Preliminary survey report on the clinical validation of in-use electronic sphygmomanometers in China / 中华心血管病杂志

Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.

Miniature Non-invasive Blood Pressure Measurement and Verification System / 中国医疗器械杂志

Mercury sphygmomanometer based on traditional auscultation method is widely used in primary medical institutions in China, but a large amount of blood pressure data can not be directly recorded and applied in scientific research analysis, meanwhile auscultation data is the clinical standard to verify the accuracy of non-invasive electronic sphygmomanometer. Focusing on this, we designed a miniature non-invasive blood pressure measurement and verification system, which can assist doctors to record blood pressure data automatically during the process of auscultation. Through the data playback function,the software of this system can evaluate and verify the blood pressure algorithm of oscillographic method, and then continuously modify the algorithm to improve the measurement accuracy. This study introduces the hardware selection and software design process in detail. The test results show that the system meets the requirements of relevant standards and has a good application prospect.

Acurácia e efetividade da medida de pressão arterial de consultório em condições ideais e não ideais de medição: ensaio clínico randomizado de equivalência entre os métodos auscultatório e oscilométrico / Accuracy and effectiveness of the measurement of office blood pressure under ideal and non-ideal measurement conditions: randomized clinical trial of equivalence between auscultatory and oscillometric methods

Estudo com objetivos de avaliar o impacto de condições não ideais de medição na acurácia da medida de pressão arterial (PA) de consultório obtida nos métodos auscultatório e oscilométrico e comparar a efetividade dos métodos para classificar a PA e identificar hipertensão. Ensaio clínico randomizado de equivalência realizado com 282 adultos, entre agosto de 2019 e março de 2020, em Fortaleza, Ceará. Os braços foram compostos por três desvios do protocolo padronizado de medição da PA, os quais, neste estudo, foram denominados condições não ideais de medição: ambiente ruidoso, uso de braçadeira pressórica de tamanho adulto padrão sem que seja esta a indicação do paciente e combinação de ambos. Consideraram-se medidas de pressão arterial sistólica (PAS) e de pressão arterial diastólica (PAD) de controle aquelas obtidas no método auscultatório, seguindo integralmente protocolo padronizado de medição. Medidas de PAS e PAD na condição de teste foram obtidas mediante inserção dos desvios de protocolo durante a medição realizada nos métodos auscultatório, com esfigmomanômetro aneroide, ou no oscilométrico, utilizando monitor automático para uso clínico. Medições auscultatórias foram realizadas simultaneamente por dois observadores e conferidas por um terceiro. Para cada participante, foram obtidas seis medidas sequenciais, intercalando-se aneroide e monitor, das quais duas primeiras em condições ideais e seguintes em não ideais. Testes de diferenças de médias foram usados para comparar valores pressóricos obtidos nos métodos auscultatório e oscilométrico. Adotaram-se plotagens de Bland-Altman para avaliar equivalência entre métodos. Os desvios de protocolo causaram maior impacto no método auscultatório e na PAD (PAS: 0,57 mmHg x 0,20 mmHg; PAD: 3,29 mmHg x -0,92 mmHg, respectivamente para auscultatório e oscilométrico). Uso de braçadeira adulto padrão acarretou maior redução de acurácia em ambos os métodos, em detrimento do ambiente ruidoso. Medição com braçadeira de tamanho inferior ao adequado gerou superestimação de PAS similar entre os métodos e de PAD maior no auscultatório. O monitor automático atendeu, em condições ideais e não ideais, aos pressupostos de equivalência, mostrando-se tão acurado quanto o esfigmomanômetro manual quando o protocolo de medição da pressão arterial é integralmente seguido, bem como nas situações em que há desvios relacionados ao tamanho da braçadeira e à presença de ruídos. Embora os métodos auscultatório e oscilométrico sejam equivalentes, as diferenças de acurácia naturalmente existem. Diante dos desvios de protocolo, a acurácia do auscultatório para classificar valores de PA foi 75,18% e do oscilométrico, 74,82%; a efetividade para identificação de hipertensão foi 95,15% e 95,52%, respectivamente. Em todas as condições de teste, o oscilométrico apresentou melhores medidas diagnósticas. Conclui-se que monitores automáticos oscilométricos e esfigmomanômetros possuem acurácia equivalente em condições ideais e não ideais de medição. Nos desvios de protocolo testados, os métodos mostraram efetividade similar para classificar valores de PA e identificar hipertensão. Nessas condições, ambos os métodos possuem maior capacidade preditiva de identificação de indivíduos verdadeiramente sem hipertensão arterial, em detrimento da identificação de pessoas com a doença. Identificação no Registro Brasileiro de Ensaios Clínicos:U1111-1238-5001. (AU)

Impacto del índice de masa corporal en la presión arterial medida con esfigmomanómetro de mercurio en niños y adolescentes con diabetes mellitus tipo 1 / The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus

Resumen Introducción Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

Abstract Background Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions A positive correlation between systolic and diastolic BP with zBMI was observed.

