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Introduction Many markers have been studied to improve the understanding of preeclampsia (PE) pathophysiology. PlGF stands out as an important marker to predict PE. We hypothesized that PlGF could be associated with the severity of the disease. Objectives To analyze PlGF levels in maternal plasma in normotensive and preeclamptic women, in the third trimester of pregnancy, and evaluate severity parameters in PE group with levels of PlGF, and correlate PlGF levels with maternal and fetal variables. Methods Case-control study that included 117 pregnant women (50 with PE and 67 in the control group). After consent of the patients, maternal plasma samples were collected and stocked at −80°C until the time of the analysis. The PlGF was quantified using MagPlexTH-C microspheres system and analyzed using ANCOVA adjusted by body mass index, gestational age (GA) and maternal age. PE group was stratified in relation to GA (cut point in 34wks) and proteinuria levels (proteinuria/creatininuria ratio – P/C, cut point in 0.5). Variables as newborn and placental weight; systolic and diastolic blood pressure were correlated to PlGF levels. To estimate the difference between groups, mean ratio (MR) and confidence interval (CI) of 95% was calculated. Analysis between PlGF levels were made by Pearson correlation. The null hypothesis was rejected when p Results There was a 62% reduction of PlGF levels in pregnant women with PE (excluding superimposed PE and HELLP Syndrome) in relation to the control group (MR=0,38; CI 95%: 0.15–0.95; p =0.041). When the PE group was stratified, PlGF levels were significantly lower in the group with PE with GA p =0.018), and those with P/C⩾0.5 vs. P/C p =0.027). It was also observed a correlation between PlGF levels and the newborn and placenta weight ( r =0.510, p r =0.331, p r =−0.352, p r =−0.360, p Conclusion It was found that the PlGF levels were significantly reduced in maternal plasma when GA 0.5. Also, it was observed a direct correlation between PlGF and weight of placenta and the newborn, and a negative correlation with blood pressure. Thus, in view of the findings presented, the question is if PlGF besides being studied with focus on the prediction of PE, could also be inserted in the context of the disease severity.

Introduction Hypertensive disorders of pregnancy (HDP) occur in 6–10% of all pregnancies. A significant proportion of previously normotensive women persist with elevated blood pressure 12 weeks postpartum. Investigation on factors involved in the persistence of hypertension is of critical importance to provide quality health care for those women. The aim of our study is to identify factors involved in the persistence of hypertension at 12 weeks after pregnancies complicated by HDP. Methods We conducted a case-control study nested in a prospective cohort of outpatient women who had HDP at a teaching hospital in Porto Alegre, RS. At first visit, all women informed socio-demographic characteristics, medical and pregnancy histories. At follow-up visits we collected information on use of antihypertensive medication, blood pressure, urinary and serum analysis. Results We selected 99 women in the cohort with no pre-existing hypertension and that were followed until 12 weeks postpartum. Hypertensive women after 12 weeks from delivery were considered cases (n = 56) and normotensive women after 12 weeks were labelled controls (n = 43). We developed a risk prediction model with independent variables for persistent hypertension after pregnancy. Our results showed that both blood pressure and use of antihypertensive medication were significantly different at first visit. Mean systolic and diastolic blood pressure were, respectively, 138.6 (20.6) mmHg and 91.9 (12.3) mmHg for the hypertensive group and 117.9 (12) mmHg and 78.4 (8.9) mmHg for controls (p 0.001). Maternal age was significantly higher in the hypertensive group. Gestational outcomes and biochemical parameters were similar between groups. Gestational age at delivery, maternal age and both systolic and diastolic blood pressures at first visit were independent variables chosen to compose a risk model with an area under the ROC of 0.896 (95% CI 0.819-0.972) to predict persistent hypertension after pregnancy. Conclusion Gestational age at delivery, maternal age and blood pressure were identified as important factors involved in persistent hypertension 12 weeks after pregnancies complicated by HDP. We believe that prospective studies with larger population are needed to access the value of a risk model to predict, at first visit postpartum, which women have increased chance to become chronically hypertensive.

Introduction: Improper cleaning of surfaces is a contributing factor to inefficiency in infection control in the hospital environment. Objective: To evaluate the effectiveness of the hemodialysis machine cleaning using bioluminescence with the Lightning MVP ICON. Materials and Method: A cross-section study at the Hemodialysis unit of the Hospital Sao Lucas. Samples were collected in 20 machines in three different shifts. The swabs were obtained in 4 pre-determine points, which are: top surface, dialyzer holder, programming and ON/OFF arrows before and after cleaning of equipment, in total were 480 collection points. The reading was held for ATP detection with the Lightning MVP ICON equipment, describing the samples in passed, alert and failure. Results: We found statistically significant differences between evaluations before and after in the case of the programming arrows (p=0.033), where was a significant increase in the rating “passed” after [48.3% (n=29)] when compared to before [25.0% (n=15)]. When the results were compared between shift, the night shift (before: 2.7±1.2 vs. after: 1.0±0.9) had a significantly reduction in the number of failures compared to morning shifts (before: 2.2±1.2 vs. after: 2.0±1.2) and afternoon shift (before: 2.2±1.0 vs. after: 2.1±1.3). Conclusion: The use of the Lightning MVP icon method to evaluate the surface cleaning of the hemodialysis equipment showed a significant decrease in the number of failures after cleaning and sanitizing and significant reduction on number of failures in procedures performed at the night shift when compared to the morning and afternoon shift.

