Comparación de protocolos de vacunación contra el virus del papiloma humano en Ecuador y América Latina / Comparation of vaccination protocols against the human papillomavirus in Ecuador and Latin America

INTRODUCCIÓN: El virus del papiloma humano (VPH), con más de 100 tipos, es de transmisión sexual. Varios países de América Latina han introducido las vacunas contra el VPH. Aunque América Latina es la región que más rápido avanzó en la vacunación contra el VPH, sus sistemas de seguimiento y vigilancia son aún deficientes. OBJETIVO: Comparar las diferentes estrategias de vacunación contra el VPH en Ecuador y América Latina. MÉTODO: Revisión bibliográfica, en la que se obtuvo información de documentos gubernamentales y artículos indexados en los últimos 5 años sobre las estrategias de vacunación contra el VPH en Ecuador y América Latina. RESULTADOS: La mayoría de los países de América Latina han logrado introducir la vacuna contra el VPH, excepto Venezuela, Martinica, Haití, Nicaragua y Cuba. CONCLUSIONES: Los protocolos de vacunación de Ecuador y América Latina necesitan mejorar sus sistemas de seguimiento y aumentar la expansión de datos de cobertura disponibles de manera consistente. Actualmente siguen existiendo desafíos para introducir las vacunas, lograr una alta cobertura y fortalecer el seguimiento, la evaluación y la notificación.

INTRODUCTION: The human papilloma virus (HPV), with more than 100 types, is a sexual transmission infection. Many Latin American countries have introduced the vaccines against the HPV. Although Latin América is the region which advanced faster against the HPV, its surveillance and follow-up systems are yet deficient. OBJECTIVE: To compare the different strategies to assume the vaccination against the HPV in Ecuador and Latin America. METHOD: Bibliographic review, in which information was obtained from government documents and articles indexed in the last five years on vaccination strategies against HPV in Ecuador and Latin America. RESULTS: Most Latin American countries have managed to introduce the vaccine against the HPV, except Venezuela, Martinica, Haiti, Nicaragua and Cuba. CONCLUSIONS: The vaccination protocols of Ecuador and Latin América need to improve their systems of follow-up and monitoring, and increase the expansion of available data in a consistent manner. Now, there are still existing challenges to introduce the vaccines, manage a high reach and fortify the follow-up, the evaluation, and the notification.

Avaliação no Mundo Real de um Stent Eluidor de Sirolimus de Hastes Ultrafinas em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST Submetidos à Intervenção Coronária Percutânea Primária (Registro INSTEMI) / Real-World Assessment of an Ultrathin Strut, Sirolimus-Eluting Stent in Patients with ST-Elevation Myocardial Infarction Submitted to Primary Percutaneous Coronary Intervention (INSTEMI Registry)

Resumo Fundamento O padrão-ouro atual dos stents farmacológicos (SF) coronários consiste em ligas metálicas com hastes mais finas e polímeros bioabsorvíveis. Objetivos Nosso objetivo foi comparar um stent eluidor de sirolimus de hastes ultrafinas (Inspiron®) com outras plataformas de SF de terceira geração em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) submetidos à intervenção coronária percutânea (ICP) primária. Métodos Analisamos dados de um registro multicêntrico de IAMCSST de centros de referência da Região Sul do Brasil. Todos os pacientes foram submetidos à ICP primária, seja com Inspiron® ou outro SF de segunda ou terceira geração. Foi calculado pareamento por escore de propensão (PEP) para gerar grupos semelhantes (Inspiron® versus outros stents) em relação às características clínicas e do procedimento. Todos os testes de hipótese tiveram um nível de significância bilateral de 0,05. Resultados De janeiro de 2017 a janeiro de 2021, 1.711 pacientes foram submetidos à ICP primária, e 1.417 pacientes preencheram nossos critérios de inclusão (709 pacientes no grupo Inspiron® e 708 pacientes no grupo dos outros SF de segunda ou terceira geração). Após PEP, a amostra do estudo foi composta por 706 pacientes (353 pacientes no grupo Inspiron® e 353 pacientes no grupo dos demais SF de segunda ou terceira geração). As taxas de revascularização do vaso alvo (odds ratio [OR] 0,52; intervalo de confiança [IC] 0,21 a 1,34; p = 0,173), trombose de stent (OR 1,00; IC 0,29 a 3,48;p = 1,000), mortalidade (hazard ratio 0,724; IC 0,41 a 1,27; p = 0,257) e os desfechos cardiovasculares maiores (OR 1,170; IC 0,77 a 1,77; p = 0,526) foram semelhantes entre os grupos após um acompanhamento mediano de 17 meses. Conclusão Nossos achados mostram que o stent Inspiron® foi eficaz e seguro quando comparado a outros SF de segunda ou terceira geração em uma coorte contemporânea do mundo real de pacientes com IAMCSST submetidos à ICP primária.

Abstract Background The current gold standard of coronary drug-eluting stents (DES) consists of metal alloys with thinner struts and bioresorbable polymers. Objectives Our aim was to compare an ultrathin strut, sirolimus-eluting stent (Inspiron®) with other third-generation DES platforms in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI). Methods We analyzed data from a STEMI multicenter registry from reference centers in the South Region of Brazil. All patients were submitted to primary PCI, either with Inspiron® or other second- or third-generation DES. Propensity score matching (PSM) was computed to generate similar groups (Inspiron® versus other stents) in relation to clinical and procedural characteristics. All hypothesis tests had a two-sided significance level of 0.05. Results From January 2017 to January 2021, 1711 patients underwent primary PCI, and 1417 patients met our entry criteria (709 patients in the Inspiron® group and 708 patients in the other second- or third-generation DES group). After PSM, the study sample was comprised of 706 patients (353 patients in the Inspiron® group and 353 patients in the other the other second- or third-generation DES group). The rates of target vessel revascularization (OR 0.52, CI 0.21 - 1.34, p = 0.173), stent thrombosis (OR 1.00, CI 0.29 - 3.48, p = 1.000), mortality (HR 0.724, CI 0.41 - 1.27, p = 0.257), and major cardiovascular outcomes (OR 1.170, CI 0.77 - 1.77, p = 0.526) were similar between groups after a median follow-up of 17 months. Conclusion Our findings show that Inspiron® was effective and safe when compared to other second- or third-generation DES in a contemporary cohort of real-world STEMI patients submitted to primary PCI.

