Controlling micropollutants in tertiary municipal wastewater by O3/H2O2, granular biofiltration and UV254/H2O2 for potable reuse applications.

A comprehensive pilot study was carried out to experimentally assess the potential of newly developed treatment trains integrating two-stage AOPs and biofiltration to reach potable reuse water quality standards from municipal wastewater. The processes consisted of a two-stage AOPs with (carbon or limestone) biofiltration, the first AOP (O3/H2O2) serving as pre-treatment to biofiltration and the second AOP (UV254/H2O2) serving as post-biofiltration finishing step to ensure advanced disinfection. A comprehensive monitoring campaign was put in place resulting from the combination of targeted, non-targeted and suspect screening measurements. It was found that 13 organic micropollutants were detected from a list of 219 suspects although at ng/L level only. For the treatment conditions piloted in this study (O3 = 13 ±â€¯0.5 mg/L, H2O2 = 11 ±â€¯0.4 mg/L for the O3/H2O2 process, and UV = 410 ±â€¯63.5 mJ/cm2, H2O2 = 5 mg/l for the UV254/H2O2 process), it was possible to estimate the overall removal efficacy for each unit process, which was found to follow this order: RO (99%)  > BAC (87%) > O3-H2O2 (78%)  > BAL (67%)  > UV/H2O2 (43%)  > AOP contact chamber (19%)  > UF(0%), with the treatment train integrating two AOPs and granular biofiltration with activated carbon (O3/H2O2 + BAC + UV254/H2O2) showing superior performance with a 99% abatement in total micropollutants. No ecotoxicologically-positive response was generally observed for any of the effluent samples from the tested trains, even when pre-concentration factors up to 100-1000 times were employed to increase the sensitivity of the bioassay methods.

Traditional knowledge and uses of medicinal plants by the inhabitants of the islands of the São Francisco river, Brazil and preliminary analysis of Rhaphiodon echinus (Lamiaceae) / Conhecimento tradicional e usos de plantas medicinais por habitantes das ilhas do rio São Francisco, Brasil e análise preliminar de Rhaphiodon echinus (Lamiaceae)

Abstract This study aimed to carry out an ethnobotanical survey of medicinal plants used by inhabitants of the Rodeadouro Island, Jatoba Island and Massangano Island, located in The Submedium São Francisco River Valley. Also phytochemicals and preliminary pharmacological tests were performed to species most cited by the community. Ethnobotanical data were collected through observation visits and semi-structured interviews with 12 key informants. We calculated the relative importance (RI), the percentage of agreement related to the main uses (cAMU) and use value (UV). The aerial parts of Rhaphiodon echinus (Ness & Mart.) Schauer were used to obtain the lyophilizate (LYO-Re), crude ethanol extract (CEE-Re) and their hexanic (HEX-Re), chloroform (CLO-Re) and ethyl acetate (EA-Re) fractions. The microdilution technique was used for determining Minimum inhibitory concentration (MIC) for selected microorganisms. Already the spasmolytic effect was evaluated in isolated uterus fragments of Wistar rats, pre contracted with KCl 60 mM. We found 34 species cited, belonging to 22 families. The most plants were grown by locals. There were 51 different diseases, but the main indication was infectious and parasitic diseases. The species R. echinus was the most reported and it was indicated for urinary tract infection and dysmenorrhea. The screening revealed a higher prevalence of flavonoids, tannins, lignans and saponins in LYO-Re and AE-Re. Already terpene compounds were more present in HEX-Re and CLO-Re. The RE-Re fraction stood out with strong effect against E. coli and S. aureus while CEE-Re has moderate effect against gram-negative bacteria. The evaluation of the spasmolytic activity showed that LYO-Re, CEE-Re and HEX-Re fractions have similar activity, with partial effect and concentration-dependent response. This work brought about knowledge and use of medicinal plants by the riparian of the São Francisco River. It also revealed the importance of other methodologies for scientific evidence for the popular use of R. echinus.