Força muscular e habilidade de locomoção em indivíduos pós-acidente vascular encefálico crônico / Fuerza muscular y habilidad de locomoción en individuos post-accidente cerebrovascular crónico / Muscle strength and locomotion ability in individuals with chronic stroke

RESUMO O objetivo do estudo foi verificar se existem diferenças na força muscular dos membros inferiores (MMII) e na habilidade de locomoção de indivíduos pós-acidente vascular encefálico (AVE) crônico, classificados como deambuladores comunitários ou não comunitários. Foi realizado um estudo transversal em 60 indivíduos pós-AVE crônico, divididos em deambuladores comunitários (n=33) e não comunitários (n=27) pela velocidade de marcha. A força muscular de sete grupos musculares bilaterais de MMII foi avaliada por meio do teste do esfigmomanômetro modificado e habilidade de locomoção pelo ABILOCO. Estatísticas descritivas foram utilizadas para caracterizar a amostra, e o teste t de Student para amostras independentes, a fim de comparar os dois grupos de indivíduos pós-AVE. Observou-se que os deambuladores comunitários apresentaram maiores valores de força muscular para a maioria dos grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), e na habilidade de locomoção (t=−2,841; p=0,006). Os indivíduos pós-AVE crônico deambuladores comunitários possuem maior força muscular de MMII e mais habilidade de locomoção em comparação aos deambuladores não comunitários. Sugere-se que a avaliação fisioterapêutica de indivíduos pós-AVE inclua, além da mensuração da força muscular de MMII e seu tratamento, a mensuração da percepção da habilidade de locomoção, para análises da evolução do paciente e da eficácia da conduta terapêutica.

RESUMEN El objetivo del estudio fue verificar si existen diferencias en la fuerza muscular de los miembros inferiores (MMII) y en la habilidad de locomoción de individuos post-accidente cerebrovascular encefálico (ACV) crónico, clasificados como deambuladores comunitarios o no comunitarios. Se realizó un estudio transversal en 60 individuos post-ACV crónico, divididos en deambuladores comunitarios (n = 33) y no comunitarios (n = 27) por la velocidad de marcha. La fuerza muscular de siete grupos musculares bilaterales de MMII fue evaluada por medio de la prueba del esfigmomanómetro modificado, y la habilidad de locomoción por el ABILOCO. Las estadísticas descriptivas se utilizaron para caracterizar la muestra, y la prueba t de Student para muestras independientes con el fin de comparar los dos grupos de sujetos post-ACV. Se observó que los deambuladores comunitarios presentaron mayores valores de fuerza muscular para la mayoría de los grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), y en la habilidad de locomoción (t=−2,841; p=0,006). Los individuos post-ACV crónico deambuladores comunitarios poseen mayor fuerza muscular de MMII y más habilidad de locomoción en comparación a los deambuladores no comunitarios. Se sugiere que la evaluación fisioterapéutica de individuos post-ACV incluya, además de la medición de la fuerza muscular de MMII y su tratamiento, la medición de la percepción de la habilidad de locomoción, para análisis de la evolución del paciente y de la eficacia de la conducta terapéutica.

ABSTRACT The objective of this study was to verify if there are differences in the lower-limb muscle strength (LL) and in the locomotion ability among post-stroke patients classified as community or non-community ambulators. A cross-sectional study was conducted in 60 post-chronic stroke subjects, divided into community (n=33) and non-community (n=27) ambulators by gait speed. The muscle strength of seven bilateral muscle groups of LL was evaluated through the modified sphygmomanometer test and locomotion ability through ABILOCO. Descriptive statistics were used to characterize the sample, and Student's t-test was used for independent samples to compare the two groups of post-stroke individuals. We observed that community ambulators had higher values of muscle strength for most muscle groups of LL (−0.973≥t≥3.189; p≤0.04), and in the locomotion ability (t=−2.841; p=0.006). Community ambulators showed higher LL muscle strength and better locomotion ability compared with non-community ambulators. Physiotherapeutic evaluation of post-stroke individuals should include, besides the measurement of LL muscle strength and its treatment, the measurement of the perception of locomotion ability to analyze the evolution of the patient and the efficacy of the therapeutic behavior.