Prevenção Farmacológica Secundária da Doença Arterial Coronariana em Pacientes Submetidos ao Manejo Clínico, Intervenção Coronária Percutânea ou Cirurgia de Revascularização Miocárdica / Secondary Pharmacological Prevention of Coronary Artery Disease among Patients Submitted to Clinical Management, Percutaneous Coronary Intervention, or Coronary Artery Bypass Graft Surgery

Resumo Fundamento A prevenção secundária é recomendada a pacientes com evidência de doença arterial coronariana (DAC) independentemente da indicação de tratamento por cirurgia de bypass da artéria coronária (CABG) ou intervenção coronária percutânea (ICP). Objetivos Este estudo avaliou se o tratamento clínico, a ICP ou o CABG teve influência na adesão à prevenção secundária farmacológica em pacientes com DAC estável. Métodos Esta coorte incluiu pacientes com idade ≥40 anos com DAC estável confirmada por angiografia coronária estável. A decisão por tratamento clínico isolado, ou combinado com ICP ou CABG foi feita por médicos assistentes. A adesão às drogas prescritas recomendadas pelas diretrizes de prevenção secundária (tratamento farmacológico ótimo), incluindo agentes antiplaquetários, drogas hipolipemianetes, betabloqueadores, e bloqueadores do sistema angiotensina aldosterona, foi avaliada no acompanhamento. Diferenças com valores de p < 0,05 foram consideradas estatisticamente significativas. Resultados Dos 928 pacientes incluídos inicialmente, 415 apresentaram DAC leve e 66 apresentaram DAC leve a moderada. O período médio de seguimento foi 5,2 ± 1,5 anos. Os pacientes submetidos ao CABG apresentaram maior probabilidade de receberem tratamento farmacológico ótimo que aqueles submetidos à ICP ou tratamento clínico (63,5% versus 39,1% versus 45,7% respectivamente, p=0,003). Fatores basais independentemente associados com maior probabilidade de prescrição de tratamento ótimo foram CABG [39% maior (6% - 83%, p=0,017)] em comparação a outros tratamentos e diabetes [25% maior (1% - 56%), p=0,042] em comparação à ausência de diabetes. Conclusões Pacientes com DAC submetidos ao CABG são mais frequentemente tratados com prevenção secundária farmacológica ótima que pacientes tratados com ICP ou exclusivamente com tratamento clínico.

Abstract Background Secondary prevention is recommended for patients with evidence of coronary artery disease (CAD) regardless of the indication for treatment by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Objectives This study evaluated whether clinical treatment, PCI or CABG had an influence on adherence to the pharmacological secondary prevention in patients with stable CAD. Methods This cohort included patients aged ≥40 years with stable CAD confirmed by coronary angiography. The decision for medical treatment alone, or additionally with PCI or CABG, was made by the attending physicians. Adherence to the prescribed drugs recommended by the guidelines for secondary prevention (optimal pharmacological treatment), including antiplatelet agents, lipid-lowering drugs, beta-blockers, and renin-angiotensin-aldosterone system blockers, was assessed at follow-up. Differences were considered significant for p values <0.05. Results From 928 patients enrolled at baseline, 415 had mild CAD and 66 moderate to severe CAD. The average follow-up was 5.2 ± 1.5 years. Patients submitted to CABG were more likely to receive the optimal pharmacological treatment than those submitted to PCI or treated clinically (63.5% versus 39.1% versus 45.7% respectively, p=0.003). Baseline factors independently associated with greater probability of having a prescription of optimal treatment at follow-up were CABG [39% higher (6% - 83%, p=0.017) and diabetes [25% higher (1% - 56%), p=0.042] than their counterparts treated by other methods and participants without diabetes, respectively. Conclusions Patients with CAD submitted to CABG are more commonly treated with optimal pharmacological secondary prevention than patients treated by PCI or exclusively with medical therapy.

Atribución de síntomas en pacientes con síntomas médicamente inexplicables. Un estudio de validación y desarrollo de la escala / Symptom attribution in patients with medically unexplained symptoms. A scale development and validation study

Resumen Introducción: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. Objetivo: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. Métodos: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. Resultados: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. Conclusión.: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.

Abstract Introduction: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. Objective: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. Methods: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. Results: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and others with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demostrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. Conclusion: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.

Effects of 70% isopropyl alcohol wipes and bleachbased wipes in disinfecting nurses' mobile phone: a quasi-experimental approach / The Health Sciences Journal

INTRODUCTION@#Concerns have been increased about the use of mobile phones in hospitals as they may be vehicles for the transmission of hospital-acquired infections. This study aimed to compare the effectiveness of 70% isopropyl alcohol wipes with bleach-based wipes in decreasing bacterial colony counts of mobile phones of staff nurses.@*METHODS@#Mobile phones of staff nurses in the UERM Hospital were assigned to be disinfected with 70% isopropyl alcohol wipes or bleach-based wipes. Mobile phones were swabbed using standard techniques before and after disinfection with 70% isopropyl alcohol wipes or bleach-based wipes. Post-disinfection colony counts were compared with baseline counts in each group and compared between the two test groups.@*RESULTS@#There was a significant decrease in the post-disinfection mean colony count compared with the mean baseline colony count in both the 70% isopropyl alcohol wipes (p < 0.001) and bleach-based wipes (p = 0.002) groups. The decrease in the 70% isopropyl alcohol wipes group was bigger (121,635 vs 85,769 CFU/mL). The mean post-disinfection colony count of the 70% isopropyl alcohol wipes was significantly lower (p = 0.007) than the other group.@*CONCLUSION@#Both 70% isopropyl alcohol wipes and bleach-based wipes are effective in decreasing bacterial colony counts of mobile phones of staff nurses. The alcohol wipes resulted in a greater decrease in colony count compared with the bleach wipes.

Syntax Score and Major Adverse Cardiac Events in Patients with Suspected Coronary Artery Disease: Results from a Cohort Study in a University-Affiliated Hospital in Southern Brazil / Syntax Escore e Eventos Cardíacos Adversos Maiores em Pacientes com Suspeita de Doença Arterial Coronariana: Resultados de um Estudo de Coorte em Hospital Universitário no Sul do Brasil

Abstract Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis.

Resumo Fundamento: A importância da anatomia coronariana na predição de eventos cardiovasculares é bem conhecida. O uso de escores anatômicos tradicionais na cineangiocoronariografia de rotina, entretanto, não foi incorporado à prática clínica. O SYNTAX escore (SXescore) é um sistema de escore que estima a extensão anatômica da doença arterial coronariana (DAC). Sua capacidade para predizer desfechos com base na cineangiocoronariografia diagnóstica de base ainda não foi testada. Objetivo: Avaliar o desempenho do SXescore para predizer eventos cardíacos adversos maiores (MACE) em pacientes encaminhados para cineangiocoronariografia diagnóstica. Métodos: Coorte prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Resultados: Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. Conclusão: O SXescore prediz independentemente MACE em pacientes submetidos a cineangiocoronariografia diagnóstica. Seu uso rotineiro nesse contexto poderia identificar pacientes de pior prognóstico.

