Antinociceptive and anti-inflammatory potential, and chemical characterization of the dichloromethane fraction of Solanum lycocarpum (Solanaceae) ripe fruits by LC-DAD-MS.

ETHNOPHARMACOLOGICAL RELEVANCE: Solanum lycocarpum A. St. Hil. (Solanaceae) is a species from the Brazilian Cerrado, exhibiting several medicinal properties, being used by the population in the treatment of ulcers, bronchitis, asthma and hepatitis, which involve inflammatory processes. AIM OF THIS STUDY: This study aimed to chemically characterize the dichloromethane fraction (DCM), as well as verify its antinociceptive, anti-inflammatory and antioxidant potential. MATERIALS AND METHODS: The DCM fraction was obtained by partitioning the ethanol extract. The chemical constituents of the DCM fraction were characterized by LC-DAD-MS. The DPPH and FRAP assays were used to evaluate the antioxidant potential. The carrageenan-induced paw edema model was used to assess the anti-inflammatory effects, and the inflammatory infiltrate was evaluated by qualitative and quantitative histological analyses. The antinociceptive action of the DCM fraction was evaluated by acetic acid-induced abdominal writhing test, formalin-induced nociception and hot-plate test. RESULTS: Steroidal alkaloids solasonine, solasodine and solamargine, as well as the alkaloid peiminine/imperialine and caffeoylquinic acids, were annotated in DCM fraction by LC-DAD-MS. The DCM fraction showed antioxidative action in the in vitro DPPH and FRAP tests, as well as an anti-inflammatory effect for the three evaluated doses of 30, 100 and 300 mg/kg in the fourth and sixth hours after the administration of carrageenan. The histological analyses evidenced considerably reduction in leukocyte migration and the number of polymorphonuclear leukocytes. The study also demonstrated antinociceptive activity for the DCM fraction, which reduced abdominal writhing at three concentrations evaluated, as well as a decrease in paw licking in the formalin-induced nociception test both in the neurogenic phase and the inflammatory phase, with greater effectiveness compared to the anti-inflammatory indomethacin. The DCM fraction also increased the latency time of the animals in the hot plate test 60 min after treatment, although it did not seem to involve the opioidergic system. CONCLUSION: This work evidenced that the dichloromethane fraction of S. lycocarpum fruit possesses antinociceptive and anti-inflammatory potential, which supports its use in folk medicine for management inflammatory conditions.

Usability of a mobile phone application to enhance activities of daily living in occupational therapy services for breast cancer survivors.

Background/Objective: The use of new technologies in rehabilitation to evaluate and improve occupational performance and quality of life is increasing. Technological applications in the health field could help meet the needs of patients, including those of women breast cancer survivors. The main aim of this study was to design a mobile phone application "MAIA" focused on the perceived needs of women who have had breast cancer to achieve optimal performance in their daily lives in a meaningful way. Methods: A cross-sectional usability study using an online questionnaire was designed. Sociodemographic and occupational performance data were collected. System Usability Scale, Engagement in Meaningful Activities Survey, Occupational Balance Questionnaire, General Self-Efficacy Scale, Functional Assessment of Cancer Therapy - General and Disabilities of the Arm, Shoulder and Hand were administered. Descriptive statistics were used to describe categorical (frequencies and percentages) and quantitative variables (mean and standard deviation). Results: The sample was composed of seventy-eight women diagnosed with breast cancer. Nine activities of daily living were affected in more than 20% of women with breast cancer. The most affected were sleep and rest and functional mobility. Conclusions: Women survivors of breast cancer showed difficulties in daily life performance and participation. The MAIA App could be useful as a new online resource in occupational therapy for the rehabilitation of breast cancer survivors.

Transcriptional Regulation, Signaling Pathways, and Subcellular Localization of Corticotropin-Releasing Factor Receptors in the Central Nervous System.

