Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) participates in the degradation of components of the extracellular matrix and it is involved in vascular remodeling and vasomotor changes. The aim of this study was to investigate the plasma levels of MMP-9 in acute vascular alterations due to hypertensive crisis. METHODS: This cross-sectional study was performed in 40 normotensive (NT) and 58 controlled hypertensive subjects (CHyp) followed up in outpatient clinic. Moreover, 57 patients with hypertensive emergency (HypEmerg) and 43 in hypertensive urgency (HypUrg), seen in emergency department, were also included. Hypertensive crisis was divided into HypEmerg, which was characterized by levels of systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg complicated with target-organ damage (TOD), and HypUrg, defined by BP elevation without TOD. Univariate and multivariate regression analysis was performed to identify the influence of independent variables on MMP-9 levels. A p-value < 0.05 was considered statistically significant. RESULTS: The mean age was 43.5 years in the NT group (11 men); 57.7 years in the CHyp group (29 men); 59.4 years in the HypUrg group (21 men) and 62.4 years in the HypEmerg group (31 men). The age was statistically different in the NT group compared to other 3 groups. The mean BP was 116.5 ± 13.9/72.4 ± 10.6 mmHg for NT, 123.2 ± 12.6/79 ± 9.2 for CHyp, 194.1 ± 24.3/121.4 ± 17.3 for HypUrg and 191.6 ± 34.3/121.7 ± 18.8 mmHg for HypEmerg, respectively (p-value< 0.0001 between groups). MMP-9 levels were statistically different between the HypEmerg (2.31 ± 0.2 ng/mL) and HypUrg groups (2.17 ± 0.3 ng/mL) compared to the NT (1.94 ± 0.3 ng/mL) (p-value < 0.01 and p-value < 0.05, respectively) and CHyp groups (1.92 ± 0.2 ng/mL) (p-value < 0.01). Uric acid was the only independent variable for predicting MMP-9 levels (p-value = 0.001). CONCLUSION: MMP-9 concentrations are significantly higher in the hypertensive crisis groups (urgency and emergency) compared to the control groups. Therefore, MMP-9 may be a biomarker or mediator of pathophysiologic pathways in cases of acute elevations of blood pressure.

[Metabolic syndrome components in arterial hypertension]. / Componentes da síndrome metabólica na hipertensão arterial.

The objectives of this study were to identify and compare the prevalence of metabolic syndrome among hypertensive individuals and people with normal blood pressure measurements. The metabolic syndrome definition used in this study is that of the National Cholesterol Education Program/Adult Treatment Panel (NCEP-ATP III). The data referring to the clinical and biochemical profiles were processed using the SPSS software to obtain absolute frequencies and percentages. The Student's t-test was used to compare the means, with values of p<0.05 considered statistically significant. The sample was comprised of 93 participants with normal blood pressure levels and 168 participants with hypertension. It was found that 60.7% of the individuals with hypertension had metabolic syndrome, versus 18.3% of those with normal blood pressure levels. Individuals with hypertension showed a significant difference in blood pressure levels (p<0.001), abdominal circumference (p<0.001), blood glucose (p<0.05) and plasma triglycerides (p<0.05). The frequency of cardiometabolic risks associated with metabolic syndrome is greater when hypertension is present.

Factors associated to patients' noncompliance with hypertension treatment.

The greatest challenge posed by Systemic Hypertension (SH) is related to patients' compliance with treatment. Thus, this study aimed to determine attendance of these patients to medical appointments and the percentage of adherence to medication and non-medication regimens, and also identify the main reasons hypertensive patients report for non-adherence. This is a descriptive study with 68 hypertensive patients (64.71% women with average age of 63.9 years) at a teaching outpatient clinic. The instruments used for data collection were: multi-professional team care report form, the Morisky-Green test and telephone interview. The results show that 61.76% attended the medical consultations, 86.76% did not comply with the medication regimen and 85.29% did not comply with the non-medication regimen, reporting at least one non-healthy life habit. The emotional factor was the most reported (69.12%) among patients' reasons for non-adherence to treatment. The study can support interventions in care delivery to patients with systemic hypertension, with a view to improving their level of adherence and quality of life.