Higher High Density Lipoprotein 2 (HDL2) to Total HDL Cholesterol Ratio Is Associated with a Lower Risk for Incident Hypertension

BACKGROUND: Recent studies have suggested that high density lipoprotein (HDL) cholesterol is inversely associated with the development of hypertension. We aimed to determine the association between different HDL cholesterol subclasses and risk of future hypertension. METHODS: A total of 270 Japanese Americans (130 men, 140 women) without hypertension between the ages of 34 to 75 years were enrolled. Blood pressure was measured with a mercury sphygmomanometer, and average blood pressure was calculated. Incident hypertension was determined 5 to 6 and 10 to 11 years after enrollment. HDL2, HDL3, and total HDL cholesterol were measured at baseline. RESULTS: During 10 years of follow-up, the cumulative incidence of hypertension was 28.1% (76/270). In univariate analysis, age, diabetes, waist circumference, systolic and diastolic blood pressure, fasting glucose, insulin resistance index, total and low density lipoprotein cholesterol, and visceral adipose tissue were significant predictors for incident hypertension. Among the HDL cholesterol subclass, HDL2 cholesterol was inversely associated with hypertension incidence, but both total and HDL3 cholesterol were not. In addition, HDL2/HDL cholesterol was inversely associated with future hypertension risk. In multivariate analysis, age (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.26 to 2.31; P=0.001), systolic blood pressure (OR, 1.83; 95% CI, 1.31 to 2.56; P < 0.001), and HDL2/HDL cholesterol (OR, 0.71; 95% CI, 0.52 to 0.98; P=0.035), were associated with future development of hypertension. CONCLUSION: A higher proportion of HDL2 cholesterol among total HDL cholesterol predicted a lower risk for incident hypertension. However, concentrations of total HDL, HDL2, and HDL3 cholesterol were not independent predictors of incident hypertension.

Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998–2016: The Korean Working Group of Pediatric Hypertension

BACKGROUND AND OBJECTIVES: Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. METHODS: BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. RESULTS: The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. CONCLUSIONS: We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Comparisons between different blood pressure measurement techniques in patients with chronic kidney disease

BACKGROUND: Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD). METHODS: This study was performed on 64 patients with CKD (stages 3–4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland–Altman graphs. RESULTS: The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland–Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM. CONCLUSION: AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.

Dispositivos de monitorização não invasivos como veículos de infecção cruzada: revisão integrativa / Noninvasive monitoring devices such as cross-infection vehicles: integrative review

Objetivo: analisar na literatura, publicações científicas que apontam uma relação entre IRAS e os principais dispositivos de monitorização não invasiva (termômetro, esfigmomanômetro, cabo de ECG e oxímetro). Método: revisão integrativa, respondendo a questão: como a literatura aborda a ocorrência das IRAS associada aos principais dispositivos de monitorização não invasivo? Realizada através de busca online de artigos científicos nas bases LILACS/SCIELO, MEDLINE, Biblioteca Cochrane e IBECS, entre julho e setembro de 2013, associando o descritor cross infection aos seguintes: thermometers, sphygmomanometers, oximetry e electrocardography. Resultados: Foram encontrados 252 artigos, aplicando-se os critérios de inclusão e exclusão obteve-se 13, nos quais todos indicam uma relação entre infecção cruzada e os dispositivos não invasivos em questão. Conclusão: após exaustiva leitura e análise dos estudos conclui-se que estes dispositivos são potencias veículos de infecção cruzada, sendo necessário aprofundamento da temática, mediante estudos científicos, possibilitando reflexões e tomada de decisão com repercussão na prática clínica.

Objective: To analyze the published works on hospital infections related to non-invasive monitoring devices.(sphygmomanometer, thermometer, oximetry, electrocardiograph) Method: Integrative review, answering the question: how does the literature address the occurrence of IRAS associated with the main non-invasive monitoring devices? It was carried out through online search of scientific articles in the databases LILACS / SCIELO, MEDLINE, Cochrane Library and IBECS, between July and September of 2013, associating the descriptor cross infection with the following: thermometers, sphygmomanometers, oximetry and electrocardography. Results: We found 252 articles, applying the inclusion and exclusion criteria obtained 13, in which all indicate a relationship between cross infection and the non-invasive devices in question. Conclusion: After exhaustive reading and analysis of studies have concluded that these noninvasive monitoring devices to be potential vehicles of cross-infection, necessitating further development of the theme by scientific studies, enabling reflections and decisions that have impact on clinical practice.

