Viruela símica: vigilancia epidemiológica en la Unidad de Monitoreo Ambulatorio Muñiz, Buenos Aires / Monkeypox: epidemiological surveillance in the Muñiz Outpatient Monitoring Unit, Buenos Aires

Resumen Introducción: La viruela símica (VS) es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus, familia Poxviridae. En 1970 se detectó por primera vez en humanos en la República Democrática del Congo. Actualmente es endémica en África central y occidental. Puede presentarse con fiebre, malestar general, linfo-adenopatías dolorosas y exantema, y durar entre 2 y 4 semanas. Suele ser autolimitada, aunque se han descrito casos graves, principalmente en personas inmunocomprometidas, con una letalidad que varía entre 3% y 6% en países endémicos. Los objetivos de la vigilancia epidemiológica en los casos sospecho sos de VS son: describir las variables personales, tiempo y lugar de los casos notificados, realizar un rastreo y seguimiento de sus contactos, identificar brotes y realizar seguimiento clínico epidemiológico. Métodos: Se realizó un estudio de cohorte retrospectivo durante el 9 de junio al 15 de septiembre de 2022. Resultados: Se han atendido 82 pacientes con sintomatología compatible 56 casos fueron positivos y 26 negativos. De los 26 casos negativos, 7 casos (27%) correspondían a varicela, 4 caso s (15%) a sífilis y 2 casos (8%) a herpes zoster. Los primeros síntomas se iniciaron dos a cinco días previos a la consulta, siendo los más frecuentes fiebre, mialgia, astenia, cefalea y linfoadenopatía dolorosa. Conclusiones: La vigilancia epidemiológica de VS permite la detección de casos, el seguimiento continuo y sistemático de los contactos mediante un proceso integrado entre vigilancia y laboratorio, para generar información oportuna, válida y confiable, que permite orientar medidas de prevención y control.

Abstract Introduction: Monkeypox (SV) is a zoonotic viral disease. Monkeypox virus belongs to the Ortho poxvirus genus of the Poxviridae family. In 1970 it was detected for the first time in humans, in the Democratic Republic of the Congo. It is currently considered an endemic disease in central and western Africa. It can pres ent with fever, malaise, painful lymphadenopathy and rash, and last between 2 and 4 weeks. It is usually self-limited, although severe cases have been described, mainly in immunocompromised people, with lethality varies between 3% and 6% in endemic countries. The objectives of epidemiological surveillance in suspected cases of SV are: to describe the personal variables, time and place of the reported cases, to track and follow up their contacts, to identify outbreaks and perform clinical epidemiological follow-up. Methods: A retrospective cohort study was conducted from June 9 to September 15, 2022. Results: 82 patients with compatible symptoms have been treated, 56 cases were positive and 26 negative. Of the 26 negative cases, 7 cases (27%) corresponded to chickenpox, 4 cases (15%) to syphilis, and 2 cases (8%) to herpes zoster. Conclusions: The first symptoms began two to five days prior to consultation, the most frequent being fever, myalgia, asthenia, headache, and painful lymphadenopathy. Epidemiological surveillance of SV provides timely detection of cases, continuous and systematic follow-up of contacts through an integrated process between surveillance and laboratory, to generate timely, valid and reliable information, which allows guiding prevention and control measures.

Herramientas de telesalud para el seguimiento posoperatorio de enfermería en servicios de cirugía mayor ambulatoria / Telehealth Tool for Nursing Postoperative Follow-up in Major Ambulatory Surgery Services

Introducción: La cirugía mayor ambulatoria ha experimentado un aumento creciente en los últimos años, la cual ha ido de la mano con nuevos desafíos para los profesionales de enfermería, quienes realizan el seguimiento posoperatorio de estos usuarios con las diferentes herramientas de telesalud. Objetivo: Identificar en las bases de datos científicas las principales herramientas de telesalud utilizadas en el seguimiento de pacientes post operados vía cirugía mayor ambulatoria. Métodos: Revisión integrativa de la literatura de estudios publicados en español, inglés y portugués, desde 2013 hasta 2019 en las bases de datos MEDLINE/PubMed, CINAHL y SciELO. A partir de la metodología PRISMA, se utilizaron las palabras clave "Teleenfermería", "Procedimientos quirúrgicos ambulatorios", "Monitoreo ambulatorio", "Telemedicina", "Cuidados posoperatorios", con los operadores AND y OR. Fueron seleccionados 10 artículos, a los que se realizó análisis de contenido. Conclusiones: Se identificaron las principales herramientas de telesalud utilizadas en el paciente posoperado de cirugía mayor ambulatoria, donde cada una posee ventajas y limitantes para su uso. Se destacan las aplicaciones móviles como una herramienta a seguir innovando por el gran potencial en prestaciones que posee(AU)