Corticotropin-releasing factor (CRF) receptors CRF-R1 and CRF-R2 are differentially distributed in body tissues, and although they respond differentially to stimuli due to their association with different signaling pathways, both receptors have a fundamental role in the response and adaptation to stressful stimuli. Here, we summarize the reported data on different forms of CRF-R1 and CRF-R2 regulation as well as on their subcellular localization. Although the presence of R1 has been described at pre- and postsynaptic sites, R2 is mainly associated with postsynaptic densities. Different studies have provided valuable information on how these receptors regulate responses at a central level, elucidating different and sometimes synergistic roles in response to stress, but despite their high sequence identity, both receptors have been described to be differentially regulated both by their ligands and by transcriptional factors. To date, and from the point of view of their promoter sequences, it has not yet been reported how the different consensus sites identified in silico could be modulating the transcriptional regulation and expression of the receptors under different conditions, which strongly limits the full understanding of their differential functions, providing a wide field to increase and expand the study of the regulation and role of CRF receptors in the CRF system. SIGNIFICANCE STATEMENT: A large number of physiological functions related to the organization of the stress response in different body tissues are associated with the corticotropin-releasing factor system. This system also plays a relevant role in depression and anxiety disorders, as well as being a direct connection between stress and addiction. A better understanding of how the receptors of this system are regulated would help to expand the understanding of how these receptors respond differently to both drugs and stressful stimuli.

Antioxidant and anti-inflammatory effects of fractions from ripe fruits of Solanum lycocarpum St. Hil. (Solanaceae) and putative identification of bioactive compounds by GC-MS and LC-DAD-MS.

Brazilian biodiversity includes species of the genus Solanum that have several biological activities, in addition to their relevance to agriculture, economics and popular medicine. The ripe fruits of Solanum lycocapum are an important nutritional food source, since they have levels of vitamin C, total soluble sugars, sucrose, phosphorus, and iron comparable or exceed the levels present in fruits such as pineapples, bananas, oranges, and mangoes. The pulp of the fruit is consumed by the population, and it is also used to produce jellies; to make marmalade, replacing the quince, and it can also be mixed with peaches in the preparation of peach. The objective of this study was to evaluate the anti-inflammatory and antioxidant activities of fractions obtained from the ripe fruits and to identify the constituents with these biological properties. The ripe fruits were collected, dried, crushed, and subjected to extraction by exhaustive percolation, obtaining an ethanol extract that was partitioned with solvents of increasing polarities, obtaining hexane (HEX), ethyl acetate (AC), and hydroethanol (HE) fractions. The AC fraction showed higher antioxidant potential compared to BHT (2,6-di-tert-butyl-4-methylphenol) and similar activity to AA (ascorbic acid) by DPPH (1,1-diphenyl-2-picrylhydrazyl) radical assay, while HEX and HE fractions exhibited of IC50 values similar to BHT. The AC fraction also presented similar activity to BHT by FRAP (Ferric Reducing Antioxidant Power) test. Intraperitoneal treatment with HEX (100 and 300 mg/kg) and HE (100 mg/kg) fractions caused significant inhibition of paw edema induced by carrageenan, 4 and 6 h after the inflammatory stimuli. When analyzed by GC-MS, fatty acids, phytosterols, and triterpenoid were identified in the HEX fraction, whilst 31 compounds were annotated in the AC and HE fractions analyzed by LC-DAD-MS, being phenylpropanoid derivatives, chlorogenic acids, and steroidal glycoalkaloids. The ripe fruits of S. lycocarpum have antioxidant and anti-inflammatory activities, and the detected chemical compounds, especially caffeoylquinic acid derivatives, spermidine, stigmasterol, and ß-sitosterol, may be correlated with these activities. The ripe fruits of this species can be a food alternative rich in bioactive compounds and with benefits for human health.

Chemical composition, antioxidant, anti-inflammatory and antinociceptive activities of the ethanol extract of ripe fruits of Solanum lycocarpum St. Hil. (Solanaceae).