Objetivo: Analizar en la literatura publicaciones científicas sobre las infecciones hospitalarias relacionadas con dispositivos de monitorización no invasiva.(esfigmomanómetro, termómetro, oxímetro, electrocardiógrafo) Método: revisión integrativa, respondiendo a la pregunta: ¿Cómo la literatura trata las ocurrencias de infecciones hospitalarias asociado con los principales dispositivos de monitorización no invasiva? Realizada mediante la búsqueda on line de artículos científicos en LILACS / SCIELO, MEDLINE, Cochrane Library y IBECS, entre julio y septiembre de 2013, asociando el descriptor cross infection con los siguientes: thermometers, sphygmomanometers, oximetry and electrocardography. Resultados 252 artículos fueron encontrados, por la aplicación de los criterios de inclusión y exclusión produjeron 13, en el que todo indica una relación entre los dispositivos no invasivos en cuestión y las infecciones cruzadas. Conclusión: Después de la lectura exhaustiva y análisis de estudios han llegado a la conclusión de que estos dispositivos de monitorización no invasiva son vehículos potenciales de la infección cruzada, lo que exige un mayor desarrollo del tema por estudios científicos, permitiendo reflexiones y decisiones que tienen impacto en la práctica clínica.

Doença arterial obstrutiva assintomática e Índice Tornozelo-Braquial em pacientes com diabetes mellitus tipo 2 / Assintomatic peripheral obstructive arterial disease and Ankle-Brachial Index in patients with diabetes mellitus type 2

OBJETIVO: Rastrear a presença de doença arterial obstrutiva periférica assintomática em portadores de diabetes. MÉTODOS: Estudo observacional, descritivo e transversal de uma amostra composta por 50 pacientes de um ambulatórios de endocrinologia e geriatria, portadores de diabetes mellitus tipo 2, com mais de 5 anos de diagnóstico. O Índice Tornozelo-Braquial foi aferido por meio de esfigmomanômetro oscilométrico automático. A análise de dados foi obtida do software SSPS, versão 22. RESULTADOS: Dos 50 pacientes avaliados, com média de idade de 70 anos (50 a 91 anos de idade), 44% apresentavam Índice Tornozelo-Braquial normal e 16% tinham valores anormais. Como fatores associados de risco, apresentavam hipertensão arterial sistêmica (84%), sedentarismo (78%), dislipidemia (72%) e história de tabagismo (34%), porém sem associação estatística com doença arterial obstrutiva periférica assintomática. CONCLUSÃO: Foi alta a frequência do Índice Tornozelo-Braquial em relação anormal na amostra estudada. Ressalta-se a importância desse índice como método de baixo custo, fácil operacionalidade, não invasivo e de alta aceitabilidade na prática clínica da Atenção Primária de pacientes com risco cardiovascular aumentado.(AU)

OBJECTIVE: To track the presence of asymptomatic peripheral obstructive arterial disease in patients with diabetes. METHODS: This is an observational, descriptive, cross-sectional study with 50 patients of an endocrinology and geriatrics outpatient's department with more than five years of diabetes mellitus type 2 diagnosis. The ankle-brachial index was measured through an automatic oscillometric sphygmomanometer. Data analysis was obtained with SSPS Software, version 22. RESULTS: Of the 50 patients evaluated, with a mean age of 70 years (50-91 years of age), 44% presented with normal ankle-brachial index, and 16% had abnormal values. They had , systemic arterial hypertension (84%), sedentarism (78%), dyslipidemia (72%), and smoking history (34%) as associated risk factors, but no statistical association with asymptomatic peripheral obstructive arterial disease. CONCLUSION: This study found a high frequency of abnormal ankle-brachial index in the sample studied. The importance of this index is highlighted as a low-cost, easy-to-operate, non-invasive, highly accepted method in the clinical practice of primary care of patients with increased cardiovascular risk.(AU)

Comparison of auscultatory and oscillometric BP measurements in children with obesity and their effect on the diagnosis of arterial hypertension / Comparación de la medición de PA auscultatoria y oscilométrica en niños con obesidad y su efecto en el diagnóstico de hipertensión arterial

