Resistant hypertension

Resistant hypertension (RH) is defined as blood pressure above a goal despite adherence to at least 3 optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Evaluation of possible RH begins with an assessment of adherence to medications. The white-coat effect should be ruled out by out-of-office blood pressure monitoring. Obesity, heavy alcohol intake, and interfering substances all contribute to RH. Dietary sodium restriction is an important part of management. RH may be secondary to problems such as renal disease, obstructive sleep apnea, or aldosteronism, and testing for these conditions should be considered. Adequate diuretic treatment is a key part of therapy. Chlorthalidone is more effective than hydrochlorothiazide in reducing blood pressure because it is more potent and lasts longer. In addition, it may reduce cardiovascular events to a greater extent than hydrochlorothiazide. When glomerular filtration rate is <30 mL/min, a loop diuretic usually is needed. The addition of spironolactone, with careful attention to potassium levels, is an evidence-based strategy for the treatment of RH. Other strategies include use of a vasodilating β-blocker, adding a long-acting nondihydropyridine calcium channel blocker, or adding clonidine. When blood pressure is not coming under control despite 4 or 5 agents, referral to a hypertension specialist may be warranted.     

Paulista Registry of glomerulonephritis: 5-year data report.

BACKGROUND: The Paulista Registry of Glomerulopathies was created in May 1999 and comprises several centres of S?o Paulo, the most populous Brazilian State, that concentrates people from all regions of the country who look for health care. METHODS: This report includes data from 2086 patients from Brazil submitted to renal biopsy due to the presumed diagnosis of glomerular diseases, registered prospectively since May 1999 until January 2005. Data were collected by the integrants of the 11 centres involved, utilizing a standardized questionnaire. RESULTS: The mean age of the patients was 34.5+/-14.6 years. Primary glomerular diseases were more frequent in males (55.1%) than in females; on the other hand, secondary glomerular diseases were more frequent in females (71.8%). The most common clinical presentation was nephrotic syndrome and the frequency of hypertension, at this time, was 55.5%. There was a predominance of indication of biopsies in the third, fourth and fifth decades of life. The most common primary glomerular diseases were focal and segmental glomerulosclerosis (29.7%), followed by membranous nephropathy (20.7%), IgA nephropathy (17.8%), minimal change disease (9.1%), membranoproliferative glomerulonephritis (7%), crescentic glomerulonephritis (4.1%), advanced chronic glomerulopathy (4%), non-IgA mesangial glomerulonephritis (3.8%), diffuse proliferative glomerulonephritis (2.5%), focal segmental proliferative glomerulonephritis (1%) and others (0.3%). The most frequent secondary glomerular disease was lupus nephritis, corresponding to 66.2% of the cases, followed by post-infectious glomerulonephritis (12.5%), diabetic nephropathy (6.2%), diseases associated to paraproteinaemia (4.9%), hereditary diseases (4.6%), vasculitis (3.2%), malignancies (0.9.%), secondary focal segmental glomerulosclerosis (0.6%) and others (0.9%). CONCLUSION: Focal segmental glomerulosclerosis was the most frequent primary glomerular disease, followed by membranous nephropathy and IgA nephropathy. Lupus nephritis predominated over all the other secondary glomerular diseases.     

Use of multidimensional data analysis for prediction of lung malignity

Diagnosis of lung malignity can be predicted or confirmed not only according to the values of appropriate laboratory tests but also using multidimensional statistical analysis, which uses simultaneously all performed tests in the form of their optimal combination. The developed new way of diagnosis prediction is applied here to the results of laboratory analysis of lung tumor markers in serum as well as pleural effusion (exudate). Four laboratory tests were used and investigated in detail: carcinoembryonic antigen, CEA, in serum as well as in pleural exudate, and cytokeratin 19 fragment, CYFRA, in serum and exudate, as well. Each test represents one dimension in the investigated biomedical problem from the statistical point of view. Joint utilization of the performed laboratory tests is based on their optimized combination into a new statistical variable using a selected chemometric principle (principal component, discriminant function, or logit in logistic regression). This approach results in enhancement of diagnostic effectiveness applied for the specified purpose.     

Contribution to the study of acrylamide polymerization, 1. Polymerization in the presence of an inhibitor

The average rate of initiation, R_i, is determined for the polymerization of acrylamide (AAM) in water in the presence of the water-soluble initiator ammonium peroxodisulfate (APS) and the inhibitor 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl (HTPO). The inhibitor and products from its interaction with the initiator to some extent participate also in other reactions: some lead to partial regeneration of inhibitor and some may be considered to be transfer reactions to the inhibitor. The determined ratio of the rate constant of termination and the square of the rate constant of propagation k_t/k²_p which does not significantly differ from the value listed for the AAM polymerization in water without admixtures, shows that participation of HTPO in propagation and termination reactions is not important.     

In vitro and in vivo inhibitory effect of ethanol and acetaldehyde on O6-methylguanine transferase

Human and rat O⁶-methylguanine transferase (O⁶MeGT) are inhibitedin vitro by ethanol at concentrations of 10 to 50 mM and byacetaldehyde, the first metabolite of ethanol, at concentrationsas low as 0.01 µM. Several other enzymes, including glyceraldehyde-3-phosphatedehydrogenase and yeast alcohol dehydrogenase, which like O⁶MeGThave cysteines in their active sites, were not inhibited byacetaldehyde at the levels that inhibited O⁶MeGT. Disulfiram,an acetaldehyde dehydrogenase inhibitor, enhanced the inhibitoryeffect of ethanol in vivo. These results indicate that the inhibitoryeffect of ethanol on O⁶MeGT activity is mediated primarily viaits metabolite, acetaldehyde.     

Humanization in health care

This study aims to reflect on humanization in health care, recovering the history of understanding about mankind, the human and humanity, until humanization in humanity and health. We discuss the national humanization program in hospital care and reflect on this proposal and on the issue of humanization in Brazilian health care nowadays. Communication is indispensable to establish humanization, as well as technical and material conditions. Both users and health professionals need to be heard, building a network of dialogues to think and promote singular humanization actions. For this process to take effect, there is a need to involve the whole that makes up the health service. This group involves different professionals, such as managers, public policy makers, professional councils and education institutions.