Caregivers' education vs rhinopharyngeal clearance in children with upper respiratory infections: impact on children's health outcomes.

Upper Respiratory Tract Infections (URTI) are very common in children having no effective pharmacological treatment. This study aimed to compare the effect of caregivers' health education regarding children's respiratory infections and the effect of a rhinopharyngeal clearance protocol in children with URTI. A factorial trial was conducted in 138 children up to 3 years, attending day-care centres. Children were distributed into four groups: control group (CG) (n = 38); education group (EG) (n = 34); intervention group (IG) (n = 35); and education and intervention group (E + IG) (n = 31). A Diary of Records was kept by caregivers during 1 month. There were significant differences between groups concerning: Lower Respiratory Tract Infections (CG = 29.4%; EG = 10.7%; IG = 3.8%; E + IG = 0.0%; p = 0.014); acute otitis media (CG = 32.4%; EG = 7.1%; IG = 11.5%; E + IG = 7.7%; p = 0.014); medical consultations (CG = 70.6%; EG = 42.9%; IG = 38.5%; E + IG = 30.8%; p = 0.021); antibiotics (CG = 44.1%; EG = 7.1%; IG = 23.1%; E + IG = 15.4%; p = 0.006); days missed from day-care (CG = 55 days; EG = 22 days; IG = 14 days; E + IG = 6 days; p = 0.020); days missed from employment (CG = 31 days; EG = 20 days; IG = 5 days; E + IG = 1 day; p = 0.021); and nasal clearance techniques (CG = 41.4%; EG = 78.6%; IG = 57.7%; E + IG = 84.6%; p = 0.011). CONCLUSION: This study showed that the most positive impact on children's health outcomes occurred when combining health education of caregivers, regarding children's respiratory infections, with a rhinopharyngeal clearance protocol in children with URTI. What is Known: • Upper Respiratory Tract Infections are very common in children but still do not have an effective pharmacological treatment. • This generates a great burden of disease for the child and families, increasing the use of antibiotics. What is New: • This study is the first one that aims to analyze the effects of caregivers' health education in comparison to non-pharmacological intervention in acute respiratory infections in children. • It shows a positive impact on children's health outcomes, empowering caregivers regarding their child's health and reducing the burden of disease, medical consultations and the use of antibiotics.

Effects of a Phase IV Home-Based Cardiac Rehabilitation Program on Cardiorespiratory Fitness and Physical Activity.

BACKGROUND: Cardiovascular diseases are the leading cause of death globally and sedentary lifestyle is one of the main risk factors. Home-based cardiac rehabilitation (CR) programs appear to be effective to improve exercise tolerance. The aim of the study, therefore, was to evaluate the effects of a phase IV (maintenance) home-based CR program on cardiorespiratory fitness and daily physical activity of patients recovering from an acute myocardial infarction. METHODS: This pilot study, with a sub-group randomised controlled trial, included 32 individuals recovering from a myocardial infarction, randomly divided into the experimental group (EG, n=16) and the control group (CG, n=16). The EG performed an exercise program, three times per week, at home during eight weeks. The two groups received health education sessions. Baseline and final assessments included cardiorespiratory fitness, resting and peak heart rate, blood pressure and rate pressure, heart rate recovery and daily physical activity. (ClinicalTrials.gov: NCT01887080). RESULTS: At baseline no significant differences were observed between groups. After eight weeks of exercise, the EG significantly increased peak oxygen uptake (p=0.02), test duration (p=0.019), peak rate pressure (p=0.003), peak heart rate (p=0.003) and heart rate recovery (0.025) when compared to the CG. No changes were observed on daily physical activity in both groups. CONCLUSION: This specific phase IV home-based exercise program seems to improve cardiorespiratory fitness, haemodynamics at peak exercise and heart rate recovery, an indicator of cardiac autonomic function.

Gold nanoparticle probes for colorimetric detection of plasma galectin-3: a simple and rapid approach.