Resumo Objetivou-se realizar um levantamento etnobotânico de plantas medicinais utilizadas nas ilhas do Massangano, Jatobá II e Rodeadouro, localizadas entre Petrolina-PE e Juazeiro-BA, no submédio do rio São Francisco e posterior investigação fitoquímica e farmacológica da espécie mais citada, conforme a indicação da comunidade. Realizaram-se visitas de observação nas ilhas e os dados etnobotânicos foram coletados por entrevistas semiestruturadas com 12 informantes-chave. Calculou-se a Importância Relativa (IR), a Porcentagem Corrigida de Concordância quanto ao Uso Principal (CUPc) e o Valor de Uso (VU). Utilizaram-se as partes aéreas da espécie mais citada para obtenção do extrato etanólico bruto (EEB-Re), suas frações hexânica (HEX-Re), clorofórmica (CLO-Re) e acetato de etila (AE-Re); o produto liofilizado (LIO-Re) e o óleo essencial (OE-Re). A técnica de microdiluição foi usada para determinar a Concentração Inibitória Mínima (CIM) para microorganismos selecionados. A atividade espasmolítica foi avaliada em fragmentos isolados de útero de ratas Wistar pré-contraídos com KCl 60 mM. Foram relatadas 34 espécies, contidas em 22 famílias diferentes. A maioria das plantas era cultivada pelos moradores. Registraram-se 51 enfermidades diferentes, mas a principal indicação foi doenças parasitárias e infecciosas. A espécie Rhaphiodon echinus (Ness & Mart.) Schauer foi a mais citada, com principal indicação para tratar infecção do trato urinário e dismenorreia. O screening fitoquímico revelou prevalência de flavonoides, taninos, lignanas e saponinas em LIO-Re e AE-Re e compostos terpênicos em HEX-Re e CLO-Re. Os testes antibacterianos mostraram que AE-Re é mais atuante contra E. coli e S. aureus do que para P. aeruginosa. O EEB-Re tem efeito parcial contra bactérias gram-negativas e OE-Re possui moderada resposta para todos microorganismos testados. LIO-Re, EEB-Re e HEX-Re possuem atividade espasmolítica dependente da concentração, sem diferença significativa e sem relaxamento total. Este trabalho trouxe conhecimento sobre o uso de plantas medicinais pelos ribeirinhos do rio São Francisco e revela a importância de estudos mais aprofundados para a comprovação científica do uso popular da R. echinus.

Traditional knowledge and uses of medicinal plants by the inhabitants of the islands of the São Francisco river, Brazil and preliminary analysis of Rhaphiodon echinus (Lamiaceae).

This study aimed to carry out an ethnobotanical survey of medicinal plants used by inhabitants of the Rodeadouro Island, Jatoba Island and Massangano Island, located in The Submedium São Francisco River Valley. Also phytochemicals and preliminary pharmacological tests were performed to species most cited by the community. Ethnobotanical data were collected through observation visits and semi-structured interviews with 12 key informants. We calculated the relative importance (RI), the percentage of agreement related to the main uses (cAMU) and use value (UV). The aerial parts of Rhaphiodon echinus (Ness & Mart.) Schauer were used to obtain the lyophilizate (LYO-Re), crude ethanol extract (CEE-Re) and their hexanic (HEX-Re), chloroform (CLO-Re) and ethyl acetate (EA-Re) fractions. The microdilution technique was used for determining Minimum inhibitory concentration (MIC) for selected microorganisms. Already the spasmolytic effect was evaluated in isolated uterus fragments of Wistar rats, pre contracted with KCl 60 mM. We found 34 species cited, belonging to 22 families. The most plants were grown by locals. There were 51 different diseases, but the main indication was infectious and parasitic diseases. The species R. echinus was the most reported and it was indicated for urinary tract infection and dysmenorrhea. The screening revealed a higher prevalence of flavonoids, tannins, lignans and saponins in LYO-Re and AE-Re. Already terpene compounds were more present in HEX-Re and CLO-Re. The RE-Re fraction stood out with strong effect against E. coli and S. aureus while CEE-Re has moderate effect against gram-negative bacteria. The evaluation of the spasmolytic activity showed that LYO-Re, CEE-Re and HEX-Re fractions have similar activity, with partial effect and concentration-dependent response. This work brought about knowledge and use of medicinal plants by the riparian of the São Francisco River. It also revealed the importance of other methodologies for scientific evidence for the popular use of R. echinus.