Seguimento de 12 meses de pacientes complexos tratados com stentsfarmacológicos liberadores de everolimus XIENCE V® na prática diária – resultados do registro brasileiro BRAVO / Twelve-month follow-up of complex patients treated with the Xience V™ everolimus drug-eluting stents in daily practice – results of the BRAVO Brazilian Registry

O stent liberador de everolimus XIENCE V® é um stent farmacológico de nova geração que incorpora uma plataforma de cromo-cobalto de baixo perfil (81 m) e um polímero de elevada biocompatibilidade (fluoropolímero), o qual carreia e controla a liberação do fármaco everolimus. Estudos recentes demonstram segurança e eficácia sustentadas do dispositivo XIENCE V® no tratamento de populações da prática clínica. Nosso objetivo foi reportar resultados clínicos de 12 meses do protocolo brasileiro BRAVO. Métodos: O registro BRAVO foi um estudo prospectivo, não randomizado, de braço único, multicêntrico (25centros), que avaliou os resultados clínicos tardios de 535 pacientes minimamente selecionados, tratados com o stent farmacológico XIENCE V®.Resultados: Cerca de 40% dos pacientes tinham diabetes, 25% infarto agudo do miocárdio prévio e 42% apresentaram-se com síndrome coronária aguda. A maioria das lesões (69%) era de elevada complexidade(ACC/AHA tipo B2/C). As médias da extensão e do diâmetro nominais dos stents foram, respectivamente, 19,9 ± 5,3 mm e 3,0 ± 0,4 mm. Os sucessos angiográfico e de procedimento foram de 99,7 e 98%, respectivamente. Aos 12 meses, a taxa cumulativa de eventos cardíacos adversos maiores, disponível em 100% dos pacientes, foi de 5,6% (morte cardíaca: 1,3%; infarto agudo do miocárdio: 3,0%; revascularização da lesão-alvo: 2,2%). Já a trombose de stent ocorreu em cinco pacientes (0,9%), sendo reportada apenas uma ocorrência entre 6 e 12 meses. Conclusões: O stent farmacológico XIENCE V® demonstrou segurança e eficácia sustentadas ao final de 12meses no tratamento de lesões coronárias complexas em pacientes da prática diária...

The Xience VTM everolimus-eluting stents is a new generation drug-eluting stent (DES)that incorporates a low profile cobalt-chromium platform (81 m) and a highly biocompatible polymer(fluoropolymer), which carries and controls the release of everolimus. Recent studies have demonstrated sustained safety and efficacy of the Xience VTM in the treatment of real-world populations. Our aim was to report the clinical results of 12 months of the BRAVO Brazilian protocol. Methods: The BRAVO Registry was a prospective, non-randomized, single-arm, multicenter (25 centers) study that evaluated the late clinical results of 535 minimally selected patients treated with the drug eluting stent Xience VTM in Brazilian daily practice. Results: Overall, 40% of patients had diabetes, 25% prior myocardial infarction, and 42% presented with acute coronary artery syndrome. The majority of lesions (69%) was highly complex (ACC/AHA type B2 or C).The mean length and the nominal stent diameter were 19.9 ± 5.3 mm and 3.0 ± 0.4 mm, respectively.The angiographic and procedural successes were 99.7 and 98%, respectively. At 12 months, the cumulative rate of major adverse cardiac events, available in 100% of patients, was 5.6% (cardiac death: 1.3%; acute myocardial infarction: 3.0%; revascularization of the target lesion: 2.2%). Stent thrombosis occurred in 5 patients (0,9%), and only 1 case was reported between 6 and 12 months. Conclusions: The drug-eluting stent Xience V™ demonstrated sustained safety and efficacy up to 12 months in the treatment of complex coronary lesions in patients from daily practice...

Volume Plaquetário Médio Como Preditor de Desfechos Cardiovasculares Maiores e Fluxo Coronariano Final em Pacientes Submetidos à Intervenção Coronária Percutânea Primária / Mean Platelet Volume as a Predictor of Major Cardiovascular Outcomes and Final Coronary Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Introdução: As plaquetas desempenham papel fundamental na fisiopatologia do infarto agudo do miocárdio. Existem evidências de que plaquetas de maior volume apresentem potencial pró- -trombótico aumentado. O objetivo deste estudo foi avaliar se o volume plaquetário médio pode predizer o fluxo coronariano do vaso tratado e os desfechos cardiovasculares adversos em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronária percutânea primária. Métodos: Desfecho primário foi considerado como a ocorrência de eventos cardiovasculares adversos (morte, acidente vascular cerebral, infarto agudo do miocárdio, trombose de stent, angina e insuficiência cardíaca classes 3 ou 4) em 30 dias. Desfecho secundário foi avaliado por meio da análise angiográfica do fluxo TIMI pós-procedimento. Resultados: Dos 215 pacientes incluídos no registro de intervenção coronária percutânea primária, 168 (78,6%) tiveram volume plaquetário médio calculado antes do procedimento e foram analisados no presente estudo. Valores do volume plaquetário médio foram estratificados em tercis, sendo considerado um valor elevado > 11 fentolitros (fl). Volume plaquetário médio > 11 fl foi preditor independente de eventos cardiovasculares em 30 dias (p = 0,02). Observou-se que pacientes com fluxo final TIMI zero ou 1 demonstraram ...

Background: Platelets play a key role in the pathophysiology of acute myocardial infarction. There is evidence that higher platelet volumes may have increased prothrombotic potential. The aim of this study was to evaluate whether mean platelet volume can predict culprit coronary vessel flow and adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods: Primary endpoint was the composite of adverse cardiovascular events (death, stroke, myocardial infarction, stent thrombosis, class-III or IV angina and heart failure) at 30 days. The secondary endpoint was evaluated by the angiographic TIMI flow grade after the procedure. Results: Of the 215 patients included in the primary percutaneous coronary intervention registry, 168 (78.6%) had their mean platelet volume calculated before the procedure and were analyzed in the present study. Mean platelet volume values were stratified in tertiles, and a high value was considered as > 11 femtoliters (fL). Mean platelet volume > 11 fL was an independent predictor of cardiovascular events at 30 days (p = 0.02). It was observed that patients with final TIMI flow grade zero or 1 showed a trend towards higher mean platelet volume compared with those with final TIMI flow 2 or 3 (11.3 ± 0.9 fL vs. 10.5 ± 1.3 fL; p = 0.06). Conclusions: Baseline mean platelet volume is a simple, useful, and easy to measure marker to predict ...

Influencia de la 6-Bencilaminopurina y el agente gelificante en la reducción de la hiperhidricidad en Tectona grandis L / Influence of 6-Benzyladenine and gelling agent on the reduction of hyperhydricity in Tectona grandis L

The influence of different factors on shoot proliferation and the occurrence of hyperhydricity in teak (Tectona grandis L.) have been studied. Four concentrations of BA (2.22, 4.44, 6.66 and 8.88 µM) and a control treatment with 0 BA were examined. Aiming at reducing the costs during commercial propagation by using gelrite in stead of agar, the use of both gelling agent in the proliferation and hyperhydricity was tested. In order to evaluate if hyperhydricity can be reduced by increasing the gelrite concentration in the culture medium, three concentrations (2.0, 2.5 and 3.0 g L-1) were tested in combination with 4.44 µM BA. The proliferation and occurrence of hyperhydricity during 21 successive subcultures were evaluated. The highest proliferation was achieved in the treatments with 6.66 or 8.88 µM BA. They yielded 5.22 and 5.56 shoots/explant, respectively. But also, the highest percent of hyperhydric shoots was achieved in this treatment. Gelrite resulted in a higher proliferation, but also an almost two times higher hyperhydricity as compared to agar-solidified media. Satisfactory reduction in hyperhydricity (18%) was achieved with 3.0 g L-1 gelrite. However, the successive subcultures onto proliferation in this treatment favored hyperhydricity compromising shoot quality and it´s competence to proliferate. in vitro teak plants were ex vitro rooted and then transferred to greenhouse conditions for acclimatization; ten weeks after transfer they were ready for field plantation.