ETHNOPHARMACOLOGICAL RELEVANCE: Solanum lycocarpum St. Hil. (Solanaceae) is widely distributed in the Brazilian Cerrado and is used in folk medicine for treatment of inflammatory disorders, such as asthma and hepatitis, as weel as antirheumatic. AIM OF THE STUDY: The aims of this study were to evaluate the antioxidant, anti-inflammatory and antinociceptive activities of the ethanol extract (EE) obtained from the ripe fruits of S. lycocarpum and to identify its chemical constituents. MATERIALS AND METHODS: The extract was obtained by percolation with ethanol. This extract was analyzed by liquid chromatography coupled to a diode array detector and mass spectrometer (LC-DAD-MS) for identify its chemical constituents. The antioxidant activity was determined by the reaction with 1,1-diphenyl-2-picrylhydrazyl radical (DPPH). In vivo anti-inflammatory potential was assessed using carrageenan-induced paw edema model, while qualitative and quantitative histological analyses evaluated of the inflammatory infiltrate at different times and treatments. The antinociceptive effect of the EE was evaluated by acetic acid-induced abdominal writhing test, formalin-induced nociception and hot-plate test. RESULTS: The main compounds identified in EE were steroidal glycoalkaloids (such as robeneoside B or hydroxysolasonine isomers and solanandaine isomers), the aglycone alkaloids peiminine and solasodine, di- and tri-O-caffeoylquinic acid derivatives, O-coumaroyl caffeoylquinic acid derivatives, N1,N10-bis-(dihydrocaffeoyl)spermidine, di-O-hexoside, and hexonic acid. In addition, the EE showed significant antioxidant activity. Intraperitoneal (i.p.) treatment with EE (300 mg/kg) exhibited anti-inflammatory activity. Qualitative and quantitative histological analyses showed that EE significantly reduced the cell infiltrate in acute inflammation. The EE, in all doses evaluated, significantly reduced the abdominal contortions in mice. Besides, reduced licking time was found in both phases in the formalin test after treatment with EE (100 and 300 mg/kg). In addition, the opioid receptor antagonist naloxone reversed the antinociceptive activity of morphine in the both phases the test, but it did not reverse the antinociceptive activity of the EE. The EE (300 mg/kg) also caused an increase in the latency to response in the hot-plate test. CONCLUSION: The ripe fruits of S. lycocarpum exhibit antioxidant, anti-inflammatory, and antinociceptive activities, attributed mainly to the presence of alkaloids, such as solasodine and peiminine, as well as caffeoylquinic acids in their chemical composition. These results contribute to use of S. lycocarpum ripe fruits for the treatment of inflammatory and painful process.

Assessment of allelopathic, cytotoxic, genotoxic and antigenotoxic potential of Smilax brasiliensis Sprengel leaves.

Smilax brasiliensis (Smilacaceae) is a native Brazilian plant found in the Cerrado biome and commonly used in folk medicine. The aim of this study was to evaluate the allelopathic, cytotoxic, genotoxic, and antigenotoxic potential of extract and fractions of Smilax brasiliensis leaves. Quercetin and rutin isomers were observed in the subfractions. The dichloromethane fraction (1000 µg/mL) decreased lettuce (Lactuca sativa) seed vigor, while and ethyl acetate and hydromethanol fractions (1000 µg/mL) affected the germination, and quercetin and rutin affected the vigor and germination of onion seeds. The extract, fractions, quercetin, and rutin inhibited or promoted lettuce hypocotyl and radicle growth. The extract and fractions inhibited onion hypocotyl growth at all concentrations. With regards to radicle growth, the results were diversified: growth was either inhibited or promoted. Rutin and quercetin inhibited onion hypocotyl and radicle growth at all concentrations. The extract and fractions of Smilax brasiliensis, rutin, and quercetin did not cause cytotoxic effect evaluated by mitotic index. The extract and fractions showed genotoxic effects. Quercetin and rutin did not cause genotoxic effects. On the other hand, the extract and fractions showed antigenotoxic effects at all tested concentrations, where they were able to revert chromosomal abnormalities caused by glyphosate. However, additional studies are required to evaluate the possible use of the S. brasiliensis leaf methanol extract and fractions as natural sources of bioherbicides.

Phenolic compounds: antioxidant and larvicidal potential of Smilax brasiliensis Sprengel leaves.

Smilax brasiliensis is a medicinal species of the Brazilian Cerrado. The extract and fractions of this plant were analysed by LC-DAD-MS. Identified constituents included glycosylated and non-glycosylated flavonoids, especially quercetin, and phenylpropanoids, such as chlorogenic acids. The antioxidant activity was significantly more pronounced for the methanol extract and fractions than that of the commercial antioxidant 2,6-di-tert-butyl-4-methylphenol (BHT). Maximum larvicidal activity of 85.83% was recorded in the dichloromethane fraction (LC50 = 469.78 µg mL-1). The methanol extract and fractions presented low toxicity to larvae of the shrimp brine Artemia salina, indicating selectivity for C. quinquefasciatus. These results contribute to the phytochemical study of S. brasiliensis. These compounds were identified for the first time in this species and encourage additional work on the isolation of compounds present in the extract and fractions of S. brasiliensis to evaluate the possibility of using them as natural sources of antioxidants, since cytotoxic effects were not demonstrated.