Traditional knowledge and uses of medicinal plants by the inhabitants of the islands of the São Francisco river, Brazil and preliminary analysis of Rhaphiodon echinus (Lamiaceae)

Abstract This study aimed to carry out an ethnobotanical survey of medicinal plants used by inhabitants of the Rodeadouro Island, Jatoba Island and Massangano Island, located in The Submedium São Francisco River Valley. Also phytochemicals and preliminary pharmacological tests were performed to species most cited by the community. Ethnobotanical data were collected through observation visits and semi-structured interviews with 12 key informants. We calculated the relative importance (RI), the percentage of agreement related to the main uses (cAMU) and use value (UV). The aerial parts of Rhaphiodon echinus (Ness & Mart.) Schauer were used to obtain the lyophilizate (LYO-Re), crude ethanol extract (CEE-Re) and their hexanic (HEX-Re), chloroform (CLO-Re) and ethyl acetate (EA-Re) fractions. The microdilution technique was used for determining Minimum inhibitory concentration (MIC) for selected microorganisms. Already the spasmolytic effect was evaluated in isolated uterus fragments of Wistar rats, pre contracted with KCl 60 mM. We found 34 species cited, belonging to 22 families. The most plants were grown by locals. There were 51 different diseases, but the main indication was infectious and parasitic diseases. The species R. echinus was the most reported and it was indicated for urinary tract infection and dysmenorrhea. The screening revealed a higher prevalence of flavonoids, tannins, lignans and saponins in LYO-Re and AE-Re. Already terpene compounds were more present in HEX-Re and CLO-Re. The RE-Re fraction stood out with strong effect against E. coli and S. aureus while CEE-Re has moderate effect against gram-negative bacteria. The evaluation of the spasmolytic activity showed that LYO-Re, CEE-Re and HEX-Re fractions have similar activity, with partial effect and concentration-dependent response. This work brought about knowledge and use of medicinal plants by the riparian of the São Francisco River. It also revealed the importance of other methodologies for scientific evidence for the popular use of R. echinus.

Resumo Objetivou-se realizar um levantamento etnobotânico de plantas medicinais utilizadas nas ilhas do Massangano, Jatobá II e Rodeadouro, localizadas entre Petrolina-PE e Juazeiro-BA, no submédio do rio São Francisco e posterior investigação fitoquímica e farmacológica da espécie mais citada, conforme a indicação da comunidade. Realizaram-se visitas de observação nas ilhas e os dados etnobotânicos foram coletados por entrevistas semiestruturadas com 12 informantes-chave. Calculou-se a Importância Relativa (IR), a Porcentagem Corrigida de Concordância quanto ao Uso Principal (CUPc) e o Valor de Uso (VU). Utilizaram-se as partes aéreas da espécie mais citada para obtenção do extrato etanólico bruto (EEB-Re), suas frações hexânica (HEX-Re), clorofórmica (CLO-Re) e acetato de etila (AE-Re); o produto liofilizado (LIO-Re) e o óleo essencial (OE-Re). A técnica de microdiluição foi usada para determinar a Concentração Inibitória Mínima (CIM) para microorganismos selecionados. A atividade espasmolítica foi avaliada em fragmentos isolados de útero de ratas Wistar pré-contraídos com KCl 60 mM. Foram relatadas 34 espécies, contidas em 22 famílias diferentes. A maioria das plantas era cultivada pelos moradores. Registraram-se 51 enfermidades diferentes, mas a principal indicação foi doenças parasitárias e infecciosas. A espécie Rhaphiodon echinus (Ness & Mart.) Schauer foi a mais citada, com principal indicação para tratar infecção do trato urinário e dismenorreia. O screening fitoquímico revelou prevalência de flavonoides, taninos, lignanas e saponinas em LIO-Re e AE-Re e compostos terpênicos em HEX-Re e CLO-Re. Os testes antibacterianos mostraram que AE-Re é mais atuante contra E. coli e S. aureus do que para P. aeruginosa. O EEB-Re tem efeito parcial contra bactérias gram-negativas e OE-Re possui moderada resposta para todos microorganismos testados. LIO-Re, EEB-Re e HEX-Re possuem atividade espasmolítica dependente da concentração, sem diferença significativa e sem relaxamento total. Este trabalho trouxe conhecimento sobre o uso de plantas medicinais pelos ribeirinhos do rio São Francisco e revela a importância de estudos mais aprofundados para a comprovação científica do uso popular da R. echinus.

Relative Change in NT-proBNP Level: An Important Risk Predictor of Cardiovascular Congestion in Haemodialysis Patients.

