[Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study]. / La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención.

OBJECTIVE: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. PATIENTS AND METHODS: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. INTERVENTION: The written results were given to the participants and presented in sessions. RESULTS: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P=ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P=.009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P=ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P=.0198) and 0 to 23.5% for obese subjects (P<.05). When more than one cuff was available, reasons for the choice went from: «making a rough guess¼ or «when velcro stops sticking¼ before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. CONCLUSION: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference.

La determinación del perímetro braquial para una adecuada medida de la presión arterial. Resultados de un estudio de intervención / Determination of arm circumference for correct measurement of blood pressure. Results of an intervention study

Objetivo: Evaluar la eficacia de una intervención para promover la determinación del perímetro braquial para seleccionar el manguito adecuado para la toma de la presión arterial. Pacientes y métodos: Estudio de intervención antes-después. Incluyó médicos, enfermeras y personal de oficinas de farmacia de un área básica de salud en Barcelona. Encuesta autoadministrada pre y posintervención (3 m). Variables recogidas: demográficas, tipo de profesional, años desde la finalización de los estudios, disponibilidad de manguitos de diferentes medidas, determinación o no del perímetro braquial, conocimiento o no de los valores de corte para cada manguito y tipo de aparatos de medida. Intervención: entrega de los resultados escritos y presentación en sesiones. Resultados: Pre y posintervención: 74,3 y 67,3% encuestas cumplimentadas (p = ns), respectivamente. La determinación del perímetro braquial varió del 1,3 al 19,1% (p = 0,009). Declararon disponer de 2 o más manguitos de diferente medida el 37,3 y el 44,1% de los encuestados (p = ns). El conocimiento del intervalo de medida correcto de los manguitos fue del 2,7 al 33,8% para el manguito estándar (p = 0,0198) y del 0 al 23,5% para el de obesos (p < 0,05). Cuando disponían de más de un manguito la elección se realizaba por motivos como «a ojo» o «cuando salta el velcro» antes y después de la intervención. La totalidad de los aparatos del centro de atención primaria eran electrónicos automáticos, así como los de 9 farmacias. Conclusión: La intervención aumentó la determinación del perímetro braquial previa a la lectura de la presión arterial y el conocimiento del intervalo de los manguitos estándar y para obesos. Hubo una mayor disponibilidad de manguitos de distinto tamaño. A pesar de ello, la utilización de uno u otro manguito no se realizaba en función de la medida del perímetro braquial

Objective: To assess the effectiveness of an intervention to promote standardized arm circumference measurement as way to choose appropriate cuff size to measure blood pressure. Patients and methods: A before-after intervention study was performed in a basic health care area in Barcelona. Doctors, nurses and pharmacy staff participated by filling out an anonymous self-administered questionnaire pre- and post-intervention (3 m). Variables included: demographics, type of professional, years since they finished their studies, availability of different cuff sizes, if arm circumference measurement were obtained or not, knowledge about the cutoff values for each cuff size and type of blood pressure monitor. Intervention: The written results were given to the participants and presented in sessions. Results: Pre- and post-intervention: 74.3 and 67.3% answered the questionnaires (P = ns), respectively. Determination of arm circumference varied from 1.3 to 19.1% (P = .009). A total of 37.3% and 44.1% declared that they had 2 or more available cuff sizes (P = ns). Knowledge about the correct measurement of the cuffs was 2.7 to 33.8% regarding the standard cuff size (P = .0198) and 0 to 23.5% for obese subjects (P < .05). When more than one cuff was available, reasons for the choice went from: «making a rough guess» or «when velcro stops sticking» before and after the intervention. All blood pressure devices in our primary health care center were electronic and automatic as were those of the 9 pharmacies. Conclusion: The intervention increased the determination of arm circumference prior to the reading of the blood pressure and the knowledge about the cutoff interval for standard and obese cuff size after intervention. There was greater availability of different sized cuffs. Despite this, the choice of the appropriate cuff size was not made based on arm circumference

Tratamiento individualizado en hipertensión arterial / Individualized treatment for arterial hypertension

No disponible

Pharmacological modulation of the renin-angiotensin system by mathematical modeling.