Allelopathic effect of the ethanol extract and fractions of the aerial parts of Lippia alba (Verbenaceae).

Lippia alba, belonging to the Verbenaceae family, is one of the most commonly utilized medicinal plants in folk medicine. The allelopathic activity was assessed using seeds of Lactuca sativa (lettuce) and Allium cepa (onion) by assessing the growth of the radicle and hypocotyl. The tests showed allelopathic efficiency in inhibiting the growth of lettuce and onion seeds. The best results for allelopathic activity were presented by the dichloromethane (DCM) fraction of the fresh plant, which inhibited radicle (23.04-100% lettuce and 64.17-66.36% onion) and hypocotyl (16.77-100% lettuce and 65.10-69.43% onion) formation, and as well as the DCM fraction of the dry plant, which also inhibited radicle (30.74-82.83% lettuce and 63.50-93.67% onion) and hypocotyl (24.12-70% lettuce and 69.07-79.95% onion) formation. Based on these results, it was found that the aerial parts of L. alba are rich in bioactive substances, suggesting the possibility of using of L. alba as a natural herbicide.

Chemical composition, antioxidant and cytotoxic activities of extracts from the leaves of Smilax brasiliensis Sprengel (Smilacaceae).

The antioxidant and cytotoxic activities of petroleum ether and methanol extracts, fatty acids and methyl esters from leaves of Smilax brasiliensis were evaluated, and the composition of the extracts was determined. Palmitic, linoleic and linolenic acids were major components of the extracts. For antioxidant activity, all samples exhibited IC50 values lower than BHT (2,6-di-tert-butyl-4-methylphenol). The extracts, fatty acids and methyl esters from S. brasiliensis presented no toxicity to larvae of the brine shrimp, Artemia salina. Among the purified substances, only methyl linolenate showed toxicity (LD50 = 21.47 µg/mL). This study showed, for the first time, the composition of petroleum ether and methanol extracts from S. brasiliensis leaves, as well as the antioxidant and cytotoxic activities of extracts, fatty acids and methyl esters.

Conversations about self-identity in Alzheimer disease: augmentative and alternative Communication memory books as an aid / Conversaciones sobre la propia identidad en la Enfermedad de Alzheimer: ayuda de los libros de memoria de Comunicación Aumentativa y Alternativa

Alzheimer disease (AD) is a progressive and degenerative neurological disorder that affects memory, language and communication, thinking, and social skills. The inability to recall incidents and events, especially when symptoms become more prevalent and severe, can cause a person to experience a loss of self or to have doubts about his or her identity. One approach to helping these patients with their memory and language problems is to use memory books, a kind of Augmentative and Alternative Communication (AAC) tool. The aim of this study was to verify whether the introduction of AAC books could have an impact on conversations about self-identity through an increase of ‘self’-positive conversational contents and on improving conversational skills. Three single case studies were carried out with three elderly women with mild, moderate and severe AD, respectively. Each participant was involved in a conversation about their ‘selves’ in an alternating treatment design (ABAB) without a memory book in phase A and with the aid of this AAC tool in phase B. The results showed a similar conversational response pattern in all participants. AAC aids increased the number of ‘self’-positive conversational statements with a reduction in negative, ambiguous and repetitive utterances. In conclusion, AAC memory tools seemed to help participants with dementia to focus their attention on relevant personal information, allowing them to centre the conversation on core positive identity contents, thus improving the quality of the conversations with fewer ambiguous utterances (AU)

La Enfermedad de Alzheimer es una enfermedad neurológica degenerativa y progresiva que afecta a la memoria, el lenguaje y la comunicación, el pensamiento y las habilidades sociales. La incapacidad para recordar incidentes y acontecimientos, cuando los síntomas son más prevalentes y severos, puede causar que la persona experimente una pérdida del self o tenga dudas sobre su identidad. Un enfoque que ayuda con los problemas de memoria y de lenguaje es el uso de los libros de memoria, herramientas de Comunicación Aumentativa y Alternativa (CAA). El objetivo de este estudio es comprobar si la introducción de libros de CAA tiene un impacto en las conversaciones sobre la propia identidad, a través del incremento de contenidos conversacionales positivos sobre "si mismo", y en la mejora de habilidades conversacionales. Se llevaron a cabo tres estudios de caso único con tres mujeres mayores con enfermedad de Alzheimer, leve, moderada y severa, respectivamente. Se implicó a cada participante en una conversación sobre "si misma" en un diseño de tratamientos alternos (ABAB) sin libro de memoria en la fase A y con apoyo de la CAA en B. Los resultados muestran un patrón de respuesta conversacional similar para las tres participantes. Con las ayudas de CAA se incrementaron las frases positivas sobre "si misma" en la conversación y se redujeron las declaraciones negativas, ambiguas y repetitivas. La conclusión es que parece que las herramientas de memoria han ayudado a enfocar la atención sobre información personal relevante, permitiendo centrar la conversación en contenidos básicos de su identidad y mejorando su calidad con menos ambigüedades (AU)