Relationship between anxiety, depressive symptoms and compulsive overeating disorder in patients with cardiovascular diseases.

OBJECTIVES: to identify the presence of compulsive overeating disorder in patients with cardiovascular diseases and to verify its relation with sociodemographic, clinical variables and the presence of anxiety and depressive symptoms. METHOD: cross-sectional, correlational study with a sample of 111 patients with cardiovascular diseases. The presence of anxiety and depressive symptoms was assessed by the Hospital Anxiety and Depression Scale instrument and compulsive overeating disorder was assessed through a likert instrument called the Periodic Eating Disorder Scale (Binge Eating Scale). RESULTS: there was a predominance of patients without compulsive overeating disorder (n=91, 82%), followed by moderated compulsive overeating (n=15, 13.5%) and severe (n=5, 4.5%) associating to high levels of body mass index (p=0.010) and the presence of anxiety (p=0.017). CONCLUSION: Compulsive overeating disorder was present in 18% of the patients, being associated with body mass index and anxiety, suggesting that health professionals should pay attention to the comprehensive evaluation of patients with cardiovascular diseases. Important results emerged from this study, emphasizing the need to implement programs to improve the patients' mental and physical health in both primary and specialized care services.

Clinical trial for the control of water intake of patients undergoing hemodialysis treatment.

OBJECTIVE: to analyze the impact of an educational and motivational intervention for patients with a chronic kidney disease, undergoing hemodialysis treatment, on the control of fluid intake during interdialytic periods. METHOD: a quasi-experimental, non-randomized clinical trial with patients from a Nephrological Unit of the State of São Paulo. Participants were included in two groups: Control Group with 106 patients and Intervention Group with 86 patients, totaling 192 participants. The used intervention was an educational and motivational video to control liquid intake, based on the Bandura's Theory. The measure of control of water intake was the percentage of lost weight, also considered the variable outcome of the research. For the data analysis, descriptive analyses and regression analysis of the Inflated Beta Model were used. RESULTS: patients who participated in the intervention had a decrease in the pattern of weight gain in interdialytic periods, with a 3.54 times more chance of reaching the goal of 100% of weight loss when compared to participants from the control group. CONCLUSION: the educational and motivational intervention was effective in reducing the percentage of weight loss in patients undergoing hemodialysis. Brazilian Clinical Trials Registry (ReBEC) under the opinion RBR-4XYTP6.

Effect of vildagliptin versus glibenclamide on endothelial function and arterial stiffness in patients with type 2 diabetes and hypertension: a randomized controlled trial.

AIMS: Several trials have reported that dipeptidyl peptidase-4 (DPP-4) inhibitors, used to treat type 2 diabetes (T2DM), improve endothelial function. The current study investigated the effects of vildagliptin, a DPP-4 inhibitor, compared to glibenclamide on endothelial function, arterial stiffness, and blood pressure in patients with T2DM and hypertension. METHODS: Patients aged over 35 years with T2DM and hypertension, but without cardiovascular disease, were randomly allocated to treatment with vildagliptin (n = 25) or glibenclamide (n = 25). Both groups took metformin. Endothelial function was evaluated by peripheral artery tonometry (Endo-PAT 2000) to calculate the reactive hyperemia index (RHI) and arterial stiffness. Primary outcome was change in the RHI after 12 weeks of treatment. Twenty-four-hour non-invasive ambulatory blood pressure monitoring was performed using a Mobil-O-Graph® 24-h PWA monitor. Arterial stiffness was assessed using the augmentation index corrected for 75 bpm (AIx75), pulse wave velocity (PWV) and central systolic blood pressure (cSBP). RESULTS: There were no changes in the RHI in the vildagliptin group (before 2.35 ± 0.59; after 2.24 ± 0.60; p value = NS) or in the glibenclamide group (before 2.36 ± 0.52; after 2.34 ± 0.50; p value = NS), with no differences between groups (p value = NS). There was also no difference between vildagliptin and glibenclamide treatment in respect to AIx75 (p value = NS), cSBP (p value = NS) or PWV (p value = NS). CONCLUSIONS: Vildagliptin and glibenclamide similarly do not change the endothelial function and arterial stiffness after 12 weeks of treatment in diabetic and hypertensive patients without cardiovascular disease. Thus, vildagliptin has a neutral effect on vascular function. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02145611, registered on 11 Jun 2013.

Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service.

OBJECTIVE: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. METHOD: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. RESULTS: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. CONCLUSION: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications.

Estresse Percebido e Autocuidado entre Pessoas com Diabetes e Doenças Cardiovasculares / Perceived Stress and Self-care Among Diabetes Patients with Cardiovascular Diseases

O Diabetes Mellitus tipo 2 (DM2) corresponde de 90 a 95% de todos os casos e apresenta etiologia multifatorial, envolvendo herança genética e fatores ambientais como: alimentação, sedentarismo, obesidade e idade avançada. Portadores de DM2 necessitam de cuidados específicos, autocuidado contínuo e controle do estresse percebido. Busca-se identificar o estresse percebido e o autocuidado de pacientes, quanto às variáveis sociodemográficas, clínicas e hábitos de vida, associar as variáveis de interesse com atividades de autocuidado. Realizou-se estudo transversal, prospectivo, quantitativo, para conhecer o estresse percebido e autocuidado de portadores DM2, internados em um Hospital Cardiovascular de São José do Rio Preto/SP, por meio de dois questionários e uma escala. Verificou-se que a maioria dos pacientes era idosa, cardiopata, hipertensa, não praticava atividade física, não seguia dieta, entre outros aspectos. O nível de estresse percebido representou escore médio de 26,4 pontos, ou seja, menos da metade do valor total, sugerindo uma baixa percepção de estresse na amostra. Em relação ao domínio do autocuidado, identificou-se que, em geral, era baixo, pois os pacientes não realizavam o autocuidado em, pelo menos, seis dias da semana. Os únicos domínios realizados foram: alimentação específica em média 5,2 dias da semana e uso de medicação em média 4,7 dias da semana. Conclui-se que o presente estudo oferece informações para planejamento do tratamento de portadores de DM2, obtenção do melhor controle glicêmico, sugerindo intervenções educativas ou metodologias e promovendo melhora da adesão aos comportamentos de autocuidado e redução do estresse que influenciam os resultados em saúde desses pacientes.

Type 2 Diabetes Mellitus (DM2) corresponds to 90-95% of all cases of DM and has a multifactorial etiology, involving genetic inheritance and environmental factors such as: diet, physical inactivity, obesity, and advanced age. People with DM2 need specific care, continuous self-care, and control of perceived stress. This study aimed to identify the perceived stress and self-care activities of patients associated with socio-demographic, clinical, and lifestyle variables. This cross-sectional, prospective, quantitative study was conducted to understand the perceived stress and self-care of DM2 patients, admitted to a Cardiovascular Hospital in São José do Rio Preto, SP, using two questionnaires and a scale. It was found that most patients were elderly, cardiopathic, hypertensive, did not practice physical activity, did not follow a diet, among other aspects. The perceived stress level represented an average score of 26.4 points, that is, less than half of the total value, suggesting a low perception of stress in the sample. Regarding the self-care domain, it was generally found to be low, as patients did not perform self-care activities on at least six days a week. The only domains performed were specific diet on average 5.2 days a week and medication use on average 4.7 days a week. It is concluded that the present study offers information for planning the treatment of patients with DM2, obtaining the best glycemic control, suggesting educational interventions or methodologies, and promoting improved adherence to self-care activities and reducing stress that influence the health outcomes of these patients.

Endothelial Changes in Individuals with Prehypertension.

INTRODUCTION: Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension. RESULTS AND DISCUSSION: The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events. CONCLUSION: The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.

[Quality of life in chronic kidney failure patients receiving hemodialysis treatment]. / Qualidade de vida de pessoas com doença renal crônica em tratamento hemodialítico.