Se estudió la influencia de diferentes factores en la proliferación y la ocurrencia de la hiperhidricidad in teca (Tectona grandis L.). Se probaron cuatro concentraciones de BA (2,22; 4,44; 6,66 and 8,88 µM) y un control sin BA. Con el objetivo de reducir los costos durante la propagación comercial se experimentó sustituir el agar por el gelrite, para lo cual se estudió en efecto de ambos gelificantes en la proliferación y la hiperhidricidad de los brotes. Se estudiaron, tres concentraciones de gelrite (2,0; 2,5 and 3,0 g L-1) combinadas con 4,44 µM BA, con el objetivo de evaluar si la hiperhidricidad podía ser reducida incrementando la concentración de gelrite. Se evaluó la proliferación de brotes y la ocurrencia de la hiperhidricidad durante 21 subcultivos. Se logró una alta proliferación de brotes en los tratamientos con 6,66 y 8,88 µM BA (5,22 y 5,56 brotes), pero el porcentaje de brotes hiperhídricos también se incrementó. El gelrite resultó en una alta proliferación de brotes, pero con mayor incidencia de la hiperhidricidad que el medio gelificado con agar. Se obtuvo una reducción satisfactoria de la hiperhidricidad (18%), cuando la concentración de gelrite se incrementó hasta 3,0 g L-1. No obstante, la multiplicación de los brotes en este tratamiento más allá del 11no subcultivo favoreció la hiperhidricidad, lo que afectó la calidad de los brotes y su competencia para la proliferación. Las plantas fueron enraizadas ex vitro, transferidas a condiciones de invernadero para su aclimatización y diez semanas después de la transferencia estaban listas para la plantación en campo.

Ureterocele ectópica em cão: relato de caso / Ectopic ureterocele in a dog: a case report

Relataram-se o quadro clínico, o diagnóstico, o tratamento e o acompanhamento de um cão com ureterocele ectópica e hidronefrose/hidroureter associados. Após as informações obtidas nos exames laboratoriais e de diagnóstico por imagem, o animal foi submetido à ureterocelectomia e à neoureterostomia. O cão apresentou evolução favorável após a conduta terapêutica. Apesar de pouco frequente, a ureterocele deve ser considerada como diagnóstico diferencial em animais jovens com histórico de incontinência urinária.

The clinical features, diagnosis, treatment and monitoring of a dog with an ectopic ureterocele and concomitant hydronephrosis/hydroureter were reported. After the information obtained in laboratory tests and imaging diagnosis, the animal was submitted to ureterocelectomy and neoureterostomy. The dog presented a favorable evolution after the therapy. Although infrequent, the ureterocele should be considered a differential diagnosis in young animals with history of urinary incontinence.

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease / Risco de apneia obstrutiva do sono detectado pelo Questionário de Berlim está associado com doença arterial coronariana

Obstructive sleep apnea (OSA), a risk factor for coronary artery disease, remains under diagnosed. We investigated if OSA identified by the Berlin Questionnaire (BQ) is associated with the risk of coronary artery disease. Cases were patients referred for elective coronariography. The cases were classified with significant coronary lesions (stenosis > 50% in an epicardial coronary) or without significant coronary lesions. Controls were selected from a population-based sample. Positive BQ results were identified in 135 (41.2%) of 328 cases, in contrast with 151 (34.4%) of 439 control subjects (p = 0.03). In a multinomial logistic analysis, the risk for OSA identified by the BQ was independently associated with coronary artery disease in cases with lesions of at least 50% (OR = 1.53; 95%CI: 1.02-2.30; p = 0.04). The risk from OSA identified by the BQ was higher in younger subjects (40-59 years) (OR = 1.76; 95%CI: 1.05-2.97; p = 0.03) and in women (OR = 3.56; 95%CI: 1.64-7.72; p = 0.001). In conclusion, OSA identified by the BQ greatly increases the risks of coronary artery disease in patients having significant coronary artery lesions indicated by anangiogram, particularly in younger individuals and in women.

Síndrome da apneia obstrutiva do sono (SAOS), fator de risco para doença arterial coronariana, permanece subdiagnosticada. Investigou-se se o risco de SAOS pelo Questionário de Berlim (QB) associa-se com doença arterial coronariana. Casos foram pacientes encaminhados para coronariografia eletiva, classificados em casos com lesão significativa (estenose > 50%) ou sem lesões significativas. Controles foram selecionados em amostra populacional. QB foi positivo em 135 (41,2%) de 328 casos, em contraste com 151 (34,4%) de 439 controles (p = 0,03). Em análise logística multinomial, o risco de SAOS identificado pelo QB associou-se com doença arterial coronariana exclusivamente nos casos com lesões de pelo menos 50% (OR: 1,53; IC95%: 1,02-2,30; p = 0,04). Em indivíduos com lesões significativas, o risco de SAOS pela QB foi maior entre os que têm 40-59 anos (OR: 1,76; IC95%: 1,05-2,97; p = 0,03) e em mulheres (OR: 3,56; IC95%: 1,64-7,72; p = 0,001). Em conclusão, alto risco para a SAOS identificados pela QB associa-se a risco de lesões coronarianas significativas na angiografia, particularmente em indivíduos mais jovens e em mulheres.

Germline mutation analysis of Tpit in Poodle dogs with ACTH-dependent hyperadrenocorticism / Análise de mutação germinativa do Tpit em cães da raça Poodle com hiperadrenocorticismo ACTH-dependente

There is a high incidence of pituitary-dependent hyperadrenocorticism (PDH) in Poodle dogs, with family members being affected by the disease, suggesting a genetic involvement. Tpit is an obligate transcription factor for the expression of pro-opiomelanocortingene and for corticotroph terminal differentiation. The aim of the present study was to screen the Tpit gene for germline mutations in Poodles with PDH. Fifty Poodle dogs (33 female, 8.71±2.8 years) with PDH and 50 healthy Poodle dogs (32 females, 9.4241 2.8 years) were studied. Genomic DNA was isolated from peripheral blood, amplified by PCR and submitted to automatic sequence. No mutation in the coding region of Tpit was found, whereas the new single nucleotide polymorphism p.S343G, in heterozygous state, was found in the same frequency in both PDH and control groups. We concluded that Tpit gain-of-function mutations are not involved in the etiology of PDH in Poodle dogs.