[Adverse event reporting in an intensive care unit at Tunja, Colombia]. / Reporte de eventos adversos en una unidad de cuidados intensivos de Tunja, Colombia.

INTRODUCTION: Patient safety in critical areas has been subject of several studies. In Colombia, there is a growing conscience about adverse events management. This study explores the first phase of this management: report in a typical private intensive care unit. OBJECTIVE: To assess adverse event report at a Colombian tertiary level institution, through frequency and report category assessment. METHODS: A descriptive study regarding adverse event report rates during 2011 period in Clinica de los Andes de Tunja, was carried out, through frequency and report category assessment. Adverse event report rate was defined as the number of reports per 1000 patient bed. We reported major and minor categories of events. RESULTS: A total of 383 admissions (2374 patient days) were recorded. 54 adverse events were reported (rate of 22,74 per 1000 patient days). The most frequent events were related to intravenous route (55%)(CI 95% 50,1-58,3) followed by process deviation (22%)(CI 95% 18,2-26,1). CONCLUSIONS: An adverse event report rate close to the upper limit of literature reports numbers was found. Probably, there is still non quantified under-report of adverse events, likely due to cultural factors.

Introducción: La seguridad de paciente en áreas hospitalarias críticas ha sido tema de diversas investigaciones. En este sentido, en Colombia está creciendo la conciencia acerca de la gestión de eventos adversos. Este estudio explora la primera fase de dicha gestión: el reporte en la unidad de cuidado intensivo de una institución privada prototipo. Objetivo: Evaluar el reporte de eventos adversos en una clínica colombiana de tercer nivel, a través de la estimación de frecuencias y categorías de los reportes. Material y Métodos: Se hizo un estudio descriptivo sobre la tasa de reporte de eventos adversos en la Clínica de los Andes de Tunja, durante 2011, a través de la estimación de frecuencias y categorías de los reportes.La tasa de reporte se definió como el número de reportes por 1000 días cama. Reportamos las categorías de los eventos adversos comomayores y menores. Resultados: Se registraron 383 admisiones a la UCI, correspondientes a 2374 días paciente. Se presentaron un total de 54 eventos adversos reportados (tasa de 22,74 por 1000 días paciente). El tipo de evento más frecuente fue el relacionado con vías intravenosas (55%)(IC 95% 50,1-58,3), seguido por desviación de procesos (22%)(IC 95% 18,2-26,1). Conclusiones: Se encontróuna tasa de reporte de eventos adversos en el rango superior de lo publicado en la literatura. Posiblemente exista aúnuna proporción no cuantificada de subregistro, que puede atribuirse principalmente a factores culturales.

Reporte de eventos adversos en una unidad de cuidados intensivos de Tunja, Colombia / [Adverse event reporting in an intensive care unit at Tunja, Colombia].

INTRODUCTION: Patient safety in critical areas has been subject of several studies. In Colombia, there is a growing conscience about adverse events management. This study explores the first phase of this management: report in a typical private intensive care unit. OBJECTIVE: To assess adverse event report at a Colombian tertiary level institution, through frequency and report category assessment. METHODS: A descriptive study regarding adverse event report rates during 2011 period in Clinica de los Andes de Tunja, was carried out, through frequency and report category assessment. Adverse event report rate was defined as the number of reports per 1000 patient bed. We reported major and minor categories of events. RESULTS: A total of 383 admissions (2374 patient days) were recorded. 54 adverse events were reported (rate of 22,74 per 1000 patient days). The most frequent events were related to intravenous route (55

50,1-58,3) followed by process deviation (22

18,2-26,1). CONCLUSIONS: An adverse event report rate close to the upper limit of literature reports numbers was found. Probably, there is still non quantified under-report of adverse events, likely due to cultural factors.