Introduction: Major ambulatory surgery has experienced a growing increase in recent years. This modality has gone hand in hand with new challenges for nursing professionals, who carry out postoperative follow-up of these users by using different telehealth tools. Objective: To identify, in scientific databases, the main telehealth tools used in the follow-up of patients who received major ambulatory surgery. Methods: Integrative review of the literature about studies published in Spanish, English and Portuguese, from 2013 to 2019 in the databases MEDLINE/PubMed, CINAHL and SciELO. Using the PRISMA methodology, the keywords Teleenfermería [Tele-nursing], Procedimientos quirúrgicos ambulatorios [ambulatory surgical procedures], Monitoreo ambulatorio [ambulatory monitoring], telemedicine [telemedicine], and Cuidados posoperatorios [postoperative care] were used, with the operators AND and OR. Ten articles were selected and content analysis was carried out with them. Conclusions: The main telehealth tools used in the postoperative patient of major outpatient surgery were identified. Each has advantages and limitations for its use. Mobile applications stand out as a tool to continue innovating due to their great potential regarding benefits(AU)

Monitoreo ambulatorio y generación de alertas tempranas ante anomalías cardiacas usando dispositivos móviles / Ambulatory monitoring and early warning generation of cardiac anomalies using mobile devices / Monitoramento ambulatorial e geração de aviso prévio de anomalias cardíacas usando dispositivos móveis

Resumen En este artículo se presenta un sistema portátil para el monitoreo ambulatorio del ritmo cardiaco y la detección temprana de las arritmias cardiacas de mayor riesgo. El sistema consta de un sensor con tres electrodos superficiales para la captura de la señal ECG, la cual se transmite vía Bluetooth a un dispositivo móvil con Android, en donde se realiza el análisis de la señal capturada durante lapsos de 5 s. El sistema propuesto distingue entre Ritmo Normal [Ritmo Sinusal - RS), Taquicardia Ventricular [TV), Fibrilación Ventricular [FV) y Asistolia, con una precisión del 100%, 55%, 75% y 90% respectivamente. Sin embargo, el sistema puede recuperarse de los errores rápidamente en el análisis de la trama subsecuente. Este trabajo se centra en el uso de dispositivos móviles de uso cotidiano, multitarea y de fácil acceso, implementando algoritmos en el dominio del tiempo para la extracción de parámetros, los cuales son idóneos para ser usados en aplicaciones móviles principalmente por su baja carga computacional y posibilidad de ejecución en tiempo real, permitiendo la detección de anomalías cardiacas de forma automática y rápida sin la necesidad de una supervisión constante por parte de un especialista para el análisis preliminar.

Abstract This paper presents a portable system for ambulatory heart rate monitoring and early detection of cardiac arrhythmias at high risk. The system consists of a sensor with three surface electrodes to capture the ECG signal, which is transmitted via bluetooth to a mobile device with Android, where the analysis is performed of the acquired signal during a time of 5 s. The proposed system distinguishes between Normal Rhythm [Rhythm Sinus - RS), Ventricular Tachycardia [VT), Ventricular Fibrillation [VF) and Asystole with an accuracy of 100%, 55%, 75% and 90% respectively. However, the system can quickly recover from errors in the subsequent analysis frame. This work focuses on using regular mobile devices which have multitasking and easy access characteristics, implementing algorithms in time domain for extracting parameters that are suitable to use in mobile applications, mainly because of their low computational load and possibility of execution in real time, allowing the detection of cardiac abnormalities automatically and quickly without the need of constant supervision by a specialist for preliminary analysis.

Resumo Neste artigo se apresenta um sistema portátil para o monitoramento da freqüência cardíaca ambulatorial e detecção precoce das arritmias cardíacas de mais risco. O sistema possui um sensor com três eletrodos superficiais para pegar o sinal ECG, o qual é transmitido via Bluetooth para um dispositivo móvel com Android, onde se faz a análise do sinal capturado durante um período de 5 s. O sistema proposto distingue entre Normal Ritmo [Ritmo Sinusal - RS), Taquicardia Ventricular [TV), Fibrilação Ventricular [FV) e Assistolia, com uma precisão do 100%, 55%, 75% e 90%, respectivamente. Porém, o sistema pode - se recuperar rapidamente dos erros na análise do quadro subsequente. Este trabalho centra-se no uso de dispositivos móveis de utilização diária, multitarefa e utilização acessível, implementação de algoritmos no domínio do tempo para a extração de parâmetros que são adequados para utilização em aplicações móveis, principalmente pela baixa carga computacional e possibilidade de execução em tempo real, permitindo a detecção de anormalidades cardíacas numa forma automática e rápida sem a necessidade de um controlo constante por um especialista para análise preliminar.