Galectin-3 (Gal-3) is a carbohydrate-binding protein associated with the development and progress of heart failure. Here, we report the first colorimetric and low-cost approach for detecting and quantifying Gal-3 using gold nanoparticles (AuNPs) bioconjugated with Gal-3 antibody. The interaction of Gal-3 with the resulting nanoprobes led to a linear response of the absorbance ratio A750nm/A526nm to Gal-3 concentration, accompanied by a change in color intensity. The assay showed a linear optical response even in complex samples, such as saliva and fetal bovine serum (FBS), up to a concentration of 200 µg L-1. The limit of detection (LOD) followed the trend LODPBS (10.0 µg L-1) < LODsaliva (22.6 µg L-1) < LODFBS (25.3 µg L-1). The potential applicability of this method to the analysis of human plasma samples was also demonstrated. Compared to conventional detection techniques, this colorimetric assay provides faster results (∼1 h) and is more cost-effective due to the use of simple and unexpensive equipment. This assay represents an exciting solution for the rapid screening of high risk for rapid progression of heart failure in patient samples (Gal-3 > 25.9 µg L-1).

Prognostic significance of ambulatory arterial stiffness index in hypertensives followed for 8.2 years: its relation with new events and cardiovascular risk estimation.

INTRODUCTION: The ambulatory arterial stiff ness index (AASI) is a new method for estimating arterial stiffness, which is associated with cardiovascular (CV) prognosis. Our aim was to evaluate the prognostic significance of AASI for new CV events. METHODS: Casual and ambulatory blood pressure (BP) measurements were obtained in 1200 hypertensive patients (645 female, age 51 +/- 12 years, BMI 27 +/- 5 kg/m2), 53% under stabilized therapy, 47% untreated, all without previous CV events. The occurrence of CV events was determined for 9833 patient-years and analyzed by a Cox proportional hazard model adjusted for confounding variables. AASI was calculated from 24h ABPM data and all patients were classified from very high to average CV risk. RESULTS: There were 62 deaths and 152 new fatal and non-fatal CV events (79 strokes, 51 coronary events, 22 other CV events) during the 15.2 years of follow-up (mean 8.2 +/- 3.0 years). AASI correlated significantly (p < 0.001) with pulse wave velocity (PWV), casual and 24h ambulatory BP, age and BMI. In subjects with very high or high CV risk (n = 401), AASI was 0.338 +/- 0.178, while in those with low or moderate CV risk (n = 715), it was 0.291 +/- 0.173 and in those with average CV risk (n = 84), it was 0.219 +/- 0.170) (p < 0.002, ANOVA). The probability of event-free and stroke-free survival (Kaplan-Meier) was better for AASI values below vs. above the median. The adjusted relative risk (HR 95% CI) for CV events, stroke and coronary events associated with a 1-SD increment in AASI values was respectively 1.27 (1.01-1.59), 1.36 (95% CI 1.02-1.89) (p < 0.02) and 0.99 (95% CI 0.67-1.48) (NS), similar to that of 24h pulse pressure (PP) and PWV. AASI hazard ratios were no longer significant after additional adjustment for 24h PP, whereas the converse did not occur. However, AASI above the median increases the predictive value of 24h PP for CV events and stroke. CONCLUSIONS: AASI correlates with PWV, stratifies CV risk and predicts total cardiovascular events and stroke but not coronary events. AASI may add predictive value to 24h PP for CV events and stroke.

Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial.

INTRODUCTION AND OBJECTIVES: Children up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI. MATERIALS AND METHODS: Randomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30min of normal activities, in the CG. RESULTS: In M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG=33.3%; CG=68.4%; p=0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0=-124daPa; M1=-92daPa; p=0.022. Right ear: M0=-102daPa; M1=-77daPa; p=0.021), which was not observed in the CG (Left ear: M0=-105daPa; M1=-115daPa; p=0.485. Right ear: M0=-105daPa; M1=-131daPa; p=0.105). There were no significant results concerning the compliance of the tympanic membrane. CONCLUSIONS: The rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI.