This descriptive study aims to evaluate the quality of life in patients receiving hemodialysis (HD) treatment and to identify the daily activities that may impair their quality of life. We investigated 125 chronic kidney failure patients under hemodialysis treatment by means of the Medical Outcome Survey-Short-Form 36 (SF-36), and their daily activities, by means of semi-structured interviews. For statistical data analysis, a significance level of 5% was used. The results evidenced that these individuals' quality of life is impaired, with lower scores for physical, emotion and vitality aspects. There was a negative correlation between time spent on HD and the physical component (r= - 0.75) and between hemodialysis time and daily activities such as work, housework and practical activities. Physical and leisure activities were the most affected in the general sample as well as in the one stratified by gender.

Adesão ao tratamento medicamentoso de adultos autorreferidos com diagnóstico de hipertensão / Adhesion to medicinal treatment of adults with hypertension

O objetivo deste estudo é identificar o nível de adesão ao tratamento medicamentoso de adultos autorreferidos com diagnóstico de hipertensão. Trata-se de um estudo descritivo-transversal envolvendo 213 indivíduos autorreferidos com diagnóstico de hipertensão participantes em campanhas de hipertensão arterial realizadas em cidade do interior paulista. Os instrumentos de coleta de dados utilizados foram entrevistas semiestruturadas e questionário de Morisky e Green. Foram aplicados o teste qui-quadrado e análise de correspondência múltipla. A maioria dos participantes do estudo relatou não aderir ao tratamento medicamentoso (84%). O sexo feminino apresentou maior adesão. As barreiras à adesão foram dificuldade para mudança de hábitos de vida, irregularidade às consultas médicas e aos horários das medicações. A adesão ao tratamento medicamentoso constitui-se de um processo complexo e multifatorial que merece atenção especial da equipe multiprofissional em saúde com o objetivo de aumentar as taxas de adesão e a qualidade de vida dos indivíduos.

Adhesion level to medicinal treatment by adults diagnosed with hypertension is identified by a descriptive and transversal study involving 213 people diagnosed with hypertension and participating in arterial hypertension campaign in a town in the hinterland of the state of São Paulo, Brazil. Data were collected by half-structured interviews and by Morisky & Green questionnaire. Most participants (84%) failed to adhere to medicinal treatment, with females complying most with adhesion. Adhesion impairments comprised difficulties in changes in lifestyle, irregular visits to the doctor´s and medicine timetable. Adhesion to medicine treatment is a complex and multifactor process that needs special attention by the multiprofessional health team to increase adhesion rates and life quality of patients.

Hypertension and diabetes-related morbidity and mortality trends in a municipality in the countryside of São Paulo.

OBJECTIVES: To identify the main causes for hospital admissions and deaths related to systemic arterial hypertension and diabetes mellitus (DM), and to analyze morbidity and mortality trends, in a municipality in São Paulo's countryside, by comparing two three-years periods, 2002 to 2004 and 2010 to 2012. METHODS: Cross-sectional study which used secondary data regarding deaths from the Information System on Mortality and concerning hospital admissions from the DataSus Hospital Information System. Univariate and multivariate statistical analyses were conducted. RESULTS: From 2002 to 2012, 325,439 people were admitted to hospitals, 14.7% of them due to circulatory system diseases (CSD) and 0.7% due to DM. The deaths distributed as the following: 29,027 deaths (31.5%) were due to CSD; 8.06% due to cerebrovascular diseases (CVD); and 2.75% due to DM. There was a significant association between admittance and death causes and patients' gender and age in the three-year periods (p<0.001). The highest lethality in hospital admissions was found to be due to CVD (10%). That trend showed that mortality rates dropped, younger patients were admitted due to DM, and older patients were admitted due to CVD - they were more often females. CONCLUSION: The main causes for hospital admissions were the CSDs; main mortality causes were the CVDs in hypertensive and diabetic women. Those findings can back public policies which prioritize the promotion of health.

Twelve-week randomized study to compare the effect of vildagliptin vs. glibenclamide both added-on to metformin on endothelium function in patients with type 2 diabetes and hypertension.