Abstract: Objective: The level of agreement between two blood pressure (BP) reading methods, auscultatory vs oscillometric, was examined using a mercury sphygmomanometer and an electronic device in children and adolescents with different levels of obesity. The readings were compared to determine their impact on the diagnosis of pre-hypertension/hypertension. Methods: Blood pressure readings were taken in children with obesity (body mass index ≥ 95th percentile) and severe obesity (≥120% 95th percentile). Bland-Altman analysis and Intraclass Correlation Coefficient were used to determine the agreement between measurements. Results: The mercury sphygmomanometer readings were lower than those obtained with the electronic device for both systolic and diastolic BP (P = .01 and P = .001, respectively). The mean systolic and diastolic BP differences between the oscillometric vs first mercury reading were 4.2/10.2 mm Hg, respectively. A large difference was observed between the BP measurement methods. The ICC showed regular to moderate reliability for the systolic BP (.595), but poor for the diastolic BP (.330). Screening using the first of three mercury measurements showed that 10.4% of the children and adolescents had BPs within the pre-hypertension/hypertension range. This was reduced to 5.2% when the mean of three mercury readings was used. Conclusions: Large discrepancies were observed in both the systolic and diastolic BP. These differences are not clinically acceptable as to consider the two instruments interchangeable. The electronic device readings were higher, and they overestimated the diagnosis of hypertension. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma Mèxico S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen: Objetivo: Para conocer el grado de concordancia entre 2 métodos de medición de presión arterial (PA), auscultatorio vs oscilométrico se utilizó un esfigmomanómetro de mercurio y un dispositivo electrónico en niños y adolescentes con diferentes grados de obesidad. Las lecturas fueron comparadas para conocer su impacto en el diagnóstico de prehipertensión/hipertensión. Método: Se midió la PA a niños con obesidad (percentil 95 del índice masa corporal) y obesidad severa (120% del percentil 95). Utilizamos análisis de Bland-Altman y Coeficiente de Correlación Intraclase (CCI) para conocer acuerdo entre mediciones. Resultados: Las lecturas con esfigmomanómetro de mercurio fueron más bajas que con el electrónico para la PA sistólica y diastólica (p = 0.01 y 0.001, respectivamente). El promedio de las diferencias en sistólica y diastólica entre oscilométrico vs. primera medición con mercurio fue de 4.2/10.2 mm Hg respectivamente. Se observó una gran diferencia de las mediciones entre los métodos de medición de PA. El CCI mostró una confiabilidad regular a moderada para la sistólica (0.595) pero pobre para la diastólica (0.330). El tamizaje con una medición mediante mercurio mostró que el 10.4% de los niños y adolescentes tenían PA en el rango de prehipertensión/hipertensión, pero se redujo a un 5.2% con el promedio de 3 mediciones. Conclusiones: Se observaron grandes discrepancias en la PA sistólica y diastólica. Tales diferencias no son clínicamente aceptables como para considerar equivalentes los 2 instrumentos. Las mediciones realizadas en este estudio con dispositivo electrónico fueron más altas y sobre estimaron el diagnóstico de hipertensión. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study / 대한마취과학회지

BACKGROUND: Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection. METHODS: Eighty American Society of Anesthesiologists class I adult patients undergoing general anesthesia were enrolled and divided into two groups of 40 each. Group I (Valsalva) patients blew into a sphygmomanometer tube raising the mercury column up to 30 mmHg for 20 seconds, while Group II (Control) patients did not. Anesthesia was induced with 1% propofol immediately afterwards. Pain was assessed on a 10-point visual analog scale (VAS), where 0 represented no pain, and 10, the worst imaginable pain, and a 4-point withdrawal response score, where 0 represented no pain, and 3, the worst imaginable pain. Scores were presented as median (interquartile range). RESULTS: We analyzed the data of 70 patients. The incidence of pain was significantly lower in the Valsalva than in the control group (53% vs 78%, P = 0.029). The withdrawal response score was significantly lower in the Valsalva group (1.00 [0.00-1.00] vs 2.00 [2.00-3.00], P < 0.001). The VAS score was significantly lower in the Valsalva group (1.00 [0.00-4.00] vs 7.00 [6.25-8.00], P < 0.001). CONCLUSIONS: A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.