O hiperadrenocorticismo ACTH-dependente (HACAD) apresenta elevada incidência em cães da raça Poodle, sendo que membros da mesma família têm sido acometidos pela doença, sugerindo envolvimento genético. Tpit é um fator de transcrição obrigatório para a expressão do gene da pro-opiomelanocortina e para a diferenciação terminal dos corticotrofos. O objetivo deste trabalho foi pesquisar mutações germinativas no gene Tpit em Poodles com HACAD. Cinquenta cães da raça Poodle, 33 fêmeas, média de idade de 8,71±2,8 anos, com HACAD, e 50 cães Poodles saudáveis, 32 fêmeas, média de idade de 9,4±2,8 anos, foram estudados. Mutações na região codificadora do gene Tpit não foram identificadas. Foi observado um novo polimorfismo em heterozigose, p.S343G, com a mesma frequência no grupo de cães com HACAD e no grupo-controle. Conclui-se que a mutação ativadora no gene Tpit não está envolvida na patogênese do hiperadrenocorticismo ACTH-dependente em cães da raça Poodle.

Stents farmacológicos libertadores de everolimus Xience TM V no tratamento de pacientes com lesões coronárias complexas na prática diária: resultados iniciais do Registro Brasileiro BRAVO / Xience TM V everolimus-eluting stents in the treatment of patients with complex coronary lesions in the daily clinical practice: early results of the Brazilian Registry BRAVO

Introdução: A eficácia e a segurança do stent farmacológico (SF) de segunda geração liberador de everolimus XienceTM V (Abbott Vascular, Santa Clara, Estados Unidos) já foram estabelecidas no tratamento de pacientes selecionados com lesões coronárias. No entanto, o impacto do stent Xience TM V em população da prática clínica com lesóes complexas ainda não está totalmente definido. Métodos: O Registro BRAVO foi um estudo prospectivo, não-randomizado, multicêntrico, que avaliou os resultados clínicos tardios de pacientes minimamente selecionados tratados com o SF Xience TM V na prática diária brasileira. No total, foram incluídos 535 pacientes em 25 centros clínicos entre setembro de 2008 e setembro de 2010. Eventos cardíacos adversos maiores (ECAM) foram definidos como morte cardíaca, infarto agudo do miocárdio (IAM) e revascularização do vaso-alvo (RVA). Resultados: A média de idade dos pacientes era de 62,7 + - 11,1 anos 40 dos quais tinham diabetes, 24,9 apresentavam IAM prévio e 41,9 apresentaram-se com síndrome coronária aguda. Cerca de dois terços dos pacientes tinham lesões tipo B2/C e 46,1 trataram a artéria descendente anterior. Implante de múltiplos stents ocorreu em 13,8 dos casos, e o sucesso angiográfico foi > 99. Na fase intra-hospitalar, a taxa de IAM periprocedimento foi de 1,9. Já no seguimento de 6 meses, as taxas cumulativas de óbito cardíaco, IAM e RVA foram de 1,1, 2,2 e 1,3, respectivamente)taxa de ECAM de 4,3). Com relação à trombose de stent (definida de acordo com os critérios do Academic Research Consortium - ARC), foram reportados 4 casos até 6 meses...

Construção e validação de um sistema integrado de dados de intervenção coronária percutânea no Brasil (registro ICP-BR): perfil clínico dos primeiros 1.249 paqcientes incluídos / Construction and validation of an Integrated Percutaneous Coronary Intervention Data System in Brazil (ICP-BR Registry): clinical profile of the first 1,249 patients included

INTRODUÇÃO: A intervenção coronária percutânea cresceu de modo expressivo nas últimas décadas. Entretanto, relatos de resultados imediatos e a longo prazo desse procedimento em instituições brasileiras são esporádicos e restritos a alguns centros. A presente proposta objetiva descrever um sistema nacional para a avaliação dos indivíduos tratados por intervenção coronária percutânea no Brasil. Método: O Registro ICP-BR foi constituído por meio de rede informatizada para a captação de dados, via web, sobre angioplastias coronárias realizadas no dia a dia da cardiologia intervencionista, sem critérios de exclusão. Em sua fase piloto, 8 centros nacionais foram selecionados para a coleta inicial de dados. Relatamos o perfil clínico e a evolução intra-hospitalar dos primeiros pacientes incluídos. Resultados: De março de 2009 a dezembro de 2009, foram incluídos 1.249 pacientes na base de dados. No total, 60 por cento foram tratados pelo Sistema Único de Saúde, 38 por cento por planos de saúde e 2 por cento eram pagantes. A média de idade era de 63,7 + ou - 11,3 anos, 36 por cento eram diabéticos, 12 por cento tinham cirúrgia prévia e 27 tinham angioplastia prévia. À admissão, 39 por cento eram estáveis e 18 por cento tinham infartro com supradesnivelamento do segmento ST. Ultrassom intracoronário...

BACKGROUND: Percutaneous coronary intervention has grown dramatically in recent decades. However, reports of immediate and long-term results of this procedure in Brazilian institutions are sporadic and limited to some centers. This study is aimed at describing a national system to evaluate patients treated by percutaneous coronary intervention in Brazil. METHODS: The ICP-BR Registry was established by a computerized network for data capture on coronary angioplasties performed in day-to-day interventional cardiology, without exclusion criteria. In the pilot phase 8 national centers were selected for the initial data collection. We report the clinical profile and in-hospital evolution of the first patients included. RESULTS: From March 2009 to December 2009, 1,249 patients were included in the database. In total, 60% were treated by the Unified Health System, 38% by health insurance plans and 2% were private patients. Mean age was 63.7 ± 11.3 years, 36% were diabetic, 12% had prior surgery and 27% prior angioplasty. Upon admission, 39% were stable and 18% had ST elevation myocardial infarction. Intracoronary ultrasound or fractional flow reserve was performed in 2.8% cases. Stents were used in 93% of procedures, and drug-eluting stents in 16.2% of the patients. Mortality was 0.2% in stable patients, 2.4% in patients with acute coronary syndromes without ST elevation, 6.1% in patients with ST elevation myocardial infarction and 3.6% in those with anginal equivalent. CONCLUSIONS: We describe the development and implementation of a computerized system to collect detailed data on percutaneous coronary intervention procedures in Brazil. Given the inclusive unrestricted character (all-comers) and prospective follow-up of patients, this data capture and recording system may contribute decisively to profile percutaneous coronary intervention in our country.

