O ECG NA MULHER HIPERTENSA, QUAL O MELHOR CRITÉRIO DE VOLTAGEM? / THE ECG IN HYPERTENSIVE WOMEN, WHAT IS THE BEST VOLTAGE CRITERIA?

Segundo a Diretriz Brasileira de Hipertensão Arterial 2020, hipertensão arterial (HA) é uma doença crônica não transmissível (DCNT) definida por níveis pressóricos, em que os benefícios do tratamento não medicamentoso e/ou medicamentoso superam os riscos; e a falta de tratamento evolui com lesão de órgão alvo, como a hipertrofia ventricular esquerda. Neste estudo avaliamos a literatura no tocante à acurácia dos critérios eletrocardiográficos para diagnóstico de hipertrofia ventricular esquerda (HVE) e por conta das diferenças entre homens e mulheres, isso constitui um grande desafio. Dentre os fatores que mais interferem no critério sensibilidade, destacam-se a massa cardíaca e o sexo, sendo a sensibilidade do ECG maior com o aumento da massa ventricular e no sexo masculino, segundo Colossimo e Povoa. No estudo de Gasperin, onde foram utilizados critérios de voltagem, observou-se que o critério de Cornell nas mulheres foi de maior sensibilidade, de 54,90%, com alta especificidade de 81,60%. Quando a sensibilidade do critério de Cornell foi comparada à de Sokolow-Lyon-Rappaport, o segundo em sensibilidade, foi de 41,18%; sem significância estatística entre os dois. A detecção precoce da HVE tem importância prognóstica, já discutida em vários trabalhos e seus critérios de validação, um constante desafio. Definir critérios específicos em mulheres torna-se necessário para maior acurácia diagnóstica e abordagem precoce para intervenções terapêuticas sejam medicamentosas ou não. Conclui-se que o critério eletrocardiográfico de Cornell foi o método com maior sensibilidade nas mulheres, nesta revisão. São necessários estudos com análises especificas para o sexo feminino, considerando suas diferenças anatômicas e antropométricas e possivelmente ajustadas à população brasileira. Torna-se uma limitação desta análise, a lacuna resultante do pequeno número de dados e poucos estudos publicados sobre o tema.

According to the Brazilian Guidelines on Hypertension 2020, hypertension (AH) is a chronic non-communicabledisease (NCD) defined by blood pressure levels, in which the benefits of non pharmacologic and/or pharmacologic therapy out weigh The risks; and lack of treatment evolves with target-organ damage such as left ventricular hypertrophy. In this study, we evaluated the literature regarding the accuracy of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy (LVH) and, due to the differences between men and women, this represents a great challenge. Among the factors that most interfere with the sensitivity criterion, cardiac mass and gender stand out, with ECG sensitivity being greater with the increase in ventricular mass and in males, according to Colossimo and Povoa. In the study by Gasperin, where voltage criteria were used, it was observed that the Cornell criterion in women was more sensitive, 54.90%, with a high specificity of 81.60%. When the sensitivity of the Cornell criterion was compared to theSokolow-Lyon-Rappaport criterion, the latter in sensitivity was 41.18%; with no statistical significance between the two. The early detection of LVH hás prognostic importance, already discussed in several works and its validation criteria, a Constant challenge. Defining specific criteria in women becomes necessary for greater diagnostic accuracy and a nearly approach to therapeutic interventions, whether drug-related or not. It is concluded that the Cornell electrocardiographic criterion was the method with the greatest sensitivity in women in this review. However, studies with specific analyzes for females are still needed, considering their anatomical and anthropometric differences and possibly adjusted to the Brazilian population. The gap resulting from the small amount of data and few published studies on the subject becomes a limitation of this analysis

Cell adhesion to plasma-coated PVC.

To produce environments suitable for cell culture, thin polymer films were deposited onto commercial PVC plates from radiofrequency acetylene-argon plasmas. The proportion of argon in the plasmas, P(Ar), was varied from 5.3 to 65.8%. The adhesion and growth of Vero cells on the coated surfaces were examined for different incubation times. Cytotoxicity tests were performed using spectroscopic methods. Carbon, O, and N were detected in all the samples using XPS. Roughness remained almost unchanged in the samples prepared with 5.3 and 28.9% but tended to increase for the films deposited with P(Ar) between 28.9 and 55.3%. Surface free energy increased with increasing P(Ar), except for the sample prepared at 28.9% of Ar, which presented the least reactive surface. Cells proliferated on all the samples, including the bare PVC. Independently of the deposition condition there was no evidence of cytotoxicity, indicating the viability of such coatings for designing biocompatible devices.

Increased response of Vero cells to PHBV matrices treated by plasma.

The copolymers poly(3-hydroxybutyric acid-co-3-hydroxyvaleric acid) (PHBV) are being intensely studied as a tissue engineering substrate. It is known that poly 3-hydroxybutyric acids (PHBs) and their copolymers are quite hydrophobic polyesters. Plasma-surface modification is an effective and economical surface treatment technique for many materials and of growing interest in biomedical engineering. In this study we investigate the advantages of oxygen and nitrogen plasma treatment to modify the PHBV surface to enable the acceleration of Vero cell adhesion and proliferation. PHBV was dissolved in methylene chloride at room temperature. The PHBV membranes were modified by oxygen or nitrogen-plasma treatments using a plasma generator. The membranes were sterilized by UV irradiation for 30 min and placed in 96-well plates. Vero cells were seeded onto the membranes and their proliferation onto the matrices was also determined by cytotoxicity and cell adhesion assay. After 2, 24, 48 and 120 h of incubation, growth of fibroblasts on matrices was observed by scanning electron microscopy (SEM). The analyses of the membranes indicated that the plasma treatment decreased the contact angle and increased the surface roughness; it also changed surface morphology, and consequently, enhanced the hydrophilic behavior of PHBV polymers. SEM analysis of Vero cells adhered to PHBV treated by plasma showed that the modified surface had allowed better cell attachment, spreading and growth than the untreated membrane. This combination of surface treatment and polymer chemistry is a valuable guide to prepare an appropriate surface for tissue engineering application.