Variabilidade da Pressão Arterial em Única Visita e Risco Cardiovascular em Participantes do ELSA-Brasil

BackgroundBlood pressure variability (BPV) is of prognostic value for fatal and non-fatal cardiovascular outcomes.ObjectiveThis study aimed to evaluate the association between within-visit BPV and cardiovascular risk among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).MethodsThe present cross-sectional study was carried out using baseline data (2008-2010) of 14,357 ELSA-Brasil participants with no prior history of cardiovascular disease. Within-visit BPV was quantified by the coefficient of variation of three standardized systolic blood pressure (SBP) measurements using an oscillometer. Anthropometric measurements and laboratory tests were also performed. Cardiovascular risk was assessed using the atherosclerotic cardiovascular disease risk estimator (ASCVD) and multivariate logistic regression analysis was employed with a significance level of 5%.ResultsSignificantly higher cardiovascular risk was determined by increased BPV for both sexes. A significantly higher prevalence of high risk was found in men than women across all quartiles, with the highest difference observed in the fourth quartile of variability (48.3% vs. 17.1%). Comparisons among quartiles in each sex revealed a significantly higher cardiovascular risk for men in the third (OR=1.20; 95%CI: 1.02 - 1.40) and fourth quartiles (OR=1.46; 95%CI: 1.25 -1.71), and for women in the fourth quartile (OR=1.27; 95%CI: 1.03 - 1.57).ConclusionAnalysis of baseline data of the ELSA-Brasil participants revealed that blood pressure variability was associated with increased cardiovascular risk, especially in men.     

Surface Morphology and Spectroscopic Features of Homoepitaxial Diamond Films Prepared by MWPACVD at High CH4 Concentrations

Single crystal diamond (SCD) is a promising material to satisfy emerging requirements of high-demand fields, such as microelectronics, beta batteries and wide-spectrum optical communication systems, due to its excellent optical characteristics, elevated breakdown voltage, high hardness and superior thermal conductivity. For such applications, it is essential to study the optically active defects in as-grown diamonds, namely three-dimensional defects (such as stacking faults and dislocations) and the inherent defects arising from the cultivation method. This paper reports the growth of SCD films on a commercial HPHT single-crystal diamond seed substrate using a 2.45 GHz microwave plasma-assisted chemical vapor deposition (MWPACVD) technique by varying the methane (CH₄) gas concentration from 6 to 12%, keeping the other parameters constant. The influence of the CH₄ concentration on the properties, such as structural quality, morphology and thickness, of the highly oriented SCD films in the crystalline plane (004) was investigated and compared with those on the diamond substrate surface. The SCD film thickness is dependent on the CH₄ concentration, and a high growth rate of up to 27 µm/h can be reached. Raman spectroscopy, high-resolution X-ray diffractometry (HRXRD), scanning electron microscopy (SEM), surface profilometry and optical microscopic analyses showed that the produced homoepitaxial SCD films are of good quality with few macroscopic defects.     

The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications

Objectives

The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain, since 1990, which include LYG as an outcome to measure the incremental cost-effectiveness ratio.

Methods

A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyse the cost per LYG results in relation with a commonly accepted Spanish cost-effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they both were calculated for the same economic evaluation.

Results

A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529€ and a median of 11,490€ (standard deviation of 183,080). Since 2003, a commonly accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson).

Conclusions

There is an increasing interest for economic health care evaluations in Spain, and the quality of the studies is also improving. Although a commonly accepted threshold exists, further information is needed for decision-making as well as to identify the relationship between the costs per LYG and per QALY gained.     

Endocavitary surgical procedures, an alternative to myomectomy in patients with symptomatic fibroids

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet.     

Disease Severity and Mortality Caused by Dengue in a Dominican Pediatric Population

Millions are infected with dengue yearly. We evaluated the epidemiological and clinical characteristics of pediatric patients infected with dengue in the Dominican Republic. The applicability of World Health Organization (WHO) warning signs for predicting severe dengue and mortality was also studied. This study was a cross-sectional retrospective review of patients with a clinical diagnosis of dengue. Univariate and multivariate analyses were performed to evaluate characteristics associated with severity and mortality. The study included 796 subjects: 288 subjects were classified as dengue, 290 subjects had alarm signs, and 207 subjects were classified as severe dengue. Common findings included thrombocytopenia (96%), abdominal pain (71%), and vomiting (59%). The most important factors associated with severe dengue were rash (P < 0.01), severe thrombocytopenia (P < 0.01), and anemia (P < 0.01). These signs and symptoms were also associated with mortality. This study validates the current WHO warning signs of severity. Rash and severe thrombocytopenia may be early warning signs and need additional study.     

Kidney Dysfunction and the Risk of Developing Aortic Stenosis

Background

Chronic kidney disease (CKD) and aortic stenosis (AS) share many risk factors.