Validation of the mobile wireless digital automatic blood pressure monitor using the cuff pressure oscillometric method, for clinical use and self-management, according to international protocols

The purpose of this study was to evaluate the accuracy of a mobile wireless digital automatic blood pressure monitor for clinical use and mobile health (mHealth). In this study, a manual sphygmomanometer and a digital blood pressure monitor were tested in 100 participants in a repetitive and sequential manner to measure blood pressure. The guidelines for measurement used the Korea Food & Drug Administration protocol, which reflects international standards, such as the American National Standard Institution/Association for the Advancement of Medical Instrumentation SP 10: 1992 and the British Hypertension Society protocol. Measurements were generally consistent across observers according to the measured mean ± SD, which ranged in 0.1 ± 2.6 mmHg for systolic blood pressure (SBP) and 0.5 ± 2.2 mmHg for diastolic blood pressure (DBP). For the device and the observer, the difference in average blood pressure (mean ± SD) was 2.3 ± 4.7 mmHg for SBP and 2.0 ± 4.2 mmHg for DBP. The SBP and DBP measured in this study showed accurate measurements that satisfied all criteria, including an average difference that did not exceed 5 mmHg and a standard deviation that did not exceed 8 mmHg. The mobile wireless digital blood pressure monitor has the potential for clinical use and managing one's own health.

Prevalencia de síndrome metabólico y factores de riesgo en la etnia kariña, estado Bolívar, Venezuela / Prevalence of metabolic syndrome and risk factors kariña etnic, Bolivar state, Venezuela

Introducción: El Síndrome Metabólico involucra factores de riesgos en conjunto: hipertensión arterial, obesidad, dislipidemia y resistencia a la insulina, que favorecen el desarrollo de enfermedades cerebrovasculares, cardiovasculares y diabetes. Objetivo general: Determinar la prevalencia del Síndrome Metabólico y sus factores de riesgo en individuos de la etnia Kariña (Mayo 2013 - Mayo 2014). Metodología: Se realizó un estudio observacional, descriptivo y corte transversal; en un universo de 203 individuos; y una muestra de 120 individuos (18-85 años) de la etnia Kariña de la Comunidad de Mayagua, Estado Bolívar, Venezuela. En todos ellos, el perfil lipídico se analizó mediante el método colorimétrico. La glicemia se cuantificó con glucómetro previo ayuno de 12 horas. Se utilizaron los criterios diagnósticos de la Federación Internacional de Diabetes, Asociación Latinoamericana de Diabetes y Panel III de Tratamiento de Adultos. Resultados: La prevalencia del síndrome metabólico fue según la Federación Internacional de Diabetes 46,67%, la Asociación Latinoamericana de Diabetes 39,17%, y Panel III de Tratamiento de Adultos 38,33%, el índice de concordancia de Kappa (k) entre Panel III de tratamiento de Adultos y Federación Internacional de Diabetes indica una fuerza de concordancia considerable, dicho índice entre Panel III de Tratamiento de Adultos y Asociación Latinoamericana de Diabetes denota una fuerza de concordancia casi perfecta al igual que el índice entre Asociación Latinoamericana de Diabetes y Federación Internacional de Diabetes. Conclusión: Se halló alta prevalencia de síndrome metabólico según criterios de Asociación Latinoamericana de Diabetes, Federación Internacional de Diabetes y Panel III de Tratamiento de Adultos; con predominio en el género femenino y en individuos mayores de 50 años.

Metabolic Syndrome includes the association of risk factors: hypertension, obesity, dyslipidemia and insulin resistance, which increases the possibility of developing cerebrovascular, cardiovascular and diabetes diseases. General objective: To determine the prevalence of the Metabolic Syndrome and its risk factors in individuals of the Kariña ethnic group. May 2013 - May 2014. Methods: An observational, descriptive study and cross section study was conducted; with a universe of 203 individuals, and a sample of 120 individuals (18-85 years) of the Kariña ethnic group of the Community of Mayagua, Bolívar State, Venezuela. In all participants, the lipid profile was analyzed with the colorimetric method. The glycemia was quantified with a glucometer prior to fasting for 12 hours.The diagnostic criteria of the International Diabetes Federation, the Latin American Diabetes Association and theAdultTreatment Panel III were used. Results: the prevalence of the metabolic syndrome was 46,67% according to the International Diabetes Federation, 39,17% Latin American Diabetes Association, and 38.33% AdultTreatment Panel II, the Kappa (k) concordance between Adult Treatment Panel III and International Diabetes Federation indicates a considerable concordance force, said Index between Adult Treatment Panel III and Latin American Diabetes Association denotes an almost perfect match strength as does the index between Latin American Diabetes Association and International Diabetes Federation. Conclusion: A high prevalence of metabolic syndrome was found by both the Latin American Diabetes Association, International Diabetes Federation and Adult Treatment Panel III criteria, with predominance in the female gender and individuals over 50 years old.