Relationship of circadian blood pressure and morning blood pressure surge with the severity of metabolic syndrome in newly diagnosed hypertensives.

OBJECTIVES: Twenty-four-hour ambulatory blood pressure (BP) data and the presence of metabolic syndrome (MS) are both good discriminators of cardiovascular risk. We examined the relationship between metabolic syndrome scores as defined by the International Diabetes Federation 2005 report (IDF-2005) and 24h ambulatory BP data in newly diagnosed hypertensives. METHODS: We evaluated 352 non-diabetic subjects (male/female: 167/185, aged 49+/-13). Based on IDF-2005 criteria, 212 subjects fulfilled 0, 1 or 2 criteria (no metabolic syndrome) and 140 fulfilled 3, 4 or 5 criteria (metabolic syndrome). Patients were divided into two groups (MS and non-MS), matched for age and casual BP All underwent 24h ambulatory blood pressure monitoring. RESULTS: No significant differences were found between non-MS and MS for casual BP (153/92+/-17/8 vs. 154/92+/-16/8 mmHg), age (48+/-14 vs. 50+/-12 years), 24h ambulatory BP (131/82+/-14/10 vs. 133/82+/-14/9 mmHg), daytime BP (135/86+/-14/11 vs. 137/85+/-14/9 mmHg), nighttime BP (122/74+/-15/11 vs. 124/74+/-15/10 mmHg), nighttime fall (9+/-6 vs. 9+/-6 %), BP on arising (131/82+/-20/15 vs. 135/82+/-21/15 mmHg), evening surge (7+/-14 vs. 10+/-15 mmHg), percentage of dippers (42.5 vs. 37.1%) or percentage of non-dippers (50.9 vs. 50.7%). However, significant differences between non-MS and MS were found for morning BP surge (25+/-12 vs. 28+/-15 mmHg, p<0.03). Also, when patients were divided into four groups according to MS scores (0/1, 2, 3 or 4/5), significant differences between groups were observed only for BP on arising (group 2 vs. 4/5, 132/79+/-21/15 vs. 140/84+/-10/15 mmHg, p<0.05; group 3 vs. 4/5, 131/81+/-20/15 vs. 140/84+/-20/15, p<0.005) and for morning BP surge (group 0/1 vs. 4/5, 24+/-11 vs. 29+/-15 mmHg, p<0.003). CONCLUSIONS: We conclude that in newly diagnosed hypertensive subjects there is no significant relationship between the severity of metabolic syndrome and ambulatory blood pressure data or circadian variations. The only exception found was a greater morning BP surge in patients with MS, whose importance as a determinant of cardiovascular risk needs to be clarified by further studies.

The OXIMAPA Study: Hypertension Control by ABPM and Association with Sleep Apnea Syndrome by Pulse Oximetry.

INTRODUCTION: Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome. MATERIAL AND METHODS: We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry. RESULTS: The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by automatic device and blood pressure in office showed no statistically significant association (p = 0.761). We found a statistically significant association between sleep apnea syndrome and daytime hypertension (p = 0.019) and non-dipper profile (p = 0.005). DISCUSSION AND CONCLUSION: Ambulatory blood pressure monitoring by automatic device detected more 12% of uncontrolled hypertension than office blood pressure. Sleep apnea syndrome is strongly associated with uncontrolled hypertension and oximetry may be a good screening method, but should be studied further.