INTRODUÇÃO: A higienização das mãos é um importante procedimento para a prevenção de infecções relacionadas à diálise peritoneal. OBJETIVO: Comparar a eficácia de duas técnicas de higienização das mãos na redução do número de unidades formadoras de colônia em pacientes em programa de diálise peritoneal. MATERIAIS E MÉTODO: Ensaio Clínico controlado. Trinta indivíduos submetidos a três coletas da flora microbiológica das mãos, em três momentos distintos: antes e após higienização das mãos com água e sabão glicerinado; após aplicação de álcool-gel etílico glicerinado a 70%. Culturas obtidas da superfície dos dedos das mãos, diretamente em placas de Agar Sangue de Carneiro. RESULTADOS: O crescimento médio nas culturas foi 31, 30 e 12 unidades formadoras de colônia antes da higienização, após a lavagem com água e sabão glicerinado e após a fricção com álcool gel, respectivamente (p < 0, 001). Staphyloccocus epidermidis ou Estafilococo coagulase-negativo foi o germe predominante, presente em 93,7% das placas. CONCLUSÃO: A higienização com álcool gel produziu maior redução no número de unidades formadoras de colônia. INTRODUCTION: Hand hygiene is an important procedure in preventing peritoneal dialysis-related infections. OBJECTIVE: To compare the effectiveness of two distinct techniques for hand hygiene in reducing the number of colony-forming units in patients on peritoneal dialysis. MATERIALS AND METHOD: Controlled clinical trial. Thirty patients underwent three collections of microbiological flora from the hands in three different instances: before and after hand washing with glycerin soap and water, and after rubbing 70% glycerin gel-alcohol. Cultures were obtained by applying the fingers surface directly on agar-blood plates. RESULTS: Cultures mean growth were 31, 30 e 12 colony-forming units prior to washing, after washing with glycerin soap and water, and following gel-alcohol, respectively (p < 0.001). Staphylococcus epidermidis was the predominant germ in culture, occurring in 93.7% of seeded plates. CONCLUSION: Hand rubbing with gel-alcohol was more effective in reducing the number of colonies recovered than the other methods.

This was a cross-sectional study that aimed to assess the association between work-related stress according to the Demand-Control Model, and the occurrence of Minor Psychic Disorder (MPD) in nursing workers. The participants were 335 professionals, out of which 245 were nursing technicians, aged predominantly between 20 and 40 years. Data were collected using the Job Stress Scale and the Self-Reporting Questionnaire-20. The analysis was performed using descriptive and analytical statistics. The prevalence of suspected MPD was 20.6%. Workers classified in the quadrants active job and high strain of the Demand-Control Model presented higher potential for developing MPD compared with those classified in the quadrant low strain. In conclusion, stress affects the mental health of workers and the aspects related to high psychological demands and high control still require further insight in order to understand their influence on the disease processes of nursing workers. Estudio transversal cuyo objetivo fue evaluar la asociación entre el estrés laboral, según el Modelo Demanda-Control, y la aparición de Trastorno Psíquico Menor (TPM) en los trabajadores de enfermería. Participaron 335 profesionales, siendo 245 técnicos de enfermería, con edad predominante entre 20 y 40 años. Los datos fueron recolectados utilizándose la Job Stress Scale y el Self-Reporting Questionnaire-20. El análisis se realizó mediante estadística descriptiva y analítica. La prevalencia de probable TPM encontrada fue del 20,6%. Los trabajadores en los cuadrantes trabajo activo y alto desgaste, del modelo demanda-control, presentan probabilidades de desarrollar TPM, en comparación con los situados en el cuadrante bajo desgaste. Se concluye que el estrés afecta la salud mental de los trabajadores y que los aspectos relacionados con la alta demanda psicológica y alto control todavía necesitan de mayores conocimientos para comprender su influencia en los procesos de enfermedad de los trabajadores de enfermería. Estudo transversal cujo objetivo foi avaliar a associação entre o estresse no trabalho, segundo o Modelo Demanda-Controle, e a ocorrência de Distúrbio Psíquico Menor (DPM) nos trabalhadores de enfermagem. Participaram 335 profissionais, sendo 245 técnicos de enfermagem, com idade predominante entre 20 e 40 anos. Os dados foram coletados utilizando-se a Job Stress Scale e o Self-Reporting Questionnaire-20. A análise foi realizada utilizando-se estatística descritiva e analítica. A prevalência de suspeição para DPM encontrada foi de 20,6%. Os trabalhadores nos quadrantes trabalho ativo e alto desgaste, do Modelo Demanda-Controle, apresentaram chances de desenvolver DPM, quando comparados com os situados no quadrante baixo desgaste. Conclui-se que o estresse afeta a saúde mental dos trabalhadores e que os aspectos relacionados a alta demanda psicológica e alto controle ainda necessitam de maiores aprofundamentos para que se entenda sua influência nos processos de adoecimento dos trabalhadores de enfermagem.

End-stage kidney disease (ESKD) is a major health problem associated with very high morbidity and mortality secondary to cardiovascular complications, especially in ESKD patients on dialysis. Therefore, exploring key mechanisms underlying cardiovascular alterations associated with ESKD may offer reasonable pharmacological targets that may benefit these patients. Imbalanced matrix metalloproteinases (MMP) activities have been implicated in many cardiovascular diseases, and growing evidence now indicates that excessive MMP activities contribute to cardiovascular complications in ESKD patients. However, there is no study on the effects of MMP inhibitors (MMPIs) in such patients. MMPIs may prevent against the vascular and cardiac changes associated with ESKD. In this MiniReview, we aimed at reviewing current evidence supporting the idea that pharmacological inhibition of imbalanced MMP activities in ESKD may decrease the morbidity and mortality associated with cardiovascular complications in ESKD patients. However, MMPs have variable effects during different phases of kidney disease, and therefore optimal timing for MMP inhibition during a disease process may vary significantly and is largely undetermined. While current research shows that MMPs play a role in the pathogenesis of the cardiovascular alterations found in ESKD patients, clinical studies are required to validate the idea of using MMPIs in ESKD.