Cronología de la regeneración del bosque tropical seco en Santa Rosa, Guanacaste, Costa Rica: I. Características edáficas

Chronology of tropical dry forest regeneration in Santa Rosa, Guanacaste, Costa Rica. I. Edaphic characteristics. We characterized soil chemical and physical properties in eight tropical dry forest (TDF) successional sites along a time sequence (10, 15, 20, 40, 60 and >100 years) in Santa Rosa, Costa Rica. Seventeen soils were identified, described, and classified in six orders. Most soils were classified as Entisols and Vertisols, but Mollisols, Alfisols, Inceptisols and Ultisols were also present. All soils showed good fertility that did not constrain species richness. High edaphic variation seemed the result of complex interactions among the pyroclastic origin of Santa Rosa ignimbritic plateau (SRIP), the lithological composition and acidity of ignimbritic rocks, the strong seasonality in rainfall, intense hydric and aeolic erosion, topographic variations within the SRIP, and past human intervention. Correlations performed on soils classified as Entisols (<60 cm deep) showed a depletion of soil cations (Ca, Mg, K, Na and CEC) during the first 20 years of forest regeneration, that later recovered in mature TDF sites. Organic matter content did not change significantly along the TDF chrono-sequence. Substantial increments in macro-pores and soil hydraulic conductivity were observed, probably resulting from higher root biomass and turnover in older successional sites. Soil available water and meso-pore abundance were negatively correlated with TDF successional age. Our results indicate that edaphic chan ges observed along TDF regeneration might have been due to annual fires in pastures and young TDF sites, addition of decaying litter and fine roots as regeneration progressed, milder microclimate conditions during late regeneration in mature TDF sites, increased nutrient cycling, and the predominance of sandy loam textures among the soils examined. These changes in the soil environment with succession may have physiological and phenological consequences on the species appearing at different stages of TDF regeneration. Rev. Biol. Trop. 57 (3): 801-815. Epub 2009 September, 30.

Se caracterizaron las propiedades químicas y físicas de los suelos a lo largo de una cronosecuencia de ocho fragmentos de bosque tropical estacionalmente seco (BTS) en Santa Rosa, Costa Rica, y se relacionaron con el estado sucesional de los sitios (10, 15, 20, 40, 60 y >100 años de regeneración). Se encontró una alta diversidad edáfica a escalas pequeñas (0.5-1 ha) y se describieron 17 clases dominantes de suelos, clasificados en seis órdenes. La mayoría de los suelos fueron clasificados como Entisoles y Vertisoles, pero los Mollisoles, Alfisoles, Inceptisoles y Ultisoles estuvieron representados también. Todos los suelos presentaron buenos índices de fertilidad que no restringieron la riqueza de las especies. La alta heterogeneidad edáfica pareció ser el resultado de la interacción entre el origen piroclástico de la meseta ignimbrítica de Santa Rosa, la composición litológica y la acidez de las rocas del material parental, la marcada estacionalidad de la lluvia, intensos procesos de erosión hídrica y eólica, variaciones topográficas locales, y la historia de intervención humana. Correlaciones efectuadas en los Entisoles (<60 cm profundidad) revelaron un agotamiento de los cationes (Ca, Mg, K, Na y CIC) durante los primeros veinte años de regeneración, que más tarde se recuperaron en los bosque maduros. El contenido de materia orgánica no varió significativamente con la regeneración. Se observaron incrementos sustanciales en los macroporos y en la conductividad hidráulica, probablemente resultado de mayor biomasa y actividad radical en sitios sucesionales más viejos. La abundancia de mesoporos y el agua disponible para las plantas disminuyeron con la regeneración del bosque. Los resultados indican que los cambios observados en el suelo son resultado de la presencia anual de fuego, la adición de materia orgánica y minerales al suelo conforme la regeneración progresó, las condiciones microclimáticas más benignas conforme el bosque se desarrolló, el creciente ciclaje de nutrimentos, y la predominancia de texturas franco-arenosas en los suelos examinados. Estos cambios en las propiedades del suelo con la sucesión pueden tener importantes consecuencias sobre la fisiología y la fenología de las diversas formas de vida vegetal observadas durante la regeneración de los bosques tropicales estacionalmente secos.

Cronología de la regeneración del bosque tropical seco en Santa Rosa, Guanacaste, Costa Rica: II. La vegetación en relación con el suelo

Chronology of tropical dry forest regeneration in Santa Rosa, Guanacaste, Costa Rica. II. Vegetation in relation to the soil. Tropical dry forest (TDF) succession was monitored in Santa Rosa, Costa Rica. We analyzed the effect of soil type on forest structure and diversity. Eight seasonally-dry TDF sites located along a successional chrono-sequence (10, 15, 20, 40, 60 and >100 years) were examined in relation to 17 soil pedons and six soil orders. Soils had moderate to high fertility and were classified as Entisols and Vertisols, although Mollisols, Alfisols, Inceptisols and Ultisols were also present. One-hundred and thirty 500 m2 plots were established, 20 plots in secondary and 10 plots in mature TDFsites. Diameter at breast height (dbh) and total tree height were measured for saplings (dbh ≥1 and <5 cm), shrubs and trees (dbh ≥5 cm). With the exception of two sites (40 and 60 years), soil type did not have significant effects on forest structure. However, tree diversity measured with Shannon-Wiener’s H’ and Fisher’s α rarefaction curves, showed substantial differences among soil types, which became accentuated in mature forests. This pattern might be explained by non-random distributions of TDF trees, the scale of the study, the plot shape, and the use of systematic sampling designs. Low-fertility sites in general had higher species richness, consistent with idea that more restrictive soils reduce competition among trees and allow co-existence of species with contrasting growth rates. Changes in soil properties along a chrono-sequence of Entisols indicated that trees may experience more severe water stress as succession progresses, which may require adjustments in biomass allocation and phenological behavior of the dominant species. Our results suggest that edaphic specialization is more pronounced in mature TDF forests, and that most TDF trees are generalists in relation to soil type, highly tolerant to site heterogeneity, and show little physiological specializations in response to edaphic heterogeneity. Rev. Biol. Trop. 57 (3): 817-836. Epub 2009 September 30.