The renin-angiotensin system (RAS) is one of the most important systems in blood pressure homeostasis and pathogenesis of cardiovascular-renal diseases. When blood volume goes down, juxtaglomerular cells in the kidneys secrete renin. Renin stimulates the production of angiotensin I (Ang I), which is then converted to angiotensin II (Ang II). Angiotensin II causes blood vessels to constrict, resulting in increased blood pressure. If the renin angiotensin system is over active, blood pressure will be too high. Most hypotensive drugs are designed to block this system at different points in the pathway. In this study, we developed a mathematical model of the renin-angiotensin system to emulate the response of the renin-angiotensin system in humans. This model consists of a set of differential equations. Special attention is paid to the estimation of all the model parameters from reported experimental data. These equations allow us to model hypertensive and normotensive patients and pharmacotherapeutic approaches to treatment. We show dose-response curves of blood pressure and biochemical components of the renin-angiotensin system. Our results reproduce clinical outcomes. We conclude that mathematical modeling of RAS is a useful approach for gaining insight into the complexities of homeostatic control of arterial pressure and pharmacotherapeutics.

Contrasting patterns of morphological and physiological differentiation across insular environments: phenotypic variation and heritability of light-related traits in Olea europaea.

Phenotypic variation of traits can reflect the ability of plants to adjust to particular environments, but how much of this variation is heritable is not frequently analyzed in natural populations. In the present paper, we investigated the patterns of phenotypic expression in light-related leaf traits of Olea europaea subsp. guanchica, a woody sclerophyllous species endemic to the Canary Islands. We explored phenotypic differentiation and heritable variation across several island populations differing in light environment. A suite of morpho-functional (leaf size, SLA and leaf angle) and physiological (pigment pools: Chl a/b ratio, xantophyll cycle and ß-carotene) traits was measured in six populations on three islands. In addition, we estimated heritabilities for these traits following Ritland's method. Variation in morpho-functional, but not in physiological, traits was observed across the islands and was significantly related to the amount of diffuse light experienced by each population. In addition, significant heritabilities were found for morpho-functional traits, whereas expression of similar phenotypes among populations was accompanied by a lack of heritable variation in physiological traits. Most recently established populations did not exhibit lower heritabilities in quantitative traits than older populations, and apparently displayed congruent phenotypes under the local conditions. Our results strongly support the idea that different types of traits show contrasted levels of genetic and phenotypic variation in populations experiencing marked environmental differences.

Hipotiroidismo y miopatia por atorvastatina: reporte de un caso / Hypothyroidism and myopathy by atorvastatin: report of a case

Se presenta un caso de un hombre de 56 años con dislipidemia e hipotiroidismo, quien desarrolló una miopatía inflamatoria asociada al uso de atorvastatina. Siete meses después de iniciado el tratamiento el paciente presentó debilidad e hipotrofia muscular progresiva, dolor tarácico y elevación sérica de los niveles de creatinquinasa total. El cuadro clínico revirtió en su totalidad después de suspender el tratamiento con lovastatina. Se revisa la literatura más reciente sobre estatinas y miopatía y se presenta su diagnóstico diferencial.

Prognostic value of p53, c-erb-B2 and MIB-1 in endometrial carcinoma.

OBJECTIVE: To assess the immunohistochemical expression of p53 protein, a tumour suppressor gene of the oncogene c-erb-B2 and MIB-1 proliferation marker (Ki-67 antigen) in endometrial carcinoma. METHODS: We studied 29 cases of endometrial carcinoma in which the p53, c-erb-B2 and MIB-1/Ki-67 antigens were investigated by an immunohistochemical method. We evaluated the correlations among the immunohistochemical positivity and the grading, depth of myometrial invasion, stage of the neoplasia and follow-up. RESULTS: Both p53 and c-erb-B2 were positive in 16 out of 29 cases (55.2%), whereas MIB-1 was positive in 19 out of 29 cases (65.5%). All these three antigens showed a positive correlation with the grading, myometrial invasion and FIGO stage. Regarding follow-up, p53, c-erb-B2 and MIB-1 were, respectively, positive in 100%, 83.4% and 66.7% of neoplasias of patients who died of disease whereas they were positive in 40%, 40% and 60%, respectively, of tumours of patients with no evidence of disease. CONCLUSION: The overexpression of p53, c-erb-B2 and MIB-1 seem to indicate a more malignant tumour phenotype.