Estudio que tuvo el objetivo identificar el estrés en el trabajo, según la Job Stress Scale y asociarlo con aspectos sociodemográficos y laborales de trabajadores de enfermería de un hospital de emergencia. Estudio de tipo transversal, cuyos datos fueron recolectados, por medio de cuestionario, con 388 profesionales de enfermería. El análisis fue realizado con la estadística descriptiva, análisis univariado y multivariado. Los resultados identificaron asociación significativa con el cargo de técnico/auxiliar de enfermería, tiempo en el cargo superior a 15 años y bajo apoyo social, con chances respectivas de 3,84; 2,25 y 4,79 mayores para el cuadrante alto desgaste. El estudio demostró que los aspectos relacionados al ambiente de trabajo deben ser acompañados por los órganos competentes con la finalidad de invertir recursos en la calidad de vida en el trabajo de la enfermería. Trata-se de estudo cujo objetivo foi identificar o estresse no trabalho, segundo a Job Stress Scale, e associá-lo aos aspectos sociodemográficos e laborais de trabalhadores de enfermagem de um hospital de pronto-socorro. É estudo tipo transversal, cujos dados foram coletados por meio de questionário, com 388 profissionais de enfermagem. A análise foi realizada pela estatística descritiva, análise univariada e multivariada. Através dos resultados identificaram-se associação significativa com o cargo de técnico/auxiliar de enfermagem, tempo no cargo superior a 15 anos e baixo apoio social, com chances respectivas de 3,84, 2,25 e 4,79 maiores para o quadrante alto desgaste. Demonstra-se, assim, que os aspectos relacionados ao ambiente de trabalho devem ser acompanhadas pelos órgãos competentes no intuito de investir na qualidade de vida no trabalho da enfermagem. This study identifies workplace stress according to the Job Stress Scale and associates it with socio-demographic and occupational variables of nursing workers from an emergency hospital. This is a cross-sectional study and data were collected through a questionnaire applied to 388 nursing professionals. Descriptive statistics were applied; univariate and multivariate analyses were performed. The results indicate there is a significant association with being a nursing technician or auxiliary, working in the position for more than 15 years, and having low social support, with 3.84, 2.25 and 4.79 times more chances of being placed in the ‘high strain job' quadrant. The study reveals that aspects related to the workplace should be monitored by competent agencies in order to improve the quality of life of nursing workers.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:25:30Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:31:08Z : No. of bitstreams: 1 2-s2.0-79952197520.pdf: 336059 bytes, checksum: 6887bfb6c66c449f86ed80f9d7459718 (MD5) Made available in DSpace on 2014-05-27T11:25:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-05 Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial Registration: Clinical Trials NCT00970931. © 2011 Fuchs et al; licensee BioMed Central Ltd. Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul, Porto Alegre Hospital Universitário Antônio Pedro Universidade Federal Fluminense, Niterói Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre Hospital das Clinicas Universidade de São Paulo, São Paulo Instituto do Coração Universidade de São Paulo, São Paulo Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto Faculdade de Medicina São José do Rio Preto, São José do Rio Preto Faculdade de Ciências Médicas Universidade de Campinas, Campinas Faculdade de Ciências Farmacêuticas Universidade de São Paulo, Ribeirão Preto Faculdade de Medicina de Botucatu Universidade Estadual de São Paulo, Botucatu Universidade do Estado do Rio de Janeiro, Rio de Janeiro Hospital das Clínicas Universidade Federal de Minas Gerais, Belo Horizonte Hospital das Clínicas de Goiânia Universidade Federal de Goiás, Goiânia Anis Rassi Hospital, Goiânia Hospital Universitário Júlio Muller Universidade Federal de Mato Grosso, Cuiabá Faculdade de Medicina Universidade de Ciências da Saúde Alagoas, Maceió Faculdade de Medicina Universidade Federal de Pernambuco, Recife Instituto de Medicina Integral Prof Fernando Figueira, Recife Hospital Universitário Oswaldo Cruz/PROCAPE Universidade de Pernambuco, Recife Hospital Universitário Valter Cantídio Universidade Federal do Ceará, Fortaleza Hospital Universitário Universidade Federal Maranhão, São Luiz Instituto de Cardiologia Fundação Universitária de Cardiologia, Porto Alegre Faculdade de Medicina Universidade Federal de Pelotas, Pelotas Hospital do Coração, São Paulo Faculdade de Medicina de Botucatu Universidade Estadual de São Paulo, Botucatu

OBJETIVO: Evaluar la validez de prediccion del Instrumento de Prediccion de Riesgo de Admision Hospitalaria Repetida de la hospitalizacion de ancianos. METODOS: Estudio de cohorte de base poblacional con seguimiento de seis meses con 515 ancianos (>;60 anos) no institucionalizados, atendidos por la Estrategia Salud de la Familia en la ciudad de Progresso, Sur de Brasil, en 2005. Los ancianos respondieron a ocho preguntas objetivas, que fueron reunidas en modelo de regresion logistica para estimar su riesgo de admision hospitalaria futura, por estratos de riesgo. Analisis de sobrevida y la curva Receiver Operating Characteristics fueron empleadas para comparar la validez del instrumento. RESULTADOS: De los entrevistados, 56,1% eran mujeres y 10,1% fueron hospitalizados. El grupo de riesgo alto tuvo frecuencia de internacion hospitalaria 6,5 veces superior con relacion al grupo de riesgo bajo. CONCLUSIONES: El instrumento es efectivo al predecir el riesgo de hospitalizacion de los ancianos atendidos por la Estrategia Salud de la Familia del Sistema Unico de Salud.