Se estudió la sucesión del bosque tropical seco (BTS) de Santa Rosa, Guanacaste, Costa Rica, en cinco sitios boscosos secundarios y tres bosques maduros. Se analizó el efecto de la clase de suelo sobre la estructura del bosque y la diversidad de especies arbóreas. Los ocho sitios sucesionales estaban localizados a lo largo de una cronosecuencia de regeneración (10, 15, 20, 40, 60 and >100 años) en la que se identificaron 17 pedones y seis órdenes de suelos con moderada a alta fertilidad, clasificados como Entisoles y Vertisoles, aunque los Mollisoles, Alfisoles, Inceptisoles y Ultisoles estuvieron presentes también. Se establecieron 130 parcelas de 10 por 50 m (0.05 ha), 20 en cada bosque secundario y 10 en cada bosque antiguo (6.5 ha en total), de acuerdo con la topografía. Se midió el diámetro a la altura de pecho (dap) de todos los individuos presentes en cada parcela, la altura dominante y el área basal (m2ha-1), usando dos poblaciones: latizales (dap ≥ 1 y < 5 cm) y árboles (dap ≥ 5 cm). Cada bosque presentó al menos dos pedones de suelo bien diferenciados. La alta variación edáfica encontrada se debió posiblemente al origen piroclástico de la meseta ignimbrítica de Santa Rosa, las variaciones en los tiempos de deposición del material parental, y los patrones de erosión. A excepción de dos sitios, no se presentaron diferencias importantes en la estructura del bosque entre las clases de suelos examinadas, según la densidad de individuos, el área basal y la altura dominante. La diversidad de especies arbóreas medida según el índice Shannon-Wiener y las curvas de rarefacción construidas con el índice α de Fisher, presentaron diferencias considerables entre las clases de suelos. Esta tendencia se explicó por la influencia de las características edáficas sobre las distribuciones no aleatorias de las especies arbóreas, la escala de medición del estudio, la forma de la parcela, y el muestreo sistemático utilizado. En general, los suelos de menor fertilidad presentaron mayor riqueza de especies, indicando que los sitios más restrictivos redujeron la competencia y permitieron la coexistencia de individuos con tasas de crecimiento disímiles. Los cambios en las propiedades físicas encontrados a lo largo de una cronosecuencia de Entisoles indicaron que los árboles podrían experimentar estrés hídrico más severo conforme la sucesión avanza, lo que podría requerir ajustes en el comportamiento fenológico y en las propiedades ecofisiológicas de las especies dominantes. En general, nuestros resultados sugieren que la especialización edáfica es más pronunciada en BTS maduros, y que la mayoría de las especies del BTS son generalistas en relación con la clase de suelo, altamente tolerantes a la heterogeneidad de los sitios, y muestran poca especialización fisiológica para responder a la variabilidad edáfica en distancias cortas.

Water use in four model tropical plant associations established in the lowlands of Costa Rica

We examined soil water use patterns of four model plant associations established in the North Caribbean lowlands of Costa Rica by comparing the stable hydrogen isotope composition, δD, in xylem sap and in soil water at different depths, under rainy and dry conditions. Four 5-year-old model plant associations composed of 2 tree species (Hyeronima alchorneoides and Cedrela odorata) having different architecture and phenology were studied. Average tree height was 8.9 and 7.6 m, respectively. Each tree species was grown in monoculture and in polyculture with 2 perennial monocotyledons (Euterpe oleracea and Heliconia imbricata). Maximum rooting depth at the time of δD determination was ~ 2 m for almost all species. Most roots of all species were concentrated in the upper soil layers. Stomatal conductance to water vapor (gS) was higher in the deciduous C. odorata than in the evergreen H. alchorneoides; within each species, gS did not differ when the trees were grown in mono or in polyculture. During the rainy season, gradients in soil water δD were not observed. Average rainy season xylem sap δD did not differ among members of the plant combinations tested (-30 ‰), and was more similar to δD values of shallow soil water. Under dry conditions, volumetric soil water content declined from 50 to ~ 35%, and modest gradients in soil water δD were observed. xylem sap δD obtained during dry conditions was significantly lower than rainy season values. xylem sap δD of plants growing in the four associations varied between -9 and -22‰, indicating that shallow water was predominantly absorbed during the dry period too. Differences in xylem sap δD of trees and monocots were also detected, but no significant patterns emerged. The results suggest that: a) the plant associations examined extracted water predominantly from shallow soil layers (<1 m), b) the natural isotopic variation in soil and plant water at the study site was low, and c) the plant mixes obtain water from more than a single soil layer simultaneously. Temporal factors were important in determining the competition and complementary relations observed among the trees and the perennial monocots. Under the prevailing environmental conditions, water use in these plant associations was determined largely by species-specific attributes such as biomass allocation to fine roots, phenology, and canopy architecture, and to a lesser extent by water limitations. Rev. Biol. Trop. 56 (4): 1947-1957. Epub 2008 December 12.

Examinamos los patrones de uso de agua del suelo de cuatro asociaciones vegetales establecidas en el Caribe norte de Costa Rica, comparando la composición isotópica del hidrógeno, δD, en la savia del xilema y en el agua del suelo en condiciones lluviosas y secas. Estudiamos cuatro asociaciones de cinco años de edad compuestas por dos árboles (Hyeronima alchorneoides y Cedrela odorata) con diferente arquitectura y fenología, cultivados en mono y policultivo con dos monocotiledóneas perennes (Euterpe oleracea y Heliconia imbricata). Las excavaciones mostraron que la profundidad máxima de las raíces fue de 2 m para casi todas las especies, y que la mayor densidad de raíces se encontraba en la superficie del suelo. La conductividad estomática (gS) fue mayor en el árbol caducifolio (C. odorata) que en el perennifolio (H. alchorneoides); dentro de cada especie, gS no difirió cuando los árboles fueron cultivados en mono o en policultivo. Los resultados sugieren que: a) las asociaciones examinadas extrajeron agua predominantemente de las capas superficiales del suelo (<1 m), b) la variación natural en el acceso al agua del suelo por parte de las especies, y en las propiedades del suelo, fue baja, y c) las combinaciones de plantas obtuvieron agua de varias capas del perfil del suelo simultáneamente. Los factores relacionados con el tiempo fueron importantes en la determinación de las relaciones de competencia y complementariedad observadas entre los árboles y las monocotiledóneas perennes. En las condiciones ambientales prevalecientes, el uso del agua por parte de estas asociaciones de plantas fue determinado más por atributos, como la asignación de biomasa a las raíces finas, la fenología, y las propiedades del dosel, que por limitaciones en la disponibilidad de agua.

Measurement of psychosocial health in medical students: Validation of the Jefferson Medical College's Questionnaire in Mexico