Effect of chronic stress on ENU-induced tumors.

The relation of stress to cancer is the subject of considerable controversy. We studied the possible influence of chronic stress on the time of development and frequency of tumors induced in rats after a single exposure to ethylnitrosourea during prenatal life. Time of development, localization, incidence, type, and size of tumors were similar in stressed rats and in controls. Our results in this paradigm do not support the hypothesis that chronic stress exerts a potentiating effect on carcinogenesis.

In situ survival of Vibrio cholerae and Escherichia coli in a tropical rain forest watershed.

For 12 months, Vibrio cholerae and fecal coliform densities were monitored along with nine other water quality parameters at 12 sites in a rain forest watershed in Puerto Rico. Densities of V. cholerae and fecal coliforms were not significantly correlated, even though the highest densities of both bacteria were found at a sewage outfall. High densities of V. cholerae were also found at pristine sites at the highest point in the watershed. The density of Escherichia coli and V. cholerae in membrane diffusion chambers did not change significantly during the course of two such studies. Physiological activity, as measured by electron transport system activity and relative nucleic acid composition, indicated that both E. coli and V. cholerae remained active. This study suggests that V. cholerae is indigenous to tropical fresh waters and that assays other than those that detect fecal coliforms or E. coli must be used for assessing public health risk in tropical waters.

In situ survival of Vibrio cholerae and Escherichia coli in tropical coral reefs.

Vibrio cholerae and Escherichia coli were inoculated into membrane diffusion chambers and placed around two small coral reef islands in Puerto Rico and monitored for 5 days. Several chambers were also buried in the sands of one of the reefs. Both E. coli and V. cholerae densities declined by 2 orders of magnitude, as measured by direct particle counts with a Coulter Counter (Coulter Electronics, Inc., Hialeah, Fla.). However, the density of neither bacteria changed dramatically when the same samples were analyzed by epifluorescent direct counts. Differences in the two direct count methods were accounted for by changes in cell morphology that occurred in both bacteria after exposure to seawater. Morphological changes occurred more rapidly in E. coli compared with those in V. cholerae. Bacteria in chambers exposed to sediment did not show significant changes in morphology and had only a slight decline in density. Physiological activity declined by more than 40% for both bacteria within 24 h. The decline in activity was less severe in the sediments. Tropical coral reef sands and turtle grass beds were shown to be less stressful environments for V. cholerae and E. coli than would have been predicted from temperature and microcosm studies. V. cholerae can survive the in situ conditions of a tropical coral reef and could become a source of bacterial contamination for fish and shellfish in this environment. The simultaneous monitoring of E. coli levels established that this bacteria can not be used as an indicator of V. cholerae or other fecal-borne pathogens in coral reef environments because of the greater stress these environments put on E. coli. Both bacteria could be of greater public health importance in tropical marine areas than previously imagined.

Freezing of infested pork muscle kills cysticerci.

A method for culturing cysticerci that allows successful evagination and growth of scolexes from metacestodes of Taenia solium was used to study the survival of cysticerci subjected to low temperatures. Refrigeration of pork muscle infested with cysticerci at temperatures above 0 degrees C did not affect the parasites' survival in culture. Conversely, freezing of meat prevented survival of cysts. A practical procedure to kill cysticerci is the storage of pork muscle for four days at -5 degrees C, three days at -15 degrees C, or one day at -24 degrees C. These simple measures would help prevent the most frequent parasitosis of man's central nervous system.

ELISA in the diagnosis of neurocysticercosis.

IgM antibodies against cysticercus antigens were measured by enzyme-linked immunosorbent assay (ELISA) in 133 serum and 126 cerebrospinal fluid (CSF) samples from patients with active neurocysticercosis (NCC), in 61 serum and 32 CSF samples from patients with inactive NCC, and in 556 serum and 449 CSF samples from patients with other neurological disorders. For diagnosis of active NCC the test showed 50% sensitivity with 70% specificity in serum and 87% sensitivity with 95% specificity in CSF. We concluded that the use of the ELISA with serum is not reliable for diagnosis of NCC and therefore cannot be used routinely for the detection of cases or epidemiological studies. Conversely, ELISA used with CSF is highly dependable for detecting all forms of active NCC. The possible explanations for the discrepancy between serum and CSF results are discussed.