Presión arterial en población indígena tzotzil de Chiapas, México / Blood pressure in a native Tzotzil population from the state of Chiapas, Mexico

Resumen Objetivo: Determinar las cifras de presión arterial en población indígena tzotzil del estado de Chiapas, México. Metodología: Estudio transversal descriptivo en población tzotzil de Chenalho del Estado de Chiapas, México, de agosto a diciembre del 2015 en el grupo de 20 a 60 años de edad. Fueron excluidos los pacientes con diagnóstico de diabetes mellitus e hipertensión, y las embarazadas. El tamaño de muestra fue de 205 utilizando como marco muestral el listado de pacientes que acudieron a la cita de control sano en el centro de salud. Se midió la presión arterial sistólica y diastólica por una sola persona; la medición se realizó en el brazo derecho con el paciente en posición sedente, 5 min después de haber ingresado al consultorio, sin haber realizado actividad física previa; se utilizó esfigmógrafo de columna de mercurio marca Adex. El análisis estadístico incluyó promedios, porcentajes e intervalos de confianza para promedios y para porcentajes. Resultados: La presión arterial diastólica promedio es 68.73 mmHg (IC del 95%, 67.63-69.69), la sistólica 103.65 mmHg (IC del 95%, 102.24-105.06) y la presión arterial media 80.37 mmHg (IC del 95%, 79.35-81.39). Conclusión: Las cifras de presión arterial en población indígena tzotzil de Chiapas, México, son inferiores a las reportadas en la literatura científica.

Abstract Objective: To determine the blood pressure in a native Tzotzil population from the state of Chiapas, Mexico. Methodology: Cross-sectional study on a Chenalho Tzotzil population from Chiapas, Mexico, from August to December 2015, aged between 20 to 60 years-old. Patients with diabetes mellitus and hypertension were excluded, as well as pregnant patients. The sample size was 205, using as sample basis, the list of patients that went to the healthy patient wellness clinic. The systolic and diastolic pressures were measured by the same person. The measurement was performed on the right arm with the patient seated, five minutes after coming into the clinic, without performing any physical activity beforehand. It was measured with an AdexTM mercury column sphygmomanometer. The statistical analysis includes mean and percentages, as well as their confidence intervals. Results: The mean diastolic blood pressure found was 68.73 mmHg (95% CI,-67.63-69.69), with a diastolic of 103.65 mmHg (95% CI; 102.24-105.06) and a mean arterial pressure 80.37 mmHg (95% CI, 79.35-81.39). Conclusion: The arterial blood pressure in a Tzotzil native population of Chiapas, Mexico is lower than that reported in the scientific literature.

Automated Office Blood Pressure Measurement

Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated.

Inadequações dos Esfigmomanômetros Utilizados em Serviços de Urgência e Emergência de uma Grande Capital Brasileira / Inadequacies of Sphygmomanometers Used in Emergency Care Services in a Large Capital City in Brazil

Fundamento: A hipertensão arterial é o principal fator de risco cardiovascular. A qualidade técnica dos esfigmomanômetros é condição fundamental para obtenção da correta medida da pressão arterial. Objetivos: Avaliar o perfil dos esfigmomanômetros disponíveis nos serviços de urgências de Belo Horizonte, Minas Gerais. Métodos: Realizamos um estudo transversal, observacional e não intervencionista para avaliar o perfil dos esfigmomanômetros disponíveis nos prontos atendimentos de adultos de hospitais públicos e privados do município de Belo Horizonte. Avaliamos 337 aparelhos de 25 hospitais, sendo 15 públicos (do total de 16) e 10 privados (do total de 12). Resultados: Foram observadas inadequações dos equipamentos em relação à validação pelo Instituto Nacional de Metrologia, Qualidade e Tecnologia ­ INMETRO, em 26% (88/337) dos equipamentos; calibração vencida em 39% (132/337) e não correspondência de marca aparelho/braçadeira em 54% (188/337). Em 13 dos 25 hospitais (52%), não havia disponibilidade de manguitos para braços de diferentes tamanhos além do padrão. Houve superioridade de adequação dos aparelhos aneroides e de mercúrio dos hospitais privados (p = 0,038 e p < 0,001, respectivamente) e dos eletrônicos nos públicos (p < 0,001). Conclusão: Conclui-se que 78% dos esfigmomanômetros disponíveis nos serviços de urgência/emergência de uma das maiores capitais brasileiras apresentavam inadequações técnicas, e em metade dos serviços não havia manguitos de diferentes tamanhos. Tal fato representa um alerta para a situação dos equipamentos disponíveis para atendimento da população no país

