., Shanghai, China) combines a stainless steel platform (L316) of fine struts (0,0040'), a powerful anti-proliferative agent (sirolimus, at a dose of 9 µg/mm²) and a coating that includes three layers of a durable polymer, which controls drug release. Though it is a most used DES in China, little is known about its performance, particularly in subgroups of greater complexity. METHOD: Between February and December 2009, patients with single bare metal stent restenotic lesions, were submitted to percutaneous coronary intervention with FirebirdTM stent implantation. Angiography and intravascular ultrasound (IVUS) were scheduled for all patients at 12 months of follow-up. The primary end-point was late loss and the percentage of in-stent volumetric obstruction at 12 months. RESULTS: Twenty-five patients with mean age of 56.8 ± 7.7 years were included, of which 80% were males and 40% diabetics. The anterior descending artery was the most frequently treated vessel (44%) and most lesions had a diffuse/proliferative pattern (64%). At 12 months, late luminal loss was 0.3 ± 0.24 mm, and no case of binary restenosis was identified. IVUS percent volumetric obstruction was 2.6 ± 1.9%. CONCLUSION: In this single center study, the new FirebirdTM DES showed favorable angiographic and IVUS results for the treatment of bare metal ISR at the one year follow-up.

[Analysis of participation in surveys in 5 countries: the importance for public health research]. / Análisis de la participación en encuestas de cinco países: relevancia para la investigación en salud pública.

This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology.

More than a tropical dream: South-South cooperation in HIV prevention.

AIDS: Latin American and Caribbean countries possess the capability and expertise to manage their own HIV/AIDS programs but still need help with financial capital and material resources for these programs to reach their potential. Latin American countries have been especially proactive in working with each other to share information and develop regional planning programs. The history of HIV program development in this region is briefly outlined. Countries are continuing to work together with each other and with the private sector to design and manage programs that prevent and/or treat HIV infection.^ieng

Antiretrovirals: reality or illusion?

AIDS: The use of antiretroviral drugs and combination therapy to treat HIV disease has been widely favored, despite obstacles such as cost, difficult dosing schedules, management of side effects, and inexperience of health practitioners in customizing treatment and counseling patients on use and adherence. Several benefits of drug therapy are discussed. One benefit is that the cost of therapy is lower than the overall cost of a patient not on therapy who will need more services and hospitalizations and will have higher incidences of opportunistic infections. Drug therapy also enables individuals to continue contributing to society by slowing the development of HIV and improving the quality of life. The Pan American Health Organization and UNAIDS are investigating ways to improve access to drugs in Latin America, the Caribbean, and other countries by working with pharmaceutical companies to coordinate drug purchases or negotiate price reductions. In addition, in order for antiretroviral therapy to be most effective, treatment should also include counseling, testing, and education.^ieng

Epidemiology of AIDS and tuberculosis.

This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Mycobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300,000 active tuberculosis cases and 120,000-150,000 tuberculosis deaths occurring annually among those coinfected. Over 500,000 coinfected people are thought to reside in the Americas, over 400,000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it affects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem. Tuberculosis prevention and control are still technically and economically feasible. However, more must be done to establish surveillance programs with laboratory support. More research is needed to determine what case prevention measures are best-suited to current circumstances and the HIV/AIDS presence. More effective preventive treatment regimens that are well tolerated, well complied with, and do not pose the risk of multiresistance need to be devised. More health workers need to be trained to suspect tuberculosis and to conduct timely and appropriate tests confirming this diagnosis. And finally, more must be done to standardize the types and durations of the various curative treatment regimens employed.

HIV/AIDS and its interaction with tuberculosis in Latin America and the Caribbean.

At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and roughly 2 million in Latin America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent Mycobacterium tuberculosis is far more common, current estimates indicating that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculous infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculous disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a bacilliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends to promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by these associated agents demands effective action in the form of well-coordinated measures involving throughgoing participation by all countries.

Role of drug injection in the spread of HIV in Argentina and Brazil.