BACKGROUND: Vildagliptin, a DPP-4 inhibitor widely used for the treatment of type 2 diabetes mellitus (T2DM), shows beneficial effects on endothelial function. This study aims to evaluate the effect of vildagliptin on endothelial function and arterial stiffness in patients with T2DM and hypertension. METHODS: Fifty over 35-year-old patients with T2DM and hypertension, without cardiovascular disease, will be randomly allocated to two groups: group 1 will receive vildagliptin added-on to metformin and group 2, glibenclamide added-on to metformin. Biochemical tests (glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, ultrasensitive C-reactive protein, and microalbuminuria), 24-h non-invasive ambulatory blood pressure monitoring, and assessment of endothelial function and arterial stiffness will be performed in both groups before and after 12 weeks of treatment. The endothelial function will be assessed by peripheral arterial tonometry, which measures the reactive hyperemia index (vasodilation), and arterial stiffness will be evaluated by applanation tonometry. All analysis will be performed using SPSS Statistical Software. For all analysis, a 2-sided P < 0.05 will be considered statistically significant. RESULTS: The study started in December 2013 and patient recruitment is programed until October 2015. The expected results are that vildagliptin will improve the endothelial function in patients with T2DM and hypertension compared to glibenclamide treatment, independently of glycemic control. CONCLUSIONS: It is expected that this DPP-4 inhibitor will improve endothelial function in patients with T2 DM. TRIAL REGISTRATION: Clinical Trials NCT02145611, registered on 11 Jun 2013.

Efeitos da doença e adequação da hemodiálise em pacientes com rigidez arterial / Efectos de la enfermedad y adecuación de la hemodiálisis en pacientes con rigidez arterial / Effects of disease and hemodialysis adequacy in patients with arterial stiffness

RESUMO Objetivos Analisar a adequação do tratamento hemodialítico em pacientes com rigidez arterial e associar os efeitos da doença renal com os fatores sociodemográficos e clínicos. Método Estudo epidemiológico, transversal realizado com 149 renais crônicos em tratamento de hemodiálise em hospital escola do interior do Estado de São Paulo. Utilizou-se para medida da rigidez arterial o aparelho de Dyna-MAPA®. Foram aplicados os testes de regressão linear multivariada, t Student e o qui-quadrado para os biomarcadores e a ocorrência de rigidez arterial. Resultados A maioria dos pacientes encontrava em idade produtiva, inativa profissionalmente, do sexo masculino, união estável, fazendo restrição hídrica e alimentar, com menos de 48 meses de tratamento dialítico; 36,9% dos pacientes apresentavam rigidez arterial. Os biomarcadores creatinina, ureia e fósforo estavam aumentados; hematócrito e hemoglobina estavam diminuídos, média de peso interdialítico de 2,34 ± 1,4 kg, e a maioria do Kt/V inadequado. Quanto aos efeitos da doença renal observou-se significância estatística com os inscritos na lista de transplantes, maior tempo de tratamento e aumento da creatinina. Conclusão Estes resultados podem proporcionar a diminuição da morbimortalidade cardiovascular nestes pacientes.

RESUMEN Objetivos Analizar la adecuación del tratamiento hemodialítico en pacientes con rigidez arterial y asociar los efectos de la enfermedad renal con los factores sociodemográficos y clínicos. Método Estudio epidemiológico, transversal realizado con 149 renales crónicos en tratamiento de hemodiálisis, en el interior del Estado de São Paulo. Utilizaron el instrumento para medir la rigidez arterial el aparato de Dyna-MAPA®. Se aplicaron los pruebas de Regresión Lineal Multivaria, t Student y el Chi-Cuadrado para los biomarcadores y la ocurrencia de rigidez arterial. Resultados La mayoría estaba en edad productiva, inactiva profesionalmente, del sexo masculino, en unión estable, haciendo restricción hídrica y alimentar y con menos de 48 meses de tratamiento dialítico y 36,9% de los pacientes presentaban rigidez arterial. Los biomarcadores creatinina, urea y fósforo estaban aumentados, hematocrito y hemoglobina estaban disminuidos, media de peso interdialítico de 2,34 ± 1,4 kg, y la mayoría del Kt / V inadecuado. En cuanto a los efectos de la enfermedad renal se observó significancia estadística con los inscritos en la lista de trasplantes, mayor tiempo de tratamiento y aumento de la creatinina. Conclusión: Se espera que estos resultados proporcionen la disminución de la morbimortalidad cardiovascular de estos pacientes.