Effects on gastric mucosa induced by dental bleaching – an experimental study with 6% hydrogen peroxide in rats

The value of aesthetic dentistry has precipitated several developments in the investigation of dental materials related to this field. The free marketing of these products is a problem and it is subject to various interpretations regarding its legality. There are several techniques for tooth whitening, the most used one being the external bleaching. It is the later version of such technique that poses the greatest danger of ingesting the product. The present study analysed the systemic effect of these products when they are swallowed.Objective This experimental study aimed to observe the effects of a tooth whitening product, whose active agent is 6% hydrogen peroxide, on the gastric mucosa of healthy and non-tumour gastric pathology animals.Material and Methods Fifty Wistar-Han rats were used and then distributed into 5 groups, one for control and four test groups in which the bleaching product was administered in animals with and without non-tumour gastric pathology (induced by the administration of 1 sample of 50% ethanol and 5% of drinking water during 6 days) at different times of study by gavage. There was a decrease in body weight in animals of groups handled during the study period, which was most pronounced in IV and VA groups. Changes in spleen weight relative to body weight revealed no statistically significant changes. An analysis of the frequency was performed on the results of macroscopic observation of the gastric mucosa.Results The gastric mucosa revealed lesions in all manipulated groups, being more frequent in groups III and IV. It appears that there is a synergism when using hydrogen peroxide and 50% ethanol in the same group.Conclusion Therefore, it seems that there are some signs of toxicity 3 to 4 days after administration of 6% hydrogen peroxide. The prescription of these therapies must be controlled by the clinician and the risks must be minimized.

Angioplastía coronaria ambulatoria seguida de telemonitoreo post alta en pacientes estables / Safety of ambulatory coronary angioplasty followed by tele-monitoring for 3 days after discharge

Introducción: La angioplastía coronaria ambulatoria (APA) es habitualmente realizada, bajo ciertos criterios de seguridad y selección de pacientes. Nuestro objetivo fue realizar monitoreo telemédico en todas las angioplastías ambulatorias, durante tres días posterior al procedimiento. Método: Análisis prospectivo de las angioplastías ambulatorias realizadas en el Hospital Dr. Sótero del Río entre Marzo y Octubre del 2014. Se excluyó an-gioplastías de tronco coronario izquierdo, bifurcaciones, en contexto de síndrome coronario agudo y falla cardíaca. Se realizó monitoreo de presión arterial, frecuencia cardíaca, saturación de oxígeno, electrocardiograma (ECG) abreviado (D2 largo), presencia de síntomas, complicaciones del sitio de punción y adherencia a medicamentos durante 3 días. Se dispuso de alertas protocolizados para cada item, en una plataforma de monitoreo telemédico 24/7. En el análisis se consideró género, edad, factores de riesgo cardiovascular clásicos, medicamentos, presencia de síntomas, signos vitales, complicaciones del sitio de punción, rehospitalizaciones, tamaño del stent, vaso tratado y morbimortalidad. Resultados: Se realizaron 52 APA, suceptibles de ingresar al programa de monitoreo. Todas fueron realizadas por via radial. Un 68% de sexo masculino, edad promedio de 60,4 años, hipertensos 67%, diabétios 29%, dislipidémicos 37%, fumadores 45% con antecedentes familiares de cardiopatía coronaria 14%, angioplastía previa 53%, cirugía de revascularización previa 3,8%. Todos los procedimientos se efectuaron vía transradial. 23% recibió más de 1 stent. Ningún paciente presentó complicaciones durante el procedimiento y el resultado angiográfico final fue satisfactorio. Durante la monitori-zación, 8 pacientes presentaron alza de presión arterial, uno de los cuales fue resuelto en el servicio de urgencia, mientras que en los restantes se ajustó la dosis de medicamentos mediante consulta telefónica. Cuatro pacientes tuvieron dolor toráxico, 3 de ellos citados a control el día siguiente con ECG y en solo 1 se decidió nuevo estudio coronario, la cual demostró Stent permeable, sin evidencia de complicaciones. Ocho pacientes tuvieron complicaciones del sitio de punción, pero en un sólo caso fue hematoma, resuelto espontáneamente y en los 7 restantes dolor u hormigueo. No se registraron complicaciones mayores, como trombosis intra stent, accidentes cerebrovasculares o muerte. Conclusión: La monitorizacion cardíaca post an-gioplastía ambulatoria en pacientes coronarios estables parece una herramienta muy útil, que permite conocer la real evolución de los pacientes en su domicilio después del procedimiento y, además, corregir eventuales complicaciones. En este grupo ningún paciente presentó alguna complicación grave.