BACKGROUND: Cross-sectional studies have shown that B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are predictive of cardiovascular death in haemodialysis (HD) patients. In the present study, we tested the hypothesis that monitoring NT-proBNP measurements adds further prognostic information, i.e. predicts congestive heart failure (CHF) events. METHODS: In a prospective cohort of 236 HD patients, NT-proBNP levels were measured monthly during 18 months. Patients were divided according to the occurrence of CHF events. In a nested case-control study, we assessed the evolution of NT-proBNP levels. RESULTS: On average, the 236 HD patients were followed up for 12.5 months, a period during which 44 patients developed a CHF event (half requiring hospitalisation). At baseline, patients who developed a CHF event had significantly more dilated cardiomyopathy and/or altered left ventricular ejection fraction and higher NT-proBNP levels compared with patients who did not develop a CHF event. During follow-up, we observed a significant increase in NT-proBNP levels preceding the CHF event. At a 20% relative increase of NT-proBNP, the sensitivity of NT-proBNP as a predictor of CHF events was 0.57 and the specificity 0.77. CONCLUSION: The relative change in NT-proBNP levels is a significant risk predictor of a CHF event.

Replacement of fresh water use by final effluent recovery in a highly optimized 100% recovered paper mill.

A further closure of the water circuit in paper mills with a relative high optimization of their water network is limited by the increase of contamination in the water and runnability problems of the paper machine. Therefore, new strategies for saving water must be focussed on the treatment of final effluents of the paper mill, aiming to obtain high quality water that may replace fresh water use in some applications. An appropriate treatment train performed at pilot scale, consisting on a previous clarification stage followed by anaerobic and aerobic treatments, ultrafiltration, and reverse osmosis, made possible producing the highest water quality from the final effluent of the mill. Anaerobic pre-treatment showed very good performance assisting the aerobic stage on removing organics and sulphates, besides it produced enough biogas for being considered as cost-effective. Permeate recovery depended on the silica content of the paper mill effluent, and it was limited to a 50-60%. The reject of the membranes fully met the legislation requirements imposed to effluents arriving to municipal wastewater treatment plants.

Actitudes del personal en la vigilancia de eventos adversos intrahospitalarios en Colombia / Attitudes of personnel monitoring intra-hospital adverse events in Colombia

Objetivos La detección de los eventos adversos (EA) es parte de la gestión de la seguridad en pacientes hospitalizados. Existen múltiples factores de la institución y de los trabajadores que afectan la adecuada vigilancia de los EA. El objetivo de esta publicación es explorar la actitud y reacciones del personal de las instituciones en cuanto a la detección y evaluación de los EA. Metodología Investigación cualitativa. Se realizó un grupo focal con informantes clave que había recolectado y monitoreado la información en un estudio cuantitativo previo: "Incidencia y evitabilidad de Eventos adversos en tres instituciones en Colombia 2006" Se construyó un marco conceptual basado en las publicaciones relativas a los EA, las instituciones de salud y la realización de resúmenes por temática del contenido del trabajo en el grupo focal mediante la sistematización, categorización y reducción de datos. Resultados Existe la creencia de que vigilancia de EA consiste en una auditoria con consecuencias laborales negativas. Esta opinión está determinada por la cultura organizacional previa. Las estrategias para incrementar el reporte fueron: el trabajo persona a persona, hacer conciencia de que nadie está exento de un evento adverso y, el apoyo administrativo para solucionar las deficiencias. Conclusiones Se requiere confianza mutua y trabajo conjunto entre los trabajadores de la salud, el personal de apoyo y la gerencia para prevenir futuros EA.

Objective Detecting adverse events (AE) is part of managing hospitalised patients' safety. Suitable AE monitoring is affected by many factors regarding any particular institution and its workers. This article was aimed at describing the difficulties emerging from identifying and evaluating events and suggested interventions from the workers' viewpoint. Methods Qualitative research. A focus group was formed with key informants from previous research entitled "The incidence and avoidability of adverse events in three institutions in Colombia, 2006." A conceptual framework was constructed based on publications pertaining to AEs and health-providing institutions; summaries were made by topic regarding the content of the focus group's work by systematising, categorising and readjusting the data. The triangulation method was used for guar-anteeing its credibility, transferability, reliability and that it could be confirmed. Results It is commonly thought that monitoring AE only consists of taking inventories related to negative work consequences into account; this opinion has been determined by prior organisational culture. Strategies used for increasing AE reporting were: intrapersonal work, raising awareness that nobody is exempt from being involved in an adverse event and encouraging administrative support for resolving deficiencies. The prospective monitoring method becomes hampered when applying it to services involving a large volume of information. A tendency was observed for specialist committees to underestimate an event's association. Conclusions Heath workers, support personnel and management must have mutual confidence and adopt team-work so that future AE may be prevented.