The identification of genetic markers associated with chronic kidney disease (CKD) may help to predict its development. Because reduced nitric oxide (NO) bioavailability and endothelial dysfunction are involved in CKD, genetic polymorphisms in the gene encoding the enzyme involved in NO synthesis (endothelial NO synthase [eNos]) may affect the susceptibility to CKD and the development of end-stage renal disease (ESRD). We compared genotype and haplotype distributions of three relevant eNOS polymorphisms (T(-786)C in the promoter region, Glu298Asp in exon 7, and 4b/4a in intron 4) in 110 healthy control subjects and 127 ESRD patients. Genotypes for the T(-786)C and Glu298Asp polymorphisms were determined by TaqMan(®) Allele Discrimination assay and real-time polymerase chain reaction. Genotypes for the intron 4 polymorphism were determined by polymerase chain reaction and fragment separation by electrophoresis. The software program PHASE 2.1 was used to estimate the haplotypes frequencies. We considered significant a probability value of p 0.05/number of haplotypes (p 0.05/8 = 0.0063). We found no significant differences between groups with respect to age, ethnicity, and gender. CKD patients had higher blood pressure, total cholesterol, and creatinine levels than healthy control subjects (all p 0.05). Genotype and allele distributions for the three eNOS polymorphisms were similar in both groups (p 0.05). We found no significant differences in haplotype distribution between groups (p 0.05). The lack of significant associations between eNOS polymorphisms and ESRD suggests that eNOS polymorphisms may not be relevant to the genetic component of CKD that leads to ESRD.

ÂFRODESOENDENTES E MISCIGENADOS Os afrodescendentes em geral respondem menos a monoterapia com betabloqueadores, IECA e BRA do que aos diureticos e ACC dihidropiridinicos (grau de recomendacao [GR] II, nivel de evidencia [EV] B).1,2 A escolha do anti-hipertensivo para tratar este grupo etnico e norteada pela presenca de comorbidades e pela eficacia em atingir as metas pretendidas.3 O uso de terapia nao medicamentosa tem apresentado melhores resultados em afrodescendentes do que em brancos (GRI, EVA).4-6 Em individuos com proteinuria o uso de IECA esta [...]

Erythrocytes l-arginine uptake is conveyed by y+ and y+L membrane transport systems. Pre-incubation with N-ethylmaleimide for 10 min at 37°C inhibits the y+ system. The aim of this study was to determine the ideal pre-incubation temperature in evaluating y+ and y+L systems. Cells were pre-incubated with or without N-ethylmaleimide for 10 min at 4°C and 37°C. l-Arginine uptake was quantified by radioisotope and standard erythrocytes membrane flux methodology. Results demonstrate that erythrocytes l-arginine content is depleted by pre-incubation at 37°C for 10 min, thus changing the V max measurement. The inhibitory effect of N-ethylmaleimide pre-incubation was temperature independent and already complete after 1 min of incubation. No significant difference in kinetic parameters was detected between cells pre-incubated at 37°C or 4°C, under zero-trans conditions. In conclusion, we suggest that measurement of erythrocytes l-arginine uptake by y+ and y+L systems could be carried out without N-ethylmaleimide pre-incubation at 37°C.

Hepatitis B (HB) may progress to cirrhosis and liver carcinoma. Its prevalence is estimated at 3.2 % in hemodialysis (HD) patients. HB vaccine when applied intramuscularly (IM) in end-stage renal disease patients often does not induce appropriate antibody titers. However, there has been suggestion for intradermal (ID) to be a more effective inoculation method.To compare the immune response to IM or ID vaccine administration on HD patients.Thirty one incident HD patients were randomly assigned alternately to IM or ID vaccine inoculation. Vaccine doses were applied at three monthly intervals, with patients being followed-up for six months. Sixteen patients were assigned to IM (40 mg/dose) and 15 to ID (4 mg/dose) vaccine administration. HB-virus surface antibody titer, hematimetric parameters, serum urea level and Kt/V were monthly evaluated. C-reactive protein, parathormone, ferritin, aminotransferases and albumin serum levels were evaluated before and at the sixth month of the initial inoculation.Urea levels were significantly higher in the ID group (P(1) = 0.031); ferritin levels were higher in the IM (P(2) = 0.037) and C-reactive protein levels tended to be higher in the ID group. An interim evaluation by the Safety Monitoring Committee recommended discontinuing the study as IM vaccination had converted 62.5% of the exposed subjects, while ID inoculation converted only 13.3%.As performed, ID applied vaccine was inferior to the IM inoculation. Such result may depend on the inoculated doses or some other factor, such as inflammation.

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To test the predictive validity of the Probability of Repeated Hospital Admissions questionnaire among older adults.A population-based cohort study with a 6-month follow-up was implemented with 515 non-institutionalized older people (60 years) cared for by the Family Health Strategy in the city of Progresso, Southern Brazil, in 2005. Participants answered eight objective questions that were entered in a logistic regression model to estimate the risk of future hospital admission, by risk strata. Survival analysis and the receiver operating characteristics curve were utilized to assess instrument validity.Among participants, 56.1% were women and 10.1% were hospitalized. The high-risk group had a 6.5 times greater frequency of hospitalization in comparison to the low-risk category.The instrument is effective in assessing the risk of hospitalization among older adults attended by the Family Health Program of the National Unified Health Care System.