Background: Hypertension is the main risk factor for cardiovascular diseases. Technical quality of sphygmomanometers is a prerequisite for the correct measurement of arterial pressure. Objectives: To evaluate sphygmomanometers available in emergency services in the city of Belo Horizonte, Brazil. Methods: We performed a cross-sectional, observational, non-interventional study to evaluate characteristics of the sphygmomanometers available in adult emergency services of public and private hospitals in the city of Belo Horizonte, Brazil. We evaluated 337 sphygmomanometers of 25 hospitals ­ 15 (of 16) public hospitals and 10 (of 12) private hospitals. Results: Twenty-six percent (88/337) of devices were considered inadequate regarding the INMETRO (National Institute of Metrology, Quality and Technology) standards, 39.2% (132/337) for calibration dates, and 54% (188/337) for the mismatching between cuff's and device's brands. In 13 of 25 hospitals (52%), there were no spare cuffs in different sizes for different arm circumferences. Higher adequacy was found for aneroid and mercury sphygmomanometers used in private hospitals (p = 0.038 and p < 0.001, respectively) and electronic devices used in public hospitals (p < 0.001) compared with others.Conclusion: Seventy-eight percent of sphygmomanometers available in emergency services had technical inadequacies, and half of these services had no spare cuffs in different sizes available. These findings serve as a warning of the conditions of the equipment used in healthcare services provided to the general population in Brazil

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Adequação do manguito do esfigmomanômetro às medidas de circunferência braquial em pessoas atendidas na Atenção Primária / Adequacy of sphygmomanometer cuff to brachial circumference of people attended in Primary Health Care Centers

RESUMO: Objetivo: Avaliar a adequação do manguito às medidas de circunferência braquial (CB) em pessoas atendidas na Atenção Primária. Métodos: Estudo epidemiológico do tipo transversal observacional e quantitativo. Foram observadas 381 medidas de pressão arterial (PA), realizadas por profissionais de enfermagem, em 18 serviços de Atenção Primária selecionados por sorteio, considerando 2 modalidades de atenção. O uso correto do manguito foi a principal variável de desfecho. A CB foi medida com fita métrica inelástica. Para análise estatística das variáveis foram utilizados os testes t de Student, χ2 ou exato de Fisher. Resultados: A medida de CB variou de 19,5 a 45,0 cm (média = 30,4; desvio padrão - DP = 4,3). Observou-se que 218 (57,2%) das medidas foram executadas com o manguito adequado, com maior frequência nas unidades com Equipes de Saúde da Família (59,6 versus 40,4; p < 0,001). Constatou-se 93 (24,2%) medidas de CB < 27 cm e 63 (16,5%) medidas de CB > 34 cm. O manguito adulto foi usado corretamente 209 (59,4%) vezes e o manguito adulto grande, 9 (31,0%) vezes. Conclusão: O estudo constatou uma inadequação no uso do manguito em 42,8% das medidas de PA na Atenção Primária à Saúde (APS). Estudos semelhantes em serviços de outras cidades e regiões devem ser realizados para estimar a magnitude do problema para o diagnóstico e monitoramento de hipertensão arterial sistêmica (HAS).

ABSTRACT: Objective: To evaluate the adequacy of sphygmomanometer cuff to brachial circumference (BC) of individuals treated at Primary Health Care Centers. Methods: Epidemiological, observational, and quantitative cross-sectional study. A total of 381 blood pressure (BP) readings conducted by nursing professionals were observed at 18 service units selected by drawing, considering two modalities of care centers. The correct use of the cuff was the main outcome variable. The BC was measured using inelastic measuring tape. The tests used for statistical analysis were Student’s t-test, χ2, or Fisher’s exact test. Results: The measurement of BC ranged from 19.5 to 45.0 cm (mean = 30.4; standard deviation - SD = 4.3). Among the BP measurements, 218 (57.2%) of them were conducted with the appropriately sized cuff, being more frequent in the units with Family Health Teams (59.6 versus 40.4; p < 0.001). Ninety-three (24.2%) BC measurements were < 27 cm and 63 (16.5%) were > 34 cm. The adult cuff was used correctly 209 (59.4%) times and the large adult cuff was used correctly 9 (31.0%) times. Conclusion: The study found an inadequacy in the use of the cuff in 42.8% of blood pressure readings in the Primary Health Care Centers. Similar studies should be performed in other cities and areas to estimate the effect of this problem in the diagnosis and monitoring of systemic arterial hypertension (SAH).