Reporte de eventos adversos en una unidad de cuidados intensivos de Tunja, Colombia. / [Adverse event reporting in an intensive care unit at Tunja, Colombia].

INTRODUCTION: Patient safety in critical areas has been subject of several studies. In Colombia, there is a growing conscience about adverse events management. This study explores the first phase of this management: report in a typical private intensive care unit. OBJECTIVE: To assess adverse event report at a Colombian tertiary level institution, through frequency and report category assessment. METHODS: A descriptive study regarding adverse event report rates during 2011 period in Clinica de los Andes de Tunja, was carried out, through frequency and report category assessment. Adverse event report rate was defined as the number of reports per 1000 patient bed. We reported major and minor categories of events. RESULTS: A total of 383 admissions (2374 patient days) were recorded. 54 adverse events were reported (rate of 22,74 per 1000 patient days). The most frequent events were related to intravenous route (55

)(CI 95

50,1-58,3) followed by process deviation (22

)(CI 95

18,2-26,1). CONCLUSIONS: An adverse event report rate close to the upper limit of literature reports numbers was found. Probably, there is still non quantified under-report of adverse events, likely due to cultural factors.

Adherencia a las guías de higiene de manos en cuidado intensivo: el caso de una clínica privada / Compliance with hand hygiene guidelines in the intensive care unit: case of a private hospital / Aderência às guias de higiene de mãos em cuidado intensivo: o caso de uma clínica privada

Objetivo: evaluar la adherencia a la guía de higiene de manos por parte del personal de salud en una clínica privada colombiana. etodología: se llevó a cabo un estudio de corte transversal descriptivo. Por medio de observación directa se recolectó información sobre la higiene de manos en el momento apropiado (oportunidad para higiene de manos). Adherencia se definió como higiene de manos de acuerdo con la guía para lavado de manos de la unidad. Los resultados se analizaron por medio de modelos de efectos mixtos con los funcionarios observados como efecto aleatorio. Resultados: se observaron 180 oportunidades en 26 funcionarios de la unidad. La adherencia global fue de 18,9%. La adherencia varió de acuerdo con el tipo de funcionario, especialmente auxiliar de enfermería y terapeuta físico, y con el tiempo con respecto al contacto con el paciente. Los análisis multivariados mostraron una razón de momios (OR) protectora para no adherencia después de contacto con el paciente (OR, 0,23. IC 95% 0,15-0,33). Conclusiones: la baja tasa de adherencia invita a desarrollar modelos de intervención especializados para una población especial de individuos que conoce de antemano los beneficios del lavado juicioso de manos.

As vivências do homem infértil que deseja ter filhos / The experiences of infertile men who wish to have children

A maioria dos estudos sobre infertilidade incidem sobre a mulher, mas esta situação, não é menos penosa para o género masculino. A vivência emocional da infertilidade por um homem é extremamente frustrante, uma vez que ainda vivemos numa cultura, onde sinal de ?ser homem? é ser um ?bom reprodutor?, contudo a dor vivenciada pelo homem com dificuldades para ter um filho, é muito pouco estudada e até mesmo, pouco reconhecida pela sociedade. Tudo é vivenciado num certo silêncio masculino Este estudo tem como objectivo, conhecer as vivências do homem infértil que deseja ter filhos. Utilizámos para a colheita da informação a entrevista a 10 homens que reuniam os critérios de inclusão e recorremos à metodologia qualitativa de enfoque fenomenológico com análise interpretativa segundo Colaizzi (1978 apud Carpenter, 2009). Encontramos como categorias: o significado de ter um filho, significado e sentimentos antes do diagnóstico e face ao diagnóstico de infertilidade, implicações da infertilidade, significado de ser infértil, estratégias para lidar com a infertilidade, mudanças sentidas, preocupações e dificuldades vivenciadas ao longo do processo. Com este estudo foi possível conhecer as vivências do homem infértil que deseja ter filhos e identificar os factores responsáveis pela variabilidade na sua adaptação psicossocial. Este permitiu ainda, adquirir o conhecimento de que a vivência da infertilidade masculina é um fenómeno pluridimensional com implicações aos mais diferentes níveis: pessoal, conjugal, sexual, familiar e social, e compreender o âmbito em que é necessário atuar de forma a colmatar as suas necessidades e a ultrapassar as dificuldades sentidas. Consideramos oportuno na senda da excelência do cuidar humano, para uma melhor compreensão e conhecimento da problemática em estudo, a realização de outros estudos neste âmbito, com vista à compreensão do modo como os indivíduos vivenciam esta problemática, em amostras maiores e com características mais heterogéneas, tendo em vista a identificação de focos de atenção neste domínio para uma maior adequação da prática de enfermagem.