ABSTRACT Objectives To analyze the adequacy of hemodialysis treatment in patients with arterial stiffness and to associate the effects of renal disease with sociodemographic and clinical factors. Method A cross-sectional epidemiological study with 149 chronic renal patients undergoing hemodialysis treatment, in the interior of the State of São Paulo. They used to measure arterial stiffness with the Dyna-MAPA® device. The tests statistical were multivariate linear regression, t Student and chi-square were applied to the biomarkers and the occurrence of arterial stiffness. Results Most were of productive age, professionally inactive, male, in a stable union, water, and food restriction, and with less than 48 months of dialysis treatment and 36.9% of patients had arterial stiffness. The biomarkers creatinine, urea, and phosphorus were increased, hematocrit and hemoglobin were decreased, mean interdialytic weight was 2.34 ± 1.4kg, and most of the Kt / V inadequate. The effects of renal disease were statistically significant with those enrolled in the transplant list, longer treatment time, and increased creatinine. Conclusion These results are expected to reduce cardiovascular morbidity and mortality in these patients.

Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital.

INTRODUCTION: In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS: A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS: OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study.

BACKGROUND: The absence of nocturnal blood pressure dipping (ND) identified by 24-h ambulatory blood pressure monitoring (ABPM) correlates with a worse cardiovascular prognosis. The renin-angiotensin system influences blood pressure levels and the occurrence of target organ damage (TOD). Thus, the aim of this study was to correlate the angiotensin-converting enzyme gene (ACE) insertion/deletion (I/D) polymorphism with the 24-h blood pressure profile and TOD in hypertensive individuals. METHODS: 155 non-diabetic hypertensive individuals on antihypertensive treatment underwent ABPM. Peripheral blood samples were drawn for biochemistry and genetic analysis of the ACE I/D polymorphism by polymerase chain reaction. ND was defined as ≥10 % differences in the mean systolic blood pressure (BP) during wakefulness and sleep. RESULTS: There were no differences in clinical or biochemical variables or TOD in respect to ND status, except for higher BP levels during sleep (p < 0.001) in non-dippers. There was significant difference in the prevalence of left ventricular hypertrophy (LVH) between ACE genotypes (II: 13.0 %; ID: 34.1 %; DD: 46.5 %; p value = 0.024) with an increased risk in carriers of the DD genotype (OR = 5.80; IC 95 % 1.50-22.44; p value = 0.011). Carriers of the D allele had higher systolic BP during wakefulness and by ABPM (p < 0.05), higher left ventricular mass (117.3 ± 50.0 vs. 100.3 ± 25.7; p value = 0.017) and higher prevalence of LVH (37.4 vs. 12.5 %; OR = 4.14; 95 % IC: 1.17-14.65; p value = 0.028), compared to the II genotype. CONCLUSIONS: The DD genotype is associated with a higher prevalence of LVH. The presence of the D allele appears to be associated with higher mean 24-h and wake systolic BP measured by ABPM in hypertensive patients under antihypertensive treatment.

