Fatores para não-adesão ao programa de controle da hipertensão arterial em Campo Grande, MS / Factors for nonadherence to the Arterial Hypertension Control Program in Campo Grande, MS, Brazil

A adesão ao tratamento farmacológico em doenças crônicas como a hipertensão arterial, é fundamental para o controle, prevenção de complicações e diminuição da mortalidade. Identificar os fatores que levam a não adesão ao programa de controle de hipertensão arterial, em Unidades Básicas de Saúde de Campo Grande, MS e produzir um modelo de predição desta condição foi o objetivo do presente estudo. Utilizou-se o método de caso-controle, aninhado a coorte de pacientes cadastrados no programa, no período de 2002 a 2005. Foi utilizada regressão logística tendo como variável-resposta ?adesão ao programa?. As associações significativas identificadas na análise univariada foram: características socioeconômicas, da doença, do tratamento e as relacionadas ao programa. Para prever a adesão, mantiveram-se no modelo as seguintes variáveis: dificuldade em ir ao programa, renda familiar, presença de diabetes, escolaridade e viver com companheiro. Com base no modelo, a probabilidade do paciente ser classificado corretamente como aderente, é de aproximadamente, 80% e como não aderente, 67%. O modelo identifica precocemente, pacientes vulneráveis à não adesão ao programa propiciando que este institua medidas voltadas aos prováveis, não aderentes.

Adherence to the pharmacological treatment of chronic diseases such as arterial hypertension is decisive in their control, in preventing complications, and in decreasing mortality rates. To identify factors that led patients to drop out of an arterial hypertension control program available at local district clinics of the government-run National Health Service in Campo Grande, MS, Brazil, and to design a model to predict adherence. A nested case?control study was conducted on subjects selected from within a cohort of patients enrolled in the above program, from 2002 to 2005. Binary logistic regression was used, with ?adherence to program? as the binary response variable. Data were subjected to logistic regression analysis to generate a model capable of predicting adherence. Factors identified: difficulty in going to the venue where the program was available, family income, presence of diabetes, level of education and living with a partner. When the logistic regression model was used, the probability of a patient being correctly classified as adherent and nonadherent was approximately 80% and 67%, respectively. The model enables early identification of patients prone to nonadherence to the control program, thus making it possible to implement measures directed at potentially nonadherent participants.

Erythrocyte glucose-6-phosphate dehydrogenase from Brazilian opossum Didelphis marsupialis

In a comparative study of erythrocyte metabolism of vertebrates, the specific activity of glucose-6-phosphate dehydrogenase (G6PD) of the Brazilian opossum Didelphis marsupialis in a hemolysate was shown to be high, 207 ± 38 IU g-1 Hb-1 min-1 at 37°C, compared to the human erythrocyte activity of 12 ± 2 IU g-1 Hb-1 min-1 at 37°C. The apparent high specific activity of the mixture led us to investigate the physicochemical properties of the opossum enzyme. We report that reduced glutathione (GSH) in the erythrocytes was only 50 percent higher than in human erythrocytes, a value lower than expected from the high G6PD activity since GSH is maintained in a reduced state by G6PD activity. The molecular mass, determined by G-200 Sephadex column chromatography at pH 8.0, was 265 kDa, which is essentially the same as that of human G6PD (260 kDa). The Michaelis-Menten constants (Km: 55 æM) for glucose-6-phosphate and nicotinamide adenine dinucleotide phosphate (Km: 3.3 æM) were similar to those of the human enzyme (Km: 50-70 and Km: 2.9-4.4, respectively). A 450-fold purification of the opossum enzyme was achieved and the specific activity of the purified enzyme, 90 IU/mg protein, was actually lower than the 150 IU/mg protein observed for human G6PD. We conclude that G6PD after purification from the hemolysate of D. marsupialis does not have a high specific activity. Thus, it is quite probable that the red cell hyperactivity reported may be explained by increased synthesis of G6PD molecules per unit of hemoglobin or to reduced inactivation in the RBC hemolysate.

Increased fetal hemoglobin levels in patients infected with human immunodeficiency virus (HIV1/2)

Fetal hemoglobin was measured in HIV1/2 patients under treatment with combined therapy (zidovudine and a protease inhibitor). A total of 143 patients and 103 normal individuals were investigated by the quantitative method of Betke and the semi-quantitative acid elution method of Kleihauer. In the normal person, hemoglobin F makes up less than 1 percent and an increase higher than 1.5 percent was observed in 21.4 percent of HIV patients by the method of Betke and in 24.8 percent of HIV-infected patients by the method of Kleihauer. The quantitative biochemical method of Betke showed that the populations were significantly different (two-tailed Mann-Whitney test). The reason for this hemoglobin F increase might be ascribed to the effect of zidovudine or to direct viral action on gamma chain expression. The finding of a higher F cell frequency indicated by the method of Kleihauer rather suggests that there is an increased F cell clone proliferation rather than an increase in hemoglobin F level in every cell

Atrial natriuretic peptide modulates the effect of angiotensin II on the concentration of free calcium in the cytosol of Mandin-Darby canine kidney cells

The effect of angiotensin II (ANG II) and atrial natriuretic peptide (ANP) on intracellular free calcium concentration [ Ca²+]i was investigated in Mandin-Darby canine kidney (MDCK) cells in culture. Changes in [Ca²+]i were monitored fluorometrically with the Ca²+ -sensitive probel fura -2/AM at 37ºC using Perkin-Elmer LS-5 spectrofluorimeter (excitation 340/380 nm,slite 3 nm; emission 520 nm, slit 10 nm). MDCK cells exhibited a mean baseline [Ca²+]i of 98 ñ 10 nM. the addition of increasing concentrations of SNG II (1 pM to 1 µM) to the cell suspension led to a progressive increase in [Ca²+]i to 2-3 times basal levels. In contrast, addition of 1 µM ANP to the cell suspension led to a very rapid 60 percent decrease in [Ca²+]i. The addition of 1 pM to 1 µM ANG II immediately after 1 µM ANP caused an increase in [Ca²+]i which never exceded the basal level in the absence of ANP. The data indicate that ANG II increases cell [Ca²+]i as expected, and provide the new observation that ANP reduces [Ca²+]i in these cells. Further more, ANP reduces the increase in [Ca²+]i elicited by ANG II, thus modulating the effect of ANG II on [Ca²+]i

Mechanical support of the circulation and the Frank-Starling law: a physiological approach

The performance curves of an external pulsatile flow pump for temporary circulatory mechanical support are analyzed with special attention to the "fill to empty" control mode and an analogy with the Frank-Starling law is established