Drug injectors' have become the second largest HIV transmission category in Argentina and Brazil, as is the case in many pattern I countries, making up more than one-quarter of all AIDS cases reported by 1991. HIV seroprevalence data suggest that the expanding proportion of AIDS cases attributable to drug injection stems from an absolute increase in the number of AIDS cases among drug injectors, and is not merely reflective of a decline in the proportion of cases reported in other transmission categories. Results of a review of studies in Argentina and Brazil indicate that HIV seroprevalence is increasing rapidly, contrary to the situation in some pattern I countries in which HIV seroprevalence among drug injectors is either stably high or increasing only slightly. Also contrary to most pattern I countries, cocaine rather than heroin is the injected drug of choice in Argentina and Brazil. Given that injectors of cocaine are more likely to be HIV infected than are heroin injectors, differences in the type of drug injected between countries may have distinct epidemiological consequences on the spread of HIV.

PIP: AIDS cases attributable to using contaminated needles in nonmedicinal drug injection have increased in Argentina from 11.3% in 1987 to 39% in 1991. A similar increase (from 1.8% in 1985 to over 30% in 1991) occurred in Brazil. To complement existing information, data searches were conducted and personal communications from current researchers were collected for a total of 24 documents from Argentina and 18 from Brazil. The median sample size was 68 in Brazil and 188 in Argentina; most studies were from outpatient facilities, males constituted more than two-thirds of the sample in half of the studies, and the median age (when reported) was between 16 and 29 years old. Analysis of data from selected studies showed that HIV seroprevalence among drug injectors in both countries has increased rapidly, with the greatest increase occurring in Brazil. This rapid increase may also be influenced by the fact that cocaine, rather than heroin, is the drug of choice. Cocaine injection involves drawing blood into the syringe before injection and also more frequent injections. The level of seroprevalence among drug injectors varies among different subpopulations. Sexually transmitted disease clinic attenders who are IV drug users show rates of 6.58% and 51.9% seropositivity. Incarcerated persons who are drug injectors were associated with seropositivity rates of 35% (adults), 60.9% (adolescents), 53.5% (adolescents in security institutes), and 18% (female inmates who volunteered for testing), with drug injection the most important risk factor in 90.4%. Among prostitute injectors, rates were reported of 20% in 1988 and 50% in 1989-90 in the same population. Street children in Rio de Janeiro who use IV drugs (68 of 3389 surveyed) had a rate of 13.2% in 1987-88. The risk factors associated with HIV infection among drug injectors are socioeconomic status and injecting and sex practices. Co-infection patterns among drug injectors have also been found, with concomitant HIV-1 and HTLV-1 reported in 20% of 85 HIV positive drug injectors. Overall, these data suggest that there is an absolute increase in the number of AIDs cases among drug injectors rather than a decline in the proportion of cases reported in other transmission categories. Drug injector transmission poses a threat to the sex partners and offspring of injectors and provides a bridge to the heterosexual infection of women. While there is no obvious quick solution to the problem of IV drug use, there are programs which can slow the spread of HIV among injectors. It is urgent to control sexual transmission and drug injection transmission of HIV in these countries.

HIV-1 and HTLV-I in sexually transmitted disease clinics in the Dominican Republic.

A cross-sectional seroprevalence study of human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus type I (HTLV-I) was undertaken among 494 attendees in two Santo Domingo sexually transmitted disease clinics in 1989. All participants were evaluated for Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and genital ulcers. Of the 494 participants, 15 (3.0%) were positive for HIV-1 and 14 (2.8%) were positive for HTLV-I. Twelve of 371 (3.2%) men were HIV-1 seropositive: 0 of 68 homosexual/bisexual and 12 (4.0%) of 302 heterosexual men (one seronegative male could not be classified). Three (2.4%) of 123 women were HIV-1 seropositive. One (1.5%) homosexual/bisexual man, five (1.7%) heterosexual men, and eight (6.5%) women were HTLV-I seropositive. Among heterosexual men, HIV-1 was associated with multiple lifetime sex partners (O.R. = 5.9; 95% C.I. = 1.4, 23; p = 0.007). HIV-1 was associated with genital ulcer disease among women (p = 0.004). Among women, HTLV-I was associated with professional sex work (O.R. = 18; 95% C.I. = 2.1, > 100; p = 0.001). These findings suggest the need for control of sexually transmitted diseases and targeted educational programs for prevention of HIV-1 and HTLV-I among individuals with high-risk behaviors in the Dominican Republic.