Background: Ambulatory coronary angioplasty (A-PTCA) has been performed in adequately selected patients. Our aim was to evaluate the feasibility and safety of adding post discharge tele-monitoring in patients undergoing A-PTCA Methods: Patients undergoing A-PTCA at Hospital Sotero del Rio (Santiago, Chile) from March to April 2014 were prospectively selected for addition of tele-monitoring. Patients with main left disease, lesions at bifurcations, those with evolving acute coronary syndromes, and those with heart failure were excluded. Tele monitoring for 3 days included arterial blood pressure, heart rate, arterial oxygen saturation, abbreviated (Lead II) ECG, symptoms, evaluation of puncture site and adherence to drug therapy. Pre designed continuous alerts were set in the monitoring system. Demographic and angiographic characteristics were recorded. Results: in 52 procedures inclusion and exclusion criteria were fulfilled and patients were included in the study. Mean age was 60.4 years old and 68% were males. Hypertension was present in 67%, diabetes en 29%, dyslipidemia in 37%, and and 45% smoked. 53% had prior PTCA and 3.8% prior CABG. PTCA was performed via the radial artery in all patients and 32% received more than 1 stent. No patient developed complications during or inmediately after PTCA. Angiographic result was satisfactory in all subjects. During tele-monitoring 8 patients presented high blood pressure: one was derived to the ER, all others had their medications appropiately adjusted. Four patients reported chest pain, and after EKG one was referred for coronary angiography, which showed a patent stent. 8 patients reported alterations at the puncture site, a small hematoma was present in one and just pain in the rest. There were no major complications, CVA or death, Conclusion: Tele-monitoring after A-PTCA in stable coronary patients appears to be useful in detecting events or complications, a small propotion of them requiring only treatment adjustments via telephone contact. No patient developed significant complications.

Avaliação dos níveis pressóricos em pacientes submetidos a tratamento cirúrgico ambulatorial / Evaluation of blood pressure in patients undergoing ambulatory surgery

O objetivo foi investigar e comparar as alterações da pressão arterial em pacientes hipertensos e normotensos submetidos à cirurgia odontológica em âmbito ambulatorial. A amostra foi constituída por dois grupos: Grupo Normotenso e Grupo Hipertenso (com 8 indivíduos em cada grupo). Pacientes foram avaliados pela Monitorizarão Ambulatorial da Pressão Arterial (MAPA) durante 24 horas. As aferições constadas no exame foram divididas para análise dos dados em 5 momentos: sono, pré-cirúrgico, transcirúrgico, pós-cirúrgico e vigília. Houve aumento significativo da pressão arterial no momento transcirúrgico do Grupo Normotenso (p = 0,02) e do Grupo Hipertenso (p = 0,04). No momento transcirúrgico notou-se o aumento significativo da pressão arterial nos dois grupos, todavia o grupo hipertenso manteve seus índices pressóricos elevados por maior fração de tempo.

The objective was investigated and compare the blood pressure variances in hypertensive and regular blood pressure patients who went thru dental surgery at ambulatory environment. The sample was made of two different groups: Regular Blood Pressure Group and Hypertensive Group (with 8 individuals on each group). Patients were evaluated by Blood Pressure Ambulatory Monitoring for 24 hours. The readings observed at the exam were divided in 5 moments: sleep, Pre-Operatory, Trans-Operatory, Post-Operatory and Follow Up. There was a significant increase observed at the Blood Pressure reading at the Trans-operatory of the Regular Blood Pressure group (p = 0,02) and the Hypertensive Group (p = 0,04). During the trans- -operatory it was observed a significant increase of the Blood Pressure on both groups, but the Hypertensive Group kept their numbers elevated for a longer time.

Wearable Sensors in Healthcare and Sensor-Enhanced Health Information Systems: All Our Tomorrows? / 대한의료정보학회지

Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuropsychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.

Wearable Sensors in Healthcare and Sensor-Enhanced Health Information Systems: All Our Tomorrows? / 대한의료정보학회지

Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuropsychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.

Integrated Solution for Physical Activity Monitoring Based on Mobile Phone and PC / 대한의료정보학회지

OBJECTIVES: This study is part of the ongoing development of treatment methods for metabolic syndrome (MS) project, which involves monitoring daily physical activity. In this study, we have focused on detecting walking activity from subjects which includes many other physical activities such as standing, sitting, lying, walking, running, and falling. Specially, we implemented an integrated solution for various physical activities monitoring using a mobile phone and PC. METHODS: We put the iPod touch has built in a tri-axial accelerometer on the waist of the subjects, and measured change in acceleration signal according to change in ambulatory movement and physical activities. First, we developed of programs that are aware of step counts, velocity of walking, energy consumptions, and metabolic equivalents based on iPod. Second, we have developed the activity recognition program based on PC. iPod synchronization with PC to transmit measured data using iPhoneBrowser program. Using the implemented system, we analyzed change in acceleration signal according to the change of six activity patterns. RESULTS: We compared results of the step counting algorithm with different positions. The mean accuracy across these tests was 99.6 +/- 0.61%, 99.1 +/- 0.87% (right waist location, right pants pocket). Moreover, six activities recognition was performed using Fuzzy c means classification algorithm recognized over 98% accuracy. In addition we developed of programs that synchronization of data between PC and iPod for long-term physical activity monitoring. CONCLUSIONS: This study will provide evidence on using mobile phone and PC for monitoring various activities in everyday life. The next step in our system will be addition of a standard value of various physical activities in everyday life such as household duties and a health guideline how to select and plan exercise considering one's physical characteristics and condition.