The impact of chronic pain on the quality of life and on the functional capacity of cancer patients and their caregivers / O impacto da dor crônica na qualidade de vida e na capacidade funcional de pacientes oncológicos e de seus cuidadores

ABSTRACT BACKGROUND AND OBJECTIVES: Pain for cancer patients might represent a worsening prognosis, decreased autonomy, well-being and quality of life, affecting all spheres of life of cancer patients and their repercussions on caregivers. Therefore, this study aimed to evaluate the impact of chronic pain on the quality of life and functional capacity of cancer patients and their caregivers. METHODS: Eleven caregivers and 15 cancer patients from a Pain Clinic were evaluated. To assess the functional capacity of the patients, we used the physical and instrumental activities of daily living scale and, for quality of life, we used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), which indicated impairment in social and emotional functions and prevalence of symptoms fatigue and insomnia. RESULTS: The average of the instrumental activities of daily living scores indicated a semi-dependence of the patients. There was a female predominance in patients (60%) and caregivers (72.2%). The average pain by the visual analog scale was 6.8. The Zarit Caregiver Overload Scale indicated that 36.3% of caregivers had moderate to severe overload and a positive correlation between functional capacity and overload (p=0.003). CONCLUSION: The presence of chronic pain impacts, negatively and significantly, the quality of life and functional capacity of cancer patients extending this impact to the caregiver.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor para o paciente oncológico pode representar agravamento do prognóstico, diminuição da autonomia, do bem-estar e qualidade de vida, afetando todas as esferas da vida do paciente com câncer e sua repercussão no cuidador. Assim, este estudo objetivou avaliar o impacto da dor crônica na qualidade de vida e na capacidade funcional de pacientes oncológicos e de seus cuidadores. MÉTODOS: Foram avaliados 11 cuidadores e 15 pacientes oncológicos de uma Clínica da Dor. Para avaliar a capacidade funcional dos pacientes, foi utilizada a escala de atividades físicas e instrumentais da vida diária e, para a qualidade de vida, foi utilizado o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, que indicou prejuízo nas funções social e emocional e prevalência dos sintomas fadiga e insônia. RESULTADOS: A média dos escores das atividades básicas e instrumentais da vida diária indicaram semi-dependência dos pacientes. Houve predominância feminina em pacientes (60%) e cuidadores (72,2%). A média de dor pela escala analógica visual foi 6,8. A Escala de Sobrecarga do Cuidador de Zarit, indicou que 36,3% dos cuidadores apresentaram de moderada a grave sobrecarga e correlação positiva entre capacidade funcional e sobrecarga (p=0,003). CONCLUSÃO: A presença de dor crônica impacta de forma negativa e significante a qualidade de vida e a capacidade funcional dos pacientes com câncer, estendendo esse impacto para a figura do cuidador.

Nutritional status of adolescents related to cardiovascular risk and body image / Estado nutricional de adolescentes relacionado ao risco cardiovascular e imagem corporal

The purpose of this study was to identify the relationship of nutritional status to body image and to cardiovascular risk of adolescents in public and private schools. This was a descriptive, cross-sectional and quantitative study performed in two schools from the State of São Paulo, involving 546 teenagers from both sexes. The Thompson & Gray device was used to identify body image; anthropometric data such as weight, height and the waist circumference were assessed. Statistical analysis used the following tests: Student t, Fisher, chi-squared and multiple correspondence analysis between variables collected from adolescents in both schools. In both schools, female gender, eutrophic nutritional status, absence of cardiovascular risk, and dissatisfaction with body image for overweight were prevalent. When comparing schools, the public schools showed more students with underweight and obese body mass indices (BMI), higher cardiovascular risk index and body image dissatisfaction related to thinness. On the other hand, the private school presented more students with a BMI of overweight, and dissatisfaction due to being overweight. The conclusion is that regardless of the nutritional status of adolescents, there is body image dissatisfaction in both schools, and high cardiovascular risk is predominant in the public school in overweight and obese students and may lead to cardiovascular diseases in adulthood