FUNDAMENTO: A síndrome de pré-eclâmpsia se associa com a disfunção endotelial e o diagnóstico diferencial entre pré-eclâmpsia pura (PE) e sobreposta (PES) só pode ser feito após 12 semanas do parto. OBJETIVO: Comparar a avaliação da função endotelial através de dilatação mediada por fluxo de gestantes com pré-eclâmpsia pura e sobreposta. MÉTODOS: A dilatação mediada por fluxo da artéria braquial foi realizada utilizando as recomendações da International Brachial Artery Reactivity Task Force em gestantes com a Síndrome de Pré-eclâmpsia. Pré-eclâmpsia (n = 14) e pré-eclâmpsia sobreposta (n = 13) foram diagnosticadas no pós-parto segundo as definições do National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: A mediana da dilatação mediada por fluxo (DMF) na PES (6,0%; 1,9-10,3) foi reduzida em comparação com PE (13,6%; 4,4-17,1), uma disparidade aparentemente relevante, mas sem diferença estatisticamente significativa (p = 0,08). A DMF inferior a 10% foi detectada em 30,8% das PE e em 69,2% das PES (p = 0,057). Diferenças significativas não ocorreram na comparação entre a morfologia das artérias uterinas de PE e PES através do espectro do Doppler. CONCLUSÃO: A DMF da artéria braquial de pacientes com Síndrome de Pré-eclâmpsia não se mostrou ser um método capaz de diferenciar PE de PES. Entretanto, os dados sugerem que PES se associa com pior função endotelial em comparação a PE. BACKGROUND: The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery. OBJECTIVE: To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia. METHODS: The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTS: The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD < 10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum. CONCLUSION: The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE. FUNDAMENTO: El síndrome de preeclampsia se asocia con la disfunción endotelial y el diagnóstico diferencial entre preeclampsia pura (PE) y sobreagregada (PES) sólo puede realizarse 12 semanas después del parto. OBJETIVO: Comparar la evaluación de la función endotelial a través de dilatación mediada por flujo en gestantes con preeclampsia pura y sobreagregada. MÉTODOS: La dilatación mediada por flujo de la arteria braquial se realizó utilizando las recomendaciones de la International Brachial Artery Reactivity Task Force en gestantes con Síndrome de Preeclampsia. La Preeclampsia (n = 14) y preeclampsia sobreagregada (n = 13) fueron diagnosticadas en el posparto según las definiciones del National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. RESULTADOS: El promedio de la dilatación mediada por flujo (DMF) en la PES (6,0%; 1,9-10,3) fue reducido en comparación con la PE (13,6%; 4,4-17,1), una disparidad aparentemente relevante, pero sin diferencia estadísticamente significativa (p = 0,08). Una DMF inferior al 10% se detectó en el 30,8% de las PE y en el 69,2% de las PES (p = 0,057). No aparecieron diferencias significativas en la comparación entre la morfología de las arterias uterinas de PE y PES a través del espectro del Doppler. CONCLUSIÓN: La DMF de la arteria braquial de pacientes con Síndrome de Preeclampsia no demostró ser un método capaz de diferenciar PE de PES. No obstante, los datos sugieren que la PES se asocia a una peor función endotelial en comparación con la PE.

Atherosclerosis, beginning in childhood, is dependent on several risk factors and may be predictive of coronary artery disease in adulthood. The risk factors for subclinical atherosclerosis are similar to those for clinical disease. Carotid intima-media thickness is a measure of subclinical atherosclerosis and a predictor of subsequent vascular events. This study aimed to examine the relationships of carotid intima-media thickness with known risk factors in asymptomatic children. Family history of cardiovascular disease was collected, together with anthropometric, demographic, and clinical data. Body mass index z-scores were calculated. Serum glucose, lipid fractions, fibrinogen, and C-reactive protein were determined. High-resolution ultrasonography was used to assess intima-media thickness. Associations and relationships of risk factors with composite intima-media thickness were explored. The study enrolled 93 children (44 girls) ranging in age from 49 to 169 months. The boys had a thicker intima-media (0.46 +/- 0.06 mm) than the girls (0.43 +/- 0.06 mm; p = 0.028). The unadjusted triglyceride levels were significantly higher in the overweight and obese children (p = 0.010). Body mass index and overweight/obesity were positively related to intima-media thickness (r = 0.259; p = 0.012 and r (s) = 0.230; p = 0.027, respectively), whereas family history of cardiovascular disease was unrelated. Only gender and overweight/obesity were related to intima-media thickness in a multiple linear regression model (R (2) = 0.125; p = 0.002). Male gender and overweight/obesity were associated with increased intima-media thickness, whereas family history of cardiovascular disease was unrelated.

The preeclampsia syndrome is associated with endothelial dysfunction and the differential diagnosis between pure preeclampsia (PE) and superimposed preeclampsia (SPE) can be only be attained 12 weeks after delivery.To compare the assessment of endothelial function through flow-mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia.The flow-mediated dilatation of the brachial artery was carried out according to the recommendations of the International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. PE (n=14) and SPE (n=13) were diagnosed in the postpartum period according to the definitions of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.The median of the flow-mediated dilatation (FMD) in SPE (6.0%; 1.9-10.3) was decreased in comparison with the PE (13.6%;4.4-17.1), an apparently relevant difference , but not statistically significant (p = 0.08). The FMD10% was detected in 30.8% of the PE cases and in 69.2% of the SPE cases (p = 0.057). Significant differences could not be detected in the morphology of the uterine arteries between the PE and SPE cases through the Doppler spectrum.The FMD of the brachial artery of patients with preeclampsia syndrome was not capable of differentiating between PE and SPE. However, the data suggest that SPE is associated with worse endothelial function I comparison to PE.