The Usefulness of Ambulatory Phonation Monitoring(APM) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of voice can be a cause of common voice disorders but may also affect the course of treatment. The information of voice use has been limited by relying on the subjective patient self-report in the past. In this study, however, we tried to determine the effectiveness of ambulatory phonation monitoring, which can provide objective vocal use parameters such as phonation time, fundamental frequency and sound pressure level. SUBJECTS AND METHOD: Four subjects (2; normal, 2; vocal disease) were recorded with Ambulatory Phonation Monitor Model 3,200 (KayPENTAX) during a working day. Ambulatory Phonation Monitor (APM) is an unobtrusive, portable device consisting of a small accelerometer, a microprocessor and the APM software. All subjects were instructed to wear APM during the entire day of normal activities and write an activity diary according to time. RESULTS: APM data displays 5 graphs which reveal important characteristics of each subject's phonatory behavior throughout the day. The patient's diary can provide the person's schedule and the correlation between subject's self recognition and the objective data analyzed by APM. CONCLUSION: APM is an overall useful device for measuring phonation parameters and evaluating voice behaviors in natural conditions. It can be used not only for the diagnosis of vocal diseases but also as a voice therapy for feedback on voice use.

A Comparative Study of Patient Experiences of Conventional Fluoroscopic and Four-Hour Ambulatory Urodynamic Studies

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.

Ischemia detection based on HMM beat segmentation and ST segment analysis

Thispaper describes an algorithm for ischemia monitoring in ambulatory electrocardiography. It relies on an automatic ST-segment anlysis. Orecise information about ST segment changes are provided by an original hidden Markov models (HMM) aproach for on line beat segmentation. The performance was evaluated on the two-channel European ST T database, according to its ST episode definitions ...

Problem in interpretation of laryngopharyngeal reflux disease according to the location of proximal probe in 24 hour ambulatory esophageal dual probe pH monitoring / 대한내과학회지

BACKGROUND: The diagnostic criteria of laryngopharyngeal reflux disease (LPRD) is defined differently according to the location of the proximal pH probe: upper esophagus, upper esophageal sphincter (UES) or hypopharynx. Clinically the location of proximal probe is determined by the location of distal probe, which is usually fixed on 5 cm above the lower esophageal sphincter. This study was performed to evaluate the difference in the diagnosis of LPRD between the results from considering the location of the proximal probe and not considering it. METHODS: This study consisted of 76 patients performed esophageal manometry and 24 hour ambulatory pH monitoring of esophagus using the dual probe. According to location of the proximal probe, the patients were divided into 3 groups : upper esophagus, UES and hypopharynx group. Firstly, we used the diagnostic criteria not considering the location of the probe concordantly in all 76 patients : criteria of the upper esophagus, UES and hypopharynx respectively. And then, we used the diagnostic criteria considering the location of the proximal probe. The results were compared. RESULTS: When the diagnostic criteria of upper esophagus was used, 3.9% (3/76) was diagnosed as LPRD. In the case of UES and hypopharynx, 18.4% (14/76) and 38.2% (29/76) was diagnosed as LPRD. When the diagnostic criteria considering the location of the proximal probe was used, 27.6% (21/76) was diagnosed as LPRD. Significant difference was found between the result considering the location of the probe and 3 results not considering it (p<0.01). CONCLUSION: It is thought to be appropriate to use the diagnostic criteria considering the location of the proximal probe for the more accurate diagnosis of LPRD.

Relação do nível médio e variabilidade da pressão arterial com a geometria do ventrículo esquerdo na hipertensão arterial sistêmica / Relation Between Average Level and Variability of Blood Pressure With the Geometry of the Left Ventricle in Systemic Hypertension