Introdução: A monitorização ambulatorial da pressão arterial é o melhor método de avaliação da pressão arterial e a síndrome da apneia do sono é a principal causa de mau controlo. A oximetria permite rastrear estes indivíduos mas a sua utilidade tem sido pouco explorada em Cuidados de Saúde Primários. O objectivo foi avaliar o controlo da pressão arterial no consultório e na monitorização ambulatorial da pressão arterial, e relacioná-la com a síndrome da apneia do sono. Material e Métodos: Selecionou-se uma amostra de 50 participantes, representativa de 3036 doentes hipertensos. As variáveis avaliadas foram: valor de pressão arterial no consultório e na monitorização ambulatorial da pressão arterial; presença de critérios de síndrome da apneia do sono na oximetria. Resultados: A prevalência de pressão arterial não controlada foi de 56% no consultório e 68% na monitorização ambulatorial da pressão arterial. Encontrou-se: 36% de hipertensão diurna, 52% de hipertensão nocturna, 40% de perfil não-dipper, 16% de hipertensão da bata-branca e 28% de hipertensão mascarada. A prevalência de síndrome da apneia do sono foi 16%. A pressão arterial no consultório e na monitorização ambulatorial da pressão arterial não mostrou associação estatisticamente significativa (p = 0,761). Encontrou-se uma associação estatisticamente significativa entre síndrome de apneia do sono e hipertensão diurna (p = 0,019) e perfil não-dipper (p = 0,005). Discussão e Conclusão: A monitorização ambulatorial da pressão arterial detetou mais 12% de casos de hipertensão não controlada do que o consultório. A síndrome da apneia do sono está fortemente associada a hipertensão não controlada e a oximetria pode ser um bom método de rastreio, mas deve ser mais estudada.

Relationship between ambulatory blood pressure monitoring values and future occurrence of ischemic cerebrovascular and coronary events in hypertensive patients.

OBJECTIVES: To evaluate in a prospective study the relationship between 24-hour ambulatory blood pressure monitoring (ABPM) values and the occurrence of nonfatal ischemic cerebrovascular and coronary events in treated hypertensive patients. METHODS: Out of 8780 ABPM recordings we identified 79 hypertensive patients (both genders) who suffered a first nonfatal ischemic event, either cerebrovascular (stroke or transient ischemic attack) (STR/TIA, n = 48) or coronary (myocardial infarction, angina or coronary bypass/PTCA) (COR, n = 31) and 223 control-hypertensive patients (CTR) without any events during the same period who were fully matched (at the time of ABPM) for age, gender, antihypertensive therapy, presence of dyslipidemia or diabetes, and casual blood pressure (BP), in the proportion of 1 STR/TIA to 3 CTR and 1 COR to 6 CTR. Matched groups were compared for various ABPM parameters. RESULTS: On average, the time between ABPM and the occurrence of STR/TIA and COR events was respectively 32.4 (1 to 88) and 28.0 (1 to 73) months. For similar values of matched variables significant differences (p < 0.05) were observed between STR/TIA vs. CTR in 24-hour systolic BP (147.4 +/- 20.6 vs. 140.1 +/- 14.9 mmHg), daytime systolic BP (151.6 +/- 21.8 vs. 144.6 +/- 15.2 mmHg) and nighttime systolic BP (138.5 +/- 21.2 vs. 130.9 +/- 16.0 mmHg), and between COR vs. CTR in 24-hour systolic BP (143.5 +/- 19.5 vs. 135.2 +/- 15.6 mmHg), daytime systolic BP (146.3 +/- 20.5 vs. 139.6 +/- 15.9 mmHg) and nighttime systolic BP (138.1 +/- 19.7 vs. 126.2 +/- 16.4 mmHg), BP on rising (146.2 +/- 31.7 vs. 133.6 +/- 19.9 mmHg) and blunted nighttime BP dipping (5.3 +/- 7.4 vs. 9.60 +/- 6.0%). Versus CTR, STR/TIA showed a lower percentage of dippers (27.7 vs. 44.4%) and a higher percentage of extreme dippers (10.6 vs. 6.3%), nondippers (48.9 vs. 41.7%) and inverted dippers (12.8 vs. 7.6%). Versus CTR, the COR group showed (p < 0.02) a lower percentage of dippers (21.9 vs. 46.8%) and extreme dippers (3.1 vs. 4.3%) and a higher percentage of nondippers (56.3 vs. 43.0%) and inverted dippers (18.8 vs. 5.9%). CONCLUSIONS: This prospective study in treated hypertensive patients shows that both high ABPM values and abnormal daytime/nighttime BP profiles are associated with later occurrence of ischemic cerebrovascular and coronary events independently of casual BP values and other cardiovascular risk factors. This reinforces the idea that ABPM is a powerful predictor of future cardiovascular events.