[Attitudes of personnel monitoring intra-hospital adverse events in Colombia]. / Actitudes del personal en la vigilancia de eventos adversos intrahospitalarios en Colombia.

OBJECTIVE: Detecting adverse events (AE) is part of managing hospitalised patients' safety. Suitable AE monitoring is affected by many factors regarding any particular institution and its workers. This article was aimed at describing the difficulties emerging from identifying and evaluating events and suggested interventions from the workers' viewpoint. METHODS: Qualitative research. A focus group was formed with key informants from previous research entitled 'The incidence and avoidability of adverse events in three institutions in Colombia, 2006.' A conceptual framework was constructed based on publications pertaining to AEs and health-providing institutions; summaries were made by topic regarding the content of the focus group's work by systematising, categorising and readjusting the data. The triangulation method was used for guar-anteeing its credibility, transferability, reliability and that it could be confirmed. RESULTS: It is commonly thought that monitoring AE only consists of taking inventories related to negative work consequences into account; this opinion has been determined by prior organisational culture. Strategies used for increasing AE reporting were: intrapersonal work, raising awareness that nobody is exempt from being involved in an adverse event and encouraging administrative support for resolving deficiencies. The prospective monitoring method becomes hampered when applying it to services involving a large volume of information. A tendency was observed for specialist committees to underestimate an event's association. CONCLUSIONS: Heath workers, support personnel and management must have mutual confidence and adopt team-work so that future AE may be prevented.

[Evaluating post-abortion care in 13 Colombian hospitals]. / Evaluación de la Atención Integral al Pos-aborto en 13 Hospitales de Colombia.

OBJECTIVES: This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning). METHODS: The study had quantitative (cross-sectional study) and qualitative components. POPULATION: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed. RESULTS: 26,199 women were treated for incomplete abortion during the study period. 40 % were treated using Manual Vacuum Aspiration (MVA) and 60 % using sharp curettage (SC). Family planning counselling was provided for 99,8 % of MVA cases; however, only 57,3 % of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 % of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 % of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well. CONCLUSIONS: MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.

Evaluación de la Atención Integral al Pos-aborto en 13 Hospitales de Colombia / Evaluating post-abortion care in 13 Colombian hospitals

Objetivos: El propósito de este trabajo es describir la experiencia con la estrategia de Atención Integral al Posaborto (APA) en 13 hospitales Colombianos en lo referente a tres componentes: Consejería, tratamiento y planificación familiar. Métodos: Estudio mixto con un componente cuantitativo (corte transversal) y otro cualitativo. Población: Hospitales en Colombia que recibieron capacitación en APA entre 1999 y 2002 y que cumplieron con criterios de inclusión y exclusión. Se hizo un muestreo secuencial por conveniencia, entrevistando 127 pacientes, 13 gerentes, y 39 proveedores. Resultados: Entre 1999 y 2002 se atendieron 26 199 mujeres con aborto incompleto. Se trataron con legrado uterino por aspiración manual (LUA) el 40 por ciento y con legrado uterino con cureta (LUC) el 60 por ciento. En los casos de LUA se brindó consejería en el 99,8 por ciento y en los de LUC en 57,3 por ciento. Utilizando LUA no hubo perforaciones uterinas aunque hubo 2 reacciones vagales mientras con LUC hubo 9 perforaciones uterinas (Chi²: 2,16; p=0,14). Con LUC hubo necesidad de reaspiración por evacuación incompleta en 13 casos mientras que en LUA en un caso (Chi²: 6,25 p=0,01). Las pacientes sometidas a LUA refirieron haber estado muy satisfechas y satisfechas en más del 90 por ciento mientras que para LUC el grado de satisfacción fue del 60 por ciento. Manifestaron satisfacción con la estrategia APA todos los proveedores y 12 de 13 gerentes. Conclusiones: La técnica LUA presentó menor morbilidad y mayor satisfacción en las usuarias. La mayoría de los gerentes y la totalidad de los proveedores manifestaron satisfacción con la estrategia APA.