PURPOSE--To study the relation between the average level and variability of blood pressure (VBP) obtained by ambulatory monitoring (AMBP) and the geometric pattern (GP) of the left ventricle (LV) obtained by echocardiography (ECHO) in patients with hypertension (Hy) METHODS--AMBP and ECHO were performed in 37 patients with Hy, divided into three groups: group A--11 women using antihypertensive therapy (AH); group B--15 men using AH and group C--7 male and 4 female without AH. The GP of LV was obtained by ECHO based on mass index (MI) and relative thickness of the wall (RTW). Mean systolic (MSBP) and diastolic (MDBP) were analyzed during daytime (DT) and nighttime (NT) periods. VBP was defined by mean standard deviation (SD) of mean pressures considered. RESULTS--In G-A, there was a significant association between the MI and both VBP and MSBP (r = 0.65 and p < 0.005, r = 0.61, and p < 0.005, respectively), and MSBP and VBP during the DP (r = 0.64 and p < 0.005, r = 0.75, and p < 0.005). In G-B, there was a relation between the LVRTW (r = 0.55 and p < 0.005), and MSBP during the DP (r = 0.65 and p < 0.005). In G-C, there was a significant association (p < 0.005) between the MI and the MDBP in the DP and with the MSBP in the NP (r valueS ranged from 0.51 to 0.66). There was also a significant relation (p < 0.005) between the LVRTW and the SD of all variables in both DP and NP (r ranged from 0.47 to 0.78 and mean diastolic in the wakeful period (r = 0.42 to 0.78) and MDBP in the DP (r = 0.42 and p < 0.05). CONCLUSION--Both the increase in VBP and the mean BP are involved in the changes of LVGP in Hy.

Efeito do urapidil sobre a pressão arterial, hemodinâmica renal, metabolismo lipídico e glicídico / The effect of urapidil on blood pressure, renal hemodynamics, lipid and glucose metabolism

PURPOSE--To evaluate the effects of urapidil on blood pressure (BP), renal hemodynamics and lipid and glucose metabolism, in patients with mild-to-moderate uncomplicated essential hypertension. METHODS--Fifteen hypertensive patients, aged 38-64 year-old were studied by ambulatory blood pressure monitoring system (ABPM). It was also evaluated: 1) the creatinine clearance; 2) the effective renal plasma flow by use of a single plasma sample after injection of orthoiodohippurate; 3) the serum triglycerides, cholesterol, and HDL-cholesterol; 4) blood levels of glucose and insulin. The urapidil dose ranged from 60 to 180 mg/day, according to the individual response. RESULTS--The values after four weeks washout-placebo and active treatment with urapidil showed: the systolic/diastolic BP was reduced from 157.7 +/- 6/108.0 +/- 2 on placebo to 140.4 +/- 4/97.3 +/- 3 mmHg (p < 0.05/p < 0.01) after urapidil, respectively, whereas heart rate was unchanged. The percentage of elevated systolic and diastolic BP values during 24h (BP load) was reduced from 60.9 to 54.4 and from 60.8 to 50.3, respectively. Effective renal plasma flow, glomerular filtration rate, filtration fraction and renal vascular resistance were unaltered by treatment. Significant increase in HDL-cholesterol was observed (from 39.5 +/- 3.6 on placebo vs 49.2 +/- 4.8 mg/dl (p < 0.01) after urapidil. Total cholesterol, LDL-cholesterol and triglycerides levels were not modified with treatment. Circulating plasma glucose and insulin remained unchanged. CONCLUSION--Urapidil is an effective antihypertensive agent without deleterious effect on renal hemodynamics, lipid and glucose metabolism.

Objetivo − Avaliar os efeitos do urapidil sobre a pressão arterial, hemodinâmica renal, metabolismo lipídico e glicídico em portadores de hipertensão arterial sistêmica primária leve a moderada. Métodos − Foram analisados 15 pacientes hipertensos, com idades entre 38 e 64 anos, utilizando-se a técnica da monitorização ambulatorial da pressão arterial (MAPA) em 24h, avaliando-se, também, os clearances de creatinina e do hipuran radioativo, espectrofotometria de cristal sólido e as dosagens do colesterol e triglicérides séricos, do HDL-colesterol, da glicemia e insulina. As doses de urapidil variaram de 60 a 180mg/dia, administradas 2 ou 3 vezes, de acordo com cada caso. A avaliação durou pelo menos 6 semanas. Resultados − Os parâmetros analisados após 4 semanas de washout-placebo e tratamento com urapidil revelaram: 1) redução significante das pressões sistólica e diastólica (157,7±6 e 108±2 na fase placebo para 140,4±4 e 97,3±3mmHg, p<0,05; p<0,01, respectivamente); 2) o fluxo plasmático renal efetivo, ritmo de filtração glomerular, fração de filtração e resistência vascular renal não sofreram mudanças significantes; 3) aumento significante na concentração sérica das HDLcolesterol (39,5±3,6 para 49,2±4,8mg/dl, p<0,01), sem modificações nos níveis séricos do colesterol total, LDL colesterol e triglicérides; 4) as curvas glicêmicas e insulínicas não se alteraram. Conclusão − O urapidil reduziu a pressão arterial sem promover alterações na hemodinâmica renal, metabolismo lipídico e glicídico