The greater the psychosocial health, the greater is the well-being and the capacity for adaptation and overcoming problems and common life frustrations in family, relationships, and work. Medical students and practicing physicians, in comparison with the general population and that of other professions, are exposed to academic and professional stress and therefore are vulnerable to psychosocial health problems and certain specific dysfunctions that may compromise their physical, mental, and social health. In the field of psychosocial research in medical education, the key issue is to find relevant and psychometrically sound measures. The Jefferson Medical College's Psychosocial Questionnaire contains abridged versions of nine personality tests, as well as questions about respondents' relationships with parents in the first five years of life and with classmates in the early schooling. The scales in the questionnaire have shown satisfactory internal consistency reliability and construct validity through factor analysis. To our knowledge, in Mexico, there is not a specific questionnaire that measures psychosocial profile in a non-clinical population such as medical students. The present study adapted and translated the questionnaire from English to Spanish in order to evaluate its validity and reliability in Mexican medical students, to further learn its predictive validity of academic performance. In this study, we compared the factor structure in Mexico to the results obtained in the United States research. Implications for predicting academic and clinical performance of medical students and physicians were discussed. Study participants consisted of 3,603 matriculates at the Escuela de Medicina de la Universidad Autónoma de Nuevo León (Mexico). Psychosocial measures included Loneliness, Test anxiety, General anxiety, Self-esteem, Extroversion, External locus of control, Neuroticism, Depression, Stressful life events, Perceptions of early relationships with mother and father, Peer relationships and Perception of health, used by researchers at Jefferson Medical College in the United States. The items were translated into Spanish and back translated from Spanish to English, following the guidelines for adaptation of instruments for psychological evaluation. The questionnaire was administered in the third month after admission of the students to the Medicine School in the students' usual classrooms, on a schedule and day set aside for it according to the school's administration program. They were assured of the strict confidentiality of the test scores and of the individual data. Dimensionality of 40 items of the eight brief psychosocial scales was assessed with factor analysis using the principal components extraction method and orthogonal rotation; the Depression Scale was not included in the factorial analysis because it was not shortened for the present study. Correlation coefficients and internal consistencies were calculated for all the scales. Unidimensionality and construct validity were confirmed for measures of Loneliness, Test anxiety, General anxiety, Self-esteem, and Extroversion. The pattern and direction of the scale correlations with external criterion measures supported the concurrent validity of some of the measures. Also, the magnitude and direction of the inter-scale correlations supported the convergent and discriminant validities with the exception of the External locus of control and Neuroticism scales. The results supported the psychometric properties of the scales useful for providing information for medical educators and mental health professionals in early detection of psychosocial problems. It is important to mention that in spite of frequent talk about the importance of health among college students, few schools of Medicine in Mexico and in Latin America actually promote empirical research and support detect problems and develop solutions once they are identified. The mental health professionals should be responsible for sharing their understanding. They are capable of helping faculty for optimizing mental health through allocation of educational and remedial resources when designing academic programs in agreement with necessities of their students.

Como la literatura consigna, los estudiantes y profesionales de la Medicina en comparación con la población general y de otras carreras conforman una población que resulta vulnerable frente a los trastornos de salud psicosocial. En la investigación psicosocial de la educación médica un punto clave corresponde a la identificación de medidas relevantes con cualidades psicométricas. En el presente trabajo se analiza la validez y confiabilidad de un conjunto de escalas psicosociales aplicadas a 3.603 alumnos de la Facultad de Medicina de la Universidad Autónoma de Nuevo León (México). Las escalas administradas fueron: Soledad, Ansiedad ante los exámenes, Ansiedad general, Autoestima, Extroversión, Locus de control externo, Neuroticismo, Depresión, Eventos estresantes en la vida, Percepción de relaciones tempranas con los padres y amigos y Percepción de estado de salud general. Estas escalas fueron propuestas por investigadores de la Escuela de Medicina de Jefferson (Estados Unidos). Se confirmó la unidimensionalidad y la validez de constructo de las mediciones de Soledad, Ansiedad ante los exámenes, Ansiedad general, Autoestima y Extroversión. Así también, la magnitud y dirección de las correlaciones interescalas apoyaron la validez convergente y discriminante, con excepción de Locus de control externo y Neuroticismo. Los resultados confirman las propiedades psicométricas de las escalas, las cuales son útiles para proveer información a los educadores médicos y a profesionales de la salud mental en la detección temprana de problemas psicosociales quienes en conjunto pueden coadyuvar en la optimización de la salud mental de los estudiantes de escuelas de Medicina a través de programas académicos acordes a sus necesidades.

Custo-efetividade dos stents recobertos por rapamicina em procedimentos percutâneos coronarianos no Brasil / Cost-effectiveness of sirolimus-eluting stents in percutaneous coronary interventions in Brazil

OBJETIVOS: Comparar as relações de custo-efetividade do stent recoberto (SR) por rapamicina com o stent convencional (SC), sob duas perspectivas: medicina suplementar e sistema público (SUS). MÉTODOS: Modelo de decisão analítico com três estratégias de tratamento de lesão coronariana: intervenção coronária percutânea (icP) com SC; com SR com rapamicina e SC seguido de SR para manejo de reestenose sintomática. Os desfechos foram: sobrevida livre de eventos em um ano e expectativa de vida. As árvores de decisão foram construídas com resultados de registros e ensaios clínicos publicados. RESULTADOS: A sobrevida em um ano livre de reestenose foi de 92,7 por cento com SR e de 78,8 por cento com SC. A expectativa de vida estimada das estratégias foi muito semelhante, entre 18,5 e 19 anos. Sob a perspectiva não-pública, a diferença de custo no primeiro ano entre SC e SR foi de R$ 3.816, com relação de custo-efetividade incremental de R$ 27.403 por evento evitado em um ano. Sob a perspectiva do SUS, o custo por evento evitado em um ano foi de R$ 47.529. Na análise de sensibilidade, foram preditores relevantes a probabilidade de reestenose, a redução de risco esperada com SR, o custo do stent e o custo do manejo da reestenose. Os dados por anos de vida demonstraram relações de custo-efetividade bastante elevadas na simulação de Monte Carlo. CONCLUSÃO: As relações de custo-efetividade do SR por rapamicina foram elevadas em modelo brasileiro. O uso de SR foi mais favorável em pacientes de alto risco de reestenose, com elevado custo do manejo de reestenose e sob a perspectiva não-pública.

OBJECTIVES: To compare the cost-effectiveness ratios of sirolimus-eluting stents (SES) with bare-metal stents (BMS) under two perspectives: the "supplementary medical system" (health plans and private patients) and the public health (SUS) system. METHODS: A decision-analytic model using three different therapeutic strategies for coronary lesions: percutaneous coronary intervention (PCI) with BMS; with SES; or with BMS followed by SES to treat symptomatic restenosis. Study endpoints were one-year event-free survival and life expectancy. Decision trees were constructed using the results of published registries and clinical trials. RESULTS: One-year restenosis-free survival was 92.7 percent with SES and 78.8 percent with BMS. Estimated life expectancy was very similar for all the strategies, ranging from 18.5 to 19 years. Under a nonpublic perspective, the cost difference in the first year between BMS and SES was R$3,816, with an incremental cost-effectiveness ratio of R$27,403 per event avoided in one year. Under the SUS perspective, the cost per event avoided in one year was R$47,529. In the sensitivity analysis, probability of restenosis, risk reduction expected with SES, the price of the stent and cost of treating restenosis were all important predictors. In the Monte Carlo simulation, data per years of life saved showed very high cost-effectiveness ratios. CONCLUSION: In the Brazilian model, the cost-effectiveness ratios for SES were elevated. The use of SES was more favorable for patients with high risk of restenosis, as it is associated with elevated costs in restenosis management of and under a nonpublic perspective.

Doença aterosclerótica da artéria renal / Atherosclerotic Illness of the Renal Artery

Neste artigo, os autores discutem aspectos relacionados ao diagnóstico e ao tratamento da doença aterosclerótica da artéria renal. Destacam-se, também, as indicações para a revascularização de pacientes com estenose significativa da artéria renal...

In the present article, the authors address aspects related to the diagnosis and the management of renal artery atherosclerotic disease. The authors also point out the indications for the revascularization of patients with significant stenosis in renal artery.