Objectives: This work describes Post-abortion Care strategy (PAC) experience in 13 Colombian hospitals regarding three components (counselling, suitable treatment and family planning). Methods: The study had quantitative (cross-sectional study) and qualitative components. Population: Colombian hospitals receiving PAC training between 1999 and 2002 and fulfilling inclusion and exclusion criteria. Sequential convenience sampling was used; 127 patients, 13 managers and 39 health-care providers were interviewed. Results: 26,199 women were treated for incomplete abortion during the study period. 40 percent were treated using Manual Vacuum Aspiration (MVA) and 60 percent using sharp curettage (SC). Family planning counselling was provided for 99,8 percent of MVA cases; however, only 57,3 percent of SC cases received it. There were 9 uterine perforations using SC and none in MVA cases (Chi square: 2.16; p=0.14). There were 2 vagal reactions using MVA. Uterine evacuation was needed in 13 SC cases but in only one MVA case (Chi square: 6,25 p=0.01). Patient satisfaction levels with hospital treatment were evaluated: 90 percent of those receiving MVA treatment reported being satisfied or very satisfied, compared to just 60 percent of those treated with SC. All health-care providers and 12 out of 13 managers reported satisfaction with the PAC strategy and with 12 out of 13 managers as well. Conclusions: MVA treatment was associated with less treatment-related morbidity and higher levels of satisfaction amongst patients. Most managers and all health-care providers stated their satisfaction with the PAC strategy.

Cost effectiveness of diagnostic laparoscopy in reproductive aged females suffering from non-specific acute low abdominal pain.

OBJECTIVE: To compare the costs and effectiveness of early laparoscopy with those of conventional diagnostic methods based on clinical and paraclinical observation and diagnostic images for ascertaining the cause of non-specific acute low abdominal pain (NSALAP) in females of reproductive age from the third-party payers' (TPP) point of view. POPULATION: 110 reproductive aged females suffering from NSALAP. PLACE: Instituto Materno Infantil, perinatal and maternal attention referral hospital in Bogotá, Colombia. RESEARCH DESIGN: cost-effectiveness study of a controlled clinical trial carried out in 1998 and 1999. Outcomes to be measured: effectiveness, direct medical costs (in Colombian pesos and their equivalent in US dollars (USD-December 2004) from length of hospital stay, diagnostic procedures carried out, medical visits and managing complications. ANALYSIS: Cost-effectiveness incremental ratio, analysing sensitivity in five different scenarios. RESULTS: Early diagnostic laparoscopy was more cost-effective in 4 out of the 5 possible scenarios. Savings varying from dollar 21.875 to dollar 69.834 (USD 9.42 and USD 30.1) were made per unit of increased effectiveness. CONCLUSION: Early diagnostic laparoscopy was cost-effective in 4 out of 5 scenarios dealing with managing NSALAP in reproductive aged females.

[Target organ effects in untreated hypertension]. / Atteinte des organes cibles dans l'HTA jamais traitée.

The parallel investigation of the renal and cardiac complications of recent and never treated systemic hypertension has only rarely been undertaken. The aim of this study was to define the renal function of never treated hypertensive subjects, separated into white coat hypertensives (HTbb: n = 19, BP at consultation 153/97 mmHg) or permanent hypertensives (HT: n = 49, BP at consultation 169/104 mmHg) as a function of their 24 hour BP. Their renal functions were then compared with those of normotensive subjects (NT: n = 10). The 68 hypertensive subjects seen consecutively underwent renal function investigation (DFG: glomerular filtration rate, DPR: renal plasmatic debit, and muAlb: microalbuminuria over 24 hours), and myocardial echography (measurement of the left ventricular mass index, IMVG). The white coat hypertensives had a normal renal function, while the permanent hypertensives had a significant decrease in DPR and a significantly higher muAlb compared to the normotensives. Compared to the white coat hypertensives, the permanent hypertensives had a significantly lower DFG and DPR, as well as a higher muAlb and IMVG. In all the hypertensives (white coat and permanent) the 24 hour systolic BP was significantly correlated with muAlb (r = 0.51, p < 0.001), filtration fraction (r = 0.30, p < 0.05), and IMVG (r = 0.52, p < 0.001). The renal and myocardial parameters were not significantly correlated. In conclusion, there seems to be a continuum between the level of ambulatory BP and the effect on target organs without a parallel progression of the renal and myocardial effects. From a practical point of view, only ambulatory BP measurement allows differentiation of permanent hypertensives who have a very early renal and/or myocardial effect, while white coat hypertensives are spared.