Ritmo circadiano da pressäo arterial e o uso da amlodipina em hipertensäo primária / Circadian Rhythm of Blood Pressure and the Use of Amlodipine in Primary Hypertension

Objetivo - Avaliar a eficácia anti-hipertensiva e tolerabilidade da amlopidina em dose única diária administrada nos períodos matutino e vespertino. Métodos - Foram avaliados 15 pacientes hipertensos através de estudo aberto, näo comparativo de 18 semanas de duraçäo. Todos os participantes foram submetidos a retirada de outras drogas anti-hipertensivas (wash-out) durante 2 semanas. Após este período, aqueles que apresentaram níveis pressóricos de acordo com os critérios de inclusäo, iniciaram o tratamento com amlopidina 5mg, titulada até um máximo de 10mg. Atingida a dose ideal, os pacientes permaneceram 8 semanas em fase de manutençäo, usando-se a amlopidina às 8h e às 20h. Resultados - A maioria dos pacientes (n=9;60//) necessitou apenas 5mg e os dados de 24h revelaram as seguintes médias de pressäo arterial sistólica (em mmHg): V2 (final do wash-out) = 149,3 ñ 4,8; V3 (dose matutina) = 150,4 ñ 3,8; V4 (dose noturna) = 134,1 ñ 2,9; V5 (final do estudo) = 129,5 ñ 6,1 (ANOVA: p = 0,000; teste de Bonferroni: p < 0,05; teste t de Student" p = 0,013, comparando V2 (final do Wash-out) com V4 (dose noturna e V5 (final do estudo). As médias de pressäo diastólica foram (em mmHg): V2 (final do wash-out) = 96 ñ 3,1; V3 (dose matutina) = 96,2 ñ 2,7; V4 (dose noturna) = 81,9 ñ 2,6; V5 (final do estudo) = 77,7 ñ 7,5 (ANOVA): p = 0,000; teste de Bonferroni: p = 0,05; teste t : p =0,05. Foram verificados os seguintes percentuais de leitura sistólicas acima dos valores normais (140 mmHg = 7 às 23h; 130 mmHg = das 0 às 7h) : V2 (final do wash-out) = 73,3// de dia e 71,1// à noite; V3 (dose matutina) = 76// de dia e 75,6// à noite; V4 (dose noturna = 29,3// de dia e 39,3// à noite; 20,9// de dia e 23// à noite. Considerando os limites de diastólica para o dia, 90 mmHg e para a noite, 80 mmHg, foram verificados os seguintes percentuais de leituras de pressäo superior aos limites de normalidade: V2 (final do wash-out) = 77,8// de dia e 91,8// à noite; V3 (dose matutina) = 80// de dia e 92,6// à noite; V4 (dose noturna) = 6,7 de dia e 15,6// à noite). Três pacientes tiveram reaçöes adversas que cederam espontaneamente e/ou näo implicaram em interrupçäo do estudo. Conclusäo - A amlopidina mostrou-se eficaz e bem tolerada e a maioria dos pacientes utilizou a dose de 5mg. Em nenhum caso a droga levou à taquicardia reflexa; em nenhum caso; mesmo reduzindo a pressäo arterial eficazmente nas 24h, manteve o ritmo circadiano inalterado. Sua tomada no início da noite produz maior queda de descenso noturno que quando tomada pela manhä, näo havendo diferenças quanto aos demais períodos

Purpose - To evaluate the anti hypertensive efficacy and tolerability of amlodipine given once daily either morning and evening doses. Methods - Fifty hipertensive patients were admitted into an open non camparative 18 weeks study. All patients were submitted to wash out period of 2 weeks. Afterwards, those with BP inclusion criteria started 5mg amlodipine, which was titrated until a maximum of 10mg Upon reaching the ideal dosage, patients were kept 8 weeis with drug given at 8:00 am and then 8:00 pm. Results - The majority of patients (60%) needed only 5mg and 24 hours data revealed the following mean systolic BP: V2 (fiinal of wash-out) = 149,3 ± 4,8; V3 (morning dose) = 150,4 ± 3,8; V4 (night dose) = 134,1 ± 2,9; V5 (final of the study) = 129,5 ± 6,1 (ANOVA p= 0,000; Bonferroni test: p< 0,05; test t of Student: p= 0,13, comparing V2 (final of wash-out) with V4 (night dose) and V5 (final of study). The mean diastolic BP wore V2 ~nal of wash-out) = 96 ± 3,2 (morning dose) = 96,2 ± 2,7; V4 (night dose) = 81,9 ± 2,6; V5 (final of the study) = 77,7 ± 7,5 (ANOVA: p= 0,000; Bonferroni test : p= <0,05; test t: p=0,05). The following systolic percentage over normal values were observed (140 mmHg from 7:00 am to 11:00 pm; 130 mmHg from midnight to 7:00 am): V2 (final of wash-out) = 73,3% during the day and 71,1% at night; V3 (morning dose) = 76% in the morning and 75,6% at night; V4 (night dose) = 29,3% during the day and 39,3% at night; 20,9% during the day and 23% at night. Considering the limits of diurnal diastolic BP 90 mmHg and nocturnal, 80 mmHg, the following percentage of readings over normal limits were observed: V2 (final of wash-out) = 77,8% during the day and 91,8% at night; V3 (morning dose) = 80% during the day and 92,6% at night; V4 (night dose) = 6,7% during the day and 15,6% at night. Three patients presented adverse events, which disappeared spontaneously and discontinuation of treatment was not necessary. Conclusion - Amlodipine was considered effective and well tolerated and the majority of patients needed only 5mg daily and no reflex tachicardia was observed. Amlodipine effectively reduced BP throughout 24h and the circadian rhythm kept unaltered and the evening administration led to a greater nocturnal fall than the morning administration. The remaining periods did not show differences