Identificar estado nutricional relacionado à imagem corporal e ao risco cardiovascular de adolescentes das escolas pública e privada. Trata se de um estudo descritivo, transversal e quantitativo realizado em duas escolas do Estado de São Paulo, sendo 546 adolescentes de ambos os sexos. Foi utilizado o instrumento de Thompson & Gray para identificar a imagem corporal; aferidos dados antropométricos como peso, altura e o perimetro da cintura. A Análise estatística utilizou os testes: t de Student, Fisher, qui-quadrado e análise de correspondência múltipla entre as variáveis coletadas dos adolescentes nas duas escolas. Em ambas as escolas, foi prevalente o sexo feminino, o estado nutricional estrófico, ausência do risco cardiovascular e a insatisfação com a imagem corporal para excesso de peso. Ao comparar as escolas, a escola pública apresentou mais alunos com o Índice de Massa Corporal (IMC) abaixo do peso e obesos, maior índice de risco cardiovascular e insatisfação da imagem corporal relacionada à magreza. Já a escola privada apresentou mais alunos com IMC de sobrepeso, insatisfeitos devido ao excesso de peso. Conclui-se que independente do estado nutricional dos adolescentes, há insatisfação da imagem corporal em ambas as escolas, e o risco cardiovascular elevado predominantemente na escola pública, em escolares com sobrepeso e obesidade podendo levar a doenças cardiovasculares na fase adulta

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

INTRODUCTION: Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes. OBJECTIVES: 1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years. METHODS: A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population. RESULTS: The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years. CONCLUSION: The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Atividades de vida diária dos pacientes na diálise peritoneal / Daily life activities of patients in peritoneal dialysis

Objetivo: analisar as atividades de vida diária dos pacientes após o início da diálise peritoneal no serviço de Nefrologia. Método: trata-se de estudo quantitativo, transversal, do tipo analítico, na unidade hospitalar de tratamento de dialítico. Constituiu-se a amostra por 50 pacientes. Utilizou-se um questionário para a coleta de dados. Elaborou-se uma base de dados no Excel e se apresentaram os dados em tabelas. Resultados: verificou-se que, dos 50 pacientes analisados, a média de idade foi de 56,92±16,26 anos; tempo médio em que descobriu a doença renal crônica foi de 50,64±56,36 meses; tempo de tratamento com diálise peritoneal foi de 16,68±10,00 meses. Houve significância entre os cruzamentos da "idade" com "atividade de vida diária" e "há quanto tempo faz diálise peritoneal? (meses)" x "atividade de vida diária". Conclusão: constatou-se que a atividade de vida diária dos pacientes sofreu alterações, pois, quanto maior a idade, maior a dificuldade nas atividades de vida diária.(AU)

Objective: to analyze the activities of daily living of patients after the beginning of peritoneal dialysis in the Nephrology service. Method: this is a quantitative, cross-sectional analytical study at the hospital dialysis treatment unit. The sample consisted of 50 patients. A questionnaire was used for data collection. An Excel database was elaborated and the data were presented in tables. Results: it was found that, of the 50 patients analyzed, the mean age was 56.92 ± 16.26 years; median time to discovery of chronic kidney disease was 50.64 ± 56.36 months; Treatment time with peritoneal dialysis was 16.68 ± 10.00 months. Was there significance between the crossings of "age" with "daily living activity" and "how long have you been peritoneal dialysis? (months) "x" activity of daily living ". Conclusion: it was found that the daily life activity of the patients changed, as the older the greater the difficulty in daily living activities.(AU)

Objetivo: analizar las actividades de vida diaria de pacientes después del inicio de diálisis peritoneal en el servicio de Nefrología. Método: este es un estudio cuantitativo, transversal, tipo analítico, en la unidad hospitalaria de tratamiento de dialítico. La muestra consistió en 50 pacientes. Se utilizó un cuestionario para la recolección de los dados. Se elaboró una base de datos en Excel y los datos fueron presentados en tablas. Resultados: se comprobó que, de los 50 pacientes analizados, el promedio de edad fue de 56,92 ± 16,26 años; tiempo promedio en que descubrió la enfermedad renal crónica fue de 50,64 ± 56,36 meses; tiempo de tratamiento con diálisis peritoneal fue de 16,68 ± 10,00 meses. ¿Qué importancia tiene entre los cruzamientos de "edad" con "actividad de vida diaria" y "cuánto tiempo hace diálisis peritoneal? (meses) "x" actividad de vida diaria". Conclusión: se comprobó que la actividad de vida diaria de los pacientes sofrió alteraciones, pues, cuanto más edad, mayor la dificultad en las actividades de vida diaria.(AU)