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries - Stratifying the Risk of a "new" Clinical Entity using an "Old" Tool

Abstract Background Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population. Methods This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) - a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Effects of aerobic exercise associated with abdominal microcurrent: a preliminary study.

OBJECTIVE: To analyze the short- and long-term effects of microcurrent used with aerobic exercise on abdominal fat (visceral and subcutaneous). METHODS: Forty-two female students from a university population were randomly assigned into five group: intervention group (IG) 1 (n=9), IG2 (n=9), IG3 (n=7), IG4 (n=8), and placebo group (PG) (n=9). An intervention program of 10 sessions encompassing microcurrent and aerobic exercise (performed with a cycloergometer) was applied in all groups, with slightly differences between them. In IG1 and IG2, microcurrent with transcutaneous electrodes was applied, with different frequency values; 30-minute exercise on the cycloergometer was subsequently performed. IG3 used the same protocol as IG1 but with different electrodes (percutaneous), while in IG4 the microcurrent was applied simultaneously with the cycloergometer exercise. Finally, the PG used the IG1 protocol but with the microcurrent device switched off. All groups were evaluated through ultrasound and abdominal perimeter measurement for visceral and subcutaneous abdominal fat assessment; through calipers for skinfolds measurement; through bioimpedance to evaluate weight, fat mass percentage, and muscular mass; and through blood analyses to measure cholesterol, triglyceride, and glucose levels. RESULTS: After intervention sessions, visceral fat decreased significantly in IG1 compared with the PG. Subcutaneous fat was reduced significantly in all groups compared with the PG. After 4 weeks, almost all results were maintained. CONCLUSION: The addition of microcurrent to aerobic exercise may reduce fat more than does aerobic exercise alone.

Prognostic value of subdivisions of nighttime blood pressure fall in hypertensives followed up for 8.2 years. Does nondipping classification need to be redefined?

To evaluate the long-term prognostic significance of different ranges of the percentage fall in nighttime blood pressure (BP) of the nondipping pattern, 1200 hypertensive patients (645 women, age 51+/-12 years) underwent ambulatory BP monitoring under stabilized therapy. The occurrence of cardiovascular (CV) events was followed for 9833 patient-years and analyzed by the Cox hazard model. There were 152 CV fatal/nonfatal events (79 strokes, 51 coronary events, 22 others) during the 15.2 years of follow-up. According to nighttime BP fall (%) the authors noted: <0% (reverse-dippers [RD], n=83); 0%-4.9% (nondippers 1 [ND1], n=207); 5%-9.9% (nondippers 2 [ND2], n=311), 10%-19.9% (dippers [D], n=523); and > or =20% (extreme dippers [ED], n=76). After adjustment for confounding variables, hazard ratios (95% confidence interval) of CV event and stroke in RD vs D were 2.29 (1.31-3.99) and 2.46 (1.11-5.49); of ND1 vs D were 1.42 (1.12-1.79) and 1.62 (1.17-2.23); and of ND1 vs ND2 were 2.24 (1.33-3.75) and 2.30 (1.15-4.58). No differences were found in RD vs ND1 and ND2 vs D. Nondippers have a higher CV risk than dippers but only for a nighttime BP fall <5% suggesting that the limits for nondipping should be redefined for a stratification of CV risk.