Objective: To evaluate associations between maternal serum uric acid (UA) levels, maternal status, and fetal outcome. Methods: Maternal UA, urinary protein-creatinine ratio (P/C), blood pressure (BP), gestational age at delivery, and birth weight were evaluated in hypertensive pregnant women (n = 58). These were divided into two groups: high UA (≥357 μmol/L) or normal UA (

Kidney transplantation is currently the treatment of choice for end-stage renal disease. As the successful transplantation improves the physical and mental quality of life, it is expected that the transplant recipient should play a productive role in the society. The present study evaluates the occurrence and predictors of employment after kidney transplantation.Population-based cross-sectional study in which 272 adult kidney recipients assisted in a Brazilian Southern state were evaluated.At the moment of the interview, 29% of the patients were employed. After analysis with logistic regression, the predictors of employment were male sex (OR 4.04; 95% CI 1.99-8.23), pre-transplant employment for non-diabetic (OR 4.35; 95% CI 3.79-4.99), diabetes for individuals who worked while on dialysis (OR 0.06; 95% CI 0.008-0.5), high educational level for individuals with mental quality of life scores above the 25th percentile (OR 3.06; 95% CI 2.98-3.14 for 50th percentile of mental quality of life). The Hosmer-Lemeshow test was of 3.33 (p = 0.91).The participation of the kidney transplant recipients with functioning graft into the work force in the Brazilian state of Rio Grande do Sul is low, being predicted mainly by sociodemographic factors. It was not detected any influence of patient perception of his/her physical conditions or other clinical variables, except for the presence of diabetes.

Introduction Caveolin-1 (cav-1) is one of the major protein components of caveolae required for the coordination of some signalling pathways, including that of angiotensin II (AngII) with its Type 1 receptor (AT1R). We have previously reported decreased cav-1 and increased AT1R protein expression in placentae from women with pre-eclampsia (PE). Within the PE placenta, an increase in AngII acting via AT1R may lead to increased vasoconstriction, but possible functional effects of altered cav-1, and interactions with components of RAS and markers of oxidative stress have not been investigated. Objective To establish mechanistic interactions of placental cav-1 with RAS components and surrogate markers of oxidative stress and antioxidant concentrations. Methods Immunohistochemistry was performed on paraffin-embedded serial placental sections from 24 normotensive (NC) and 19 women with PE, using antibodies to cav-1, prorenin receptor (PRR), angiotensinogen (AGT), AT1R, AngII type 2 receptor (AT2R) and eNOS. Protein expression was semi-quantitatively assessed and also analysed with respect to previously measured maternal plasma TBARS (Thiobarbituric acid-reactive substances) concentration and placental glutathione peroxidase (GPx) activity. Results Positive correlations were observed between placental expression of cav-1 and the AT2R ( P = 0.003) and PRR ( P P > 0.7, P > 0.5). However, cav-1 was inversely correlated with eNOS expression in both NC and PE placentae ( P P = 0.003). No significant correlations were observed with AGT or AT1R. A negative correlation was observed between maternal TBARS and cav-1 protein ( P = 0.003), and between placental GPx activity and cav-1 protein ( P = 0.027) only in the PE placentae. Conclusions A complex cascade links activation of the AT1R with NADPH oxidase activation, generation of reactive oxygen species (ROS), the uncoupling of eNOS and subsequent modification of redox-sensitive caveolar proteins in vascular smooth muscle outside pregnancy. Our findings suggest that this cascade is altered in hypertensive pregnancy, in a direction which would lead to enhanced local vasoconstriction.

Objective The purpose of this study was to evaluate the angiotensin-converting enzyme gene polymorphism in pregnant women with and without preeclampsia. Study design Preeclampsia was defined as hypertension and pathologic proteinuria in pregnant women after gestational week 20. Genomic DNA was isolated from leukocytes. The insertion-deletion polymorphism in intron 16 of the angiotensin-converting enzyme gene was detected in DNA samples with the use of the polymerase chain reaction. Chi-squared and Student t tests were used for statistical analysis. Results In preeclampsia (n=51 women) angiotensin-converting enzyme genotypes were deletion-D (DD) in 16 women (31%), insertion-I (II) in 12 women (24%), and insertion-deletion in 23 women (45%); in the control group (n=71), the angiotensin-converting enzyme genotypes were DD in 21 women (30%), II in 17 women (24%), and insertion-deletion in 33 women (46%). Angiotensin-converting enzyme genotype distribution and allelic frequencies were not different between groups. Conclusion No difference in the angiotensin-converting enzyme genotype distribution was found between preeclampsia and normal pregnancy. The results showed no association between angiotensin-converting enzyme polymorphism and the development of preeclampsia.

Generic prognostic scores used in acute renal failure (ARF) give imprecise results; disease-specific indices applied to distinct populations or intensive care practices becomes inaccurate. The current study evaluates the adequacy of prognostic scores, in patients with severe ARF needing dialysis.Known generic (APACHE II) and disease-specific (ATN-ISS) indices were applied to a cohort (n = 280) with ARF needing dialysis, under intensive care. Possible risk factors as causal factors, organ dysfunctions and clinical variables were examined, and a local index assembled by multivariate logistic regression analysis. Area under the receiver operating characteristics (ROC) curves evaluated the indices discriminating capacity. Goodness-of-fit testing and linear regression analysis appraised calibration. Validation was accomplished by the bootstrapping technique. The end-point was hospital mortality.Overall mortality was 85%. Female gender44 years (OR: 0.29; 95% CI: 0.10-0.84), liver/obstructive biliary disease (OR: 6.03; 95% CI: 1.65-22.08), being conscious (OR: 0.49; 95% CI: 0.21-1.14), use of vasoactive drug (OR: 3.13; 95% CI: 1.25-7.83), respiratory dysfunction (OR: 5.20; 95% CI: 1.25-7.83) or sepsis (OR: 2.62; 95% CI: 1.14-6.02) were associated with outcome. Areas under the ROC curve of 0.815, 0.652 and 0.814; Goodness-of-fit test P = 0.593, P0.001 and P = 0.002; and linear regression R2 = 0.973, R2 = 0.526 and R2 = 0.919 for the local index, APACHE II and ATN-ISS, respectively, indicate better performance by the local index. The local index median area under the ROC curve, by bootstrapping, was 0.820 (95% CI: 0.741-0.907).APACHE II score was inaccurate, and ATN-ISS poorly calibrated. When mortality or intensive care practices significantly deviate, local scores may better evaluate prognosis in severe ARF.