Lack of adequate blood pressure control in the morning and evening periods in medicated hypertensive patients considered to be controlled in the office.

BACKGROUND AND AIM: In hypertensive patients tight blood pressure (BP) control during the critical morning and evening periods may be relevant for preventing cardiovascular events, which most frequently occur at these times of the day. METHODS: In a prospective study we evaluated 24h ambulatory BP (ABP) values (24h, daytime, nighttime, morning period between 6-10 am and evening period between 6-10 pm), in 103 hypertensive patients (HTs), aged between 18-79 years, considered to be controlled in the office in the previous two months (office BP < 140/90 mmHg, 2 x 3 readings, before taking medication), who were being treated with antihypertensive drugs taken once daily in the morning. Based on ABP data, HTs were considered to have good BP control if daytime BP values were < 135/85 mmHg, < 133.1/85.4 mmHg during the morning period, and < 138.1/89.3 mmHg during the evening period. Otherwise control of ABP was considered poor. These limits correspond to the upper 95% confidence limits of BP calculated for each period in a normotensive control population of 210 subjects age-matched to the HTs. RESULTS: Of the 103 HTs, 39 were under monotherapy and the remaining 64 on combination regimens (34 with two drugs, 29 with three and one with four). Based on ABP data of the 103 HTs, poor ABP control was observed in 36 (35%) in the morning period, in 24 (23%) in the evening period and in 29 (28%) for daytime BP values. ABP values during both the morning and evening periods correlated significantly with daytime values (r = 0.72 and r = 0.89 respectively, p < 0.01) but not with office values. CONCLUSIONS: A significant proportion of treated HTs who are considered to be controlled in the office present abnormally high ABP levels, particularly in the critical early morning period, but also during the evening and throughout the daytime period.

Morning rise, morning surge and daytime variability of blood pressure and cardiovascular target organ damage. A cross-sectional study in 743 subjects.

OBJECTIVE: To evaluate in a large population the relationship between cardiovascular target organ damage and values of the night-to-morning rise of systolic blood pressure (MR-BP), the morning surge of BP at the moment of rising (BP surge) and daytime BP variability (standard deviation [SD] of daytime BP). METHODS: This was a cross-sectional study, evaluating 743 subjects, aged 30-75 years, 416 female, with normal renal function and no previous cardiovascular events. The population included: I-174 patients with type 2 diabetes, II-317 hypertensive patients with ongoing treatment over at least the previous 6 months, III-127 hypertensive patients untreated in the last 6 months, IV-125 healthy normotensive subjects. All underwent 24-hour ambulatory BP monitoring to calculate MR-BP, BP surge and SD of daytime BP. Target organ evaluation included: pulse wave velocity (PWV) (an indicator of aortic stiffness) in 711 subjects, left ventricular mass index (LVMI) in 185 subjects and 24-hour albuminuria in 239 subjects. RESULTS: In the population as a whole, BP surge, MR-BP and SD of daytime BP correlated significantly with PWV (r = 0.434, p < 0.0001; r = 0.126, p < 0.001; 0.337, p < 0.001, respectively), with LVMI (r = 0.447, p < 0.0001; r = 0.307, p < 0.001; 0.162, p < 0.05, respectively) and to a lesser degree with albuminuria (r = 0.126, p < 0.05; r = 0.083, NS; 0.082, NS, respectively). In the upper quintile of distribution of BP surge, the percentage of cases with abnormal PWV (>12 m/s) (21%), cardiac hypertrophy (53 %) and microalbuminuria (47 %) was significantly greater (p < 0.03) than that observed in the lower quintile (1%, 14% and 27%, respectively). BP surge correlated more strongly with indices of target organ damage than did MR-BP or SD of daytime BP, independently of night-time BP and nocturnal BP fall. CONCLUSIONS: In this large population, MR-BP, BP surge and daytime BP variability are strongly correlated with target organ damage severity, and are probably related to organ deterioration