Eficácia anti-hipertensiva da nitrendipina por 24 horas / Antihypertensive efficacy of nitrendipine for 24 hours

Estudar a eficácia anti-hipertensiva da nitrendipina por 24 horas. Vinte indivíduos com hipertensäo arterial primária leve a moderada. O estudo foi do tipo duplo-cego, com 90 dias de duraçäo. Após 15 dias sem drogas, os pacientes forma divididos aleatoriamente em dois grupos: 1) uso de nitrendipina 20 mg por 30 dias; 2) uso de placebo por 30 dias. Após outros 15 dias de "wash out", os grupos foram cruzados. A pressäo arterial foi avaliada por monitorizaçäo ambulatorial de 24 horas. A pressäo arterial sistólica média das 24 horas, da fase com nitrendipina foi significativamente (p > 0,0001) menor (127,7 ñ 8 mmHg) do que a com placebo (139,2 ñ 8 mmHg) do que a com placebo (139,2 ñ 8 mm Hg); a pressäo arterial diastólica média de 24 horas foi significativamente (p < 0,0001) menor com nitrenpidina (84,6 ñ 4 mmHg) do que com placebo (90,7 ñ 5 mmHg). As demais médias de 24 horas näo diferiram significativamente entre si. A nitrendipina mostrou-se anti-hipertensivo seguro e eficaz durante as 24 horas. A droga reduz as cifras tensionais mantendo o ritmo circadiano da pressäo arterial sem produzir períodos de hipotensäo arterial

Purpose: To evaluate the efficacy of nitrendipine 20 mg OD in mild to moderate hypertensive subjects. Patients and Methods: Twenty patients followed for 90 days. The protocol was a double blind placebo control trial using 24 hours ambulatory blood pressure monitoring system for pressure and heart rate observations. After 15 days without any drug patients were randomly assigned to the study divided into two subgroups: one remained 30 days using placebo and the other nitrendipina. After a new 15 days washout period there was a cross over of the study groups and then other 30 days of follow-up. Results: The 24 hours mean systolic blood pressure decreased (p < 0.0001) with nitrendipine (127.7 ± 8 mmHg) in relation to placebo (139.2 ± 8 mmHg); the mean diastolic blood pressure decreased (p < 0.0001) with nitrendipine (84.6 ± 4 mmHg) in relation to placebo (90.7 ± 5 mmHg). There were no signifcant changes on heart rate and body weight. Conclusion: Nitrendipine seems to be a safe and efficient antibypertensive agent for 24 hours blood pressure control. The drug can decrease blood pressure levels without signifcant changes over the circadian pattern of the 24 hours blood pressure curve and without unwanted drop of blood pressure levels.

RESULTS OF TWENTY FOUR HOURS AMBULATORY MONITORING OF ELECTROCARDIOGRAM AND EXERCISE STRESS TESTING IN PVC SCHOOL CHILDREN WITHOUT ORGANIC HEART DISEASE / 体力科学

Twenty four hours ambulatory monitoring of electrocardiogram and exercise stress testing were performed in 60 children who were refered to our hospital because of isolated premature ventricular contractions (PVCs) .<BR>Complex ventricular ectopy was found in 28 out of 60 PVC children. Out of 28 subjects with complex ventricular ectopies 21 had PVCs originated from the right ventricle.<BR>Frequency of PVCs per day was high in primary ventricular tachycardia and low in ventricular tachycardia with organic heart disease and there was statistical significance (p<0.01) between these two groups.<BR>There was no characteristics in coupling interval, prematurity index and vulnerability index which could specify ventricular tachycardia, couplets PVCs and isolated PVC.<BR>VT rate in exercise stress testing was higher than that in twenty four hours ambulatory monitoring of electrocardiogram (Holter recording) . Both exercise stress testing and twenty four hours monitering of electrocardiogram should be done to control VT school children.