Guidelines on arterial blood pressure (BP) measurements recommend a time interval between readings. There has been little evidence supporting this recommendation. Therefore, we measured the variation in arterial pressure between the pairs of measurements without an interval (n = 269) or with venous congestion interposed (n = 79). The variation in BP readings was not significantly greater whether a 60-sec interval or venous congestion were present. These overall results do not support the hypothesis that the absence of the time interval or of presence of venous congestion, as may occur in clinical practice, significantly affects BP measurements.

Introduction The ABO-system of antigens and the Rh-system (D-antigen) is genetically determined and remains the most important blood group systems clinically. Several studies have examined the association between ABO and Rhesus blood group systems and pre-eclampsia. At present there is no consensus to define this association, especially not in a Brazilian population. Objectives The purpose of the present study was to evaluate the association between pre-eclampsia versus ABO and Rhesus blood group systems in pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil – Hospital S a o Lucas (HSL). Methods Pre-eclampsia/eclampsia (PE/E) was diagnosed by the National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy guidelines. This study consisted of 14,894 pregnant women admitted to the Maternity Department between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Complications in pregnancy not related to pre-eclampsia/eclampsia (PE/E) and those with uncompleted data were excluded. Medical records of 410 women were used to diagnose PE/E. The control group consisted of 8781 women. Each group was subdivided according to their blood groups. Results In comparison to the PE/E women and controls, no specific relation in blood groups was observed. With respect to ABO and Rh groups, no differences between PE/E and controls were observed ( P =0.479 and P =0.169 respectively). When analyzed with both Rh and ABO Pearson Chi-Square also showed no differences ( P =0.569). ABO/RhNormal (%)PE/E (%)TotalO−401 (4,56)16 (3,90)417O+4014 (45,71)205 (50)4219A−335 (3,81)13 (3,17)348A+2833 (32,2)120 (29,2)2953B−83 (0,94)2 (0,48)85B+867 (9,87)42 (10,24)909AB−24 (0,27)0 (0)24AB+224 (2,55)12 (2,92)236Total8781 (100)410 (100)9191 Conclusion This study aimed to demonstrate some association between blood groups and PE/E using a large sample from the south of Brazil, a population not investigated before. In our study, no specific differences were observed between PE/E and controls in the distribution of the blood groups. In conclusion, the results of this study suggest no association between ABO and Rhesus blood group systems and PE/E in our population. Funding CAPES Foundation-Ministry of Education of Brazil

Introducao: O periodo pos-transplante tardio e marcado por uma serie de alteracoes nutricionais, os quais podem reduzir a sobrevida do orgao transplantado e do paciente. Objetivo: Avaliar a evolucao do peso durante o primeiro ano de transplante renal (TR) e o desenvolvimento de Diabetes Mellitus pos-transplante (DMPT) apos cinco anos de seguimento. Materiais e Metodos: Estudo de coorte retrospectiva, onde foram coletados dados de peso e outros parâmetros clinicos em prontuario do Setor de Nefrologia do Hospital Sao Lucas da PUCRS em Porto Alegre. Resultados: Dos 35 pacientes estudados, ao final do primeiro ano, descrito como T12, observamos ganho de peso medio de 8,2%, sendo que 29 deles (82,9%) ganharam peso. O aumento torna-se significativo a partir do sexto mes apos TR (T6) nas mulheres e apos nove meses (T9) nos homens. O ganho de peso promove impacto sobre o IMC, apresentando diferenca estatistica entre dados iniciais (T0) (23,2±4,3kg/m2) e em T12 (24,9±4,4 kg/m2) (p

AIMS: To describe a case of Takayasu arteritis diagnosed during the early postpartum period, demonstrating the importance of proper blood pressure measurement for the diagnosis of gestational hypertension. CASE DESCRIPTION: A 40 year old woman in her fourth pregnancy, with gestational age of 36 weeks and three days, was hospitalized for high-risk pregnancy due to chronic hypertension. During hospitalization, difference in blood pressure levels and pulse asymmetry between the upper limbs were observed. In the postpartum the patient underwent carotid Doppler ultrasound, which showed occlusion of the left common carotid artery and left subclavian artery, leading to the diagnosis of Takayasu arteritis. CONCLUSIONS: Early diagnosis of Takayasu arteritis is difficult because initial manifestations are nonspecific and symptoms are mild. However, a careful physical examination may reveal signs that raise suspicion and warrant further investigation, which may prevent a negative outcome, especially during pregnancy.

AIMS: To compare Interleukin-6 soluble receptor (IL-6sR) plasmatic levels between normotensive pregnant controls and preeclamptic women. METHODS: Maternal blood samples were collected before delivery from 21 patients with preeclampsia and 39 normotensive pregnant controls. Samples were stored at -80°C until laboratory assay. IL-6sR was measured by ELISA enzyme immunoassay. To compare groups Student's t test was used. Results with P less than 0.05 were considered significant. RESULTS: Data from preeclampsia and normotensive pregnant controls were respectively: maternal age 22.3±4.8 vs 26.0±3.7 years (P=0.06); gestational age 32.7±5.8 vs 40.1±0.8 weeks (P=0.01); systolic blood pressure 143.0±2.2 vs 118.8±3.1 mmHg (P=0.01); diastolic blood pressure 112.5±4.0 vs 77.2±10.2 mmHg (P=0.01); uric acid 5.87±1.10 vs 4.57±0.12 mg/dL (P=0.02); creatinine 0.82±0.12 vs 0.73±0.09 mg/dL (P=0.01); birth weight 2130.7±839.3 vs 3555.0±261.0 g (P=0.01); placental weight 621.3±167.0 vs 796.3±154.2 g (P=0,05). Proteinuria over creatininuria ratio in the preeclampsia group was 2.40±1.31. The concentration of IL-6sR (ng/dL) was 28.7±10.8 in preeclampsia vs 16.5±6.4 in normotensive pregnant controls (P=0.01). CONCLUSIONS: These results show an increased plasma levels of IL-6sRin patients with preeclampsia compared to normotensive pregnant women. More studies are necessary to clarify the pathophysiology of this entity, including the analysis of other cytokines linked to this receptor, due to the fact that they can be the key for the systemic inflammatory response that occurs in these patients and therefore for their treatment.

Streptococcus agalactiae causes a rare and often fatal peritonitis in continuous ambulatory peritoneal dialysis (CAPD). A 52-year-old white female with Alport and chronic kidney disease was initiated on CAPD treatment. Nineteen months later she had a S. agalactiae peritonitis identified and received initially gentamicin-cephalothin, which was changed to ceftazidime, tobramycin, and vancomycin. Recovery started after peritoneal catheter removal. After 3 weeks, severe leucopenia occurred. Granulokine and steroids were given. Six weeks later, she felt well and an abdominal video laparoscopic procedure disclosed a diffuse peritoneal fibrosis, precluding CAPD resumption. She is now doing well on hemodialysis (HD).

Objetivo: Analisar o perfil do sobrepeso e obesidade de trabalhadores de enfermagem de unidades de intensivismo e emergencia. Materiais e Metodos: Estudo transversal, realizado em um hospital de pronto-socorro, nas areas de intensivismo e emergencia, com 241 trabalhadores de enfermagem. Foi aplicado um questionario abordando as caracteristicas sociodemograficas e laborais e verificadas as medidas antropometricas. A analise dos resultados ocorreu pela estatistica descritiva. Para associacao foi utilizado o teste Qui-quadrado ou Exato de Fisher. Resultados: A circunferencia da cintura mostrou-se inadequada em 61,0% dos trabalhadores; a relacao cintura/quadril, inadequada em 43,2%. Quanto ao indice de massa corporea, 68,9% dos trabalhadores possuiam classificacao inadequada, representando, respectivamente, 37,8% destes com sobrepeso e 31,1% com obesidade. Conclusao: Evidenciou-se elevado percentual de sobrepeso e obesidade (68,9%), nos trabalhadores investigados. Mudancas nos habitos de vida, principalmente a inclusao de uma alimentacao saudavel e a pratica de exercicios fisicos, sao medidas importantes e necessarias para a prevencao e o controle das doencas cardiovasculares, considerando o crescente aumento do sobrepeso e obesidade em nossa sociedade.

Objectives To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. Design Secondary analysis of the Vitamins in Pre-Eclampsia Trial. Setting 25 UK hospitals in ten geographical areas. Population 946 women with pre-existing risk factors for pre-eclampsia. Methods Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). Main Outcome Measures Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA)

Apresentacao Reunem-se, novamente, representantes das sociedades brasileiras de Cardiologia (SBC), de Hipertensao (SBH) e de Nefrologia (SBN) para uma revisao e atualizacao das ultimas diretrizes de MAPA e MRPA. O processo para a producao obedeceu a um cronograma de trabalho exclusivamente realizado via web com dois grupos de trabalhos voltados para cada um dos metodos. […] 6a DIRETRIZES DE MONITORIZACAO AMBULATORIAL DA PRESSAO ARTERIAL E 4a DIRETRIZES DE MONITORIZACAO RESIDENCIAL DA PRESSAO ARTERIAL

Background Adrenocortical carcinoma (ACC) is a rare tumor in which prognostic factors are still not well established. Programmed Death Ligand-1 (PD-L1) expression in ACC and its association with clinico-pathological features and survival outcomes are unknown. Methods Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 28 patients with ACC. PD-L1 expression was evaluated by immunohistochemistry (IHC) in both tumor cell membrane and tumor infiltrating mononuclear cells (TIMC). PD-L1 positivity on tumor cells was defined as ≥5% tumor cell membrane staining. TIMC were evaluated by IHC using a CD45 monoclonal antibody. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrates and percentage of positive cells was developed. Any score greater that zero was considered PD-L1 positive. Baseline clinico-pathological characteristics and follow up data were retrospectively collected. Comparisons between PD-L1 expression and clinico-pathological features were evaluated using unpaired t-test and Fisher’s exact test. Kaplan-Meier method and log-rank test were used to assess association between PD-L1 expression and 5-year overall survival (OS). Results Among 28 patients with surgically treated ACC, 3 (10.7%) were considered PD-L1 positive on tumor cell membrane. On the other hand, PD-L1 expression in TIMC was performed in 27 specimens and PD-L1 positive staining was observed in 19 (70.4%) patients. PD-L1 positivity in either tumor cell membrane or TIMC was not significantly associated with higher stage at diagnosis, higher tumor grade, excessive hormone secretion, or OS. Conclusions PD-L1 expression can exist in ACC in both tumor cell membrane and TIMC with no relationship to clinico-pathologic parameters or survival. Electronic supplementary material The online version of this article (doi:10.1186/s40425-015-0047-3) contains supplementary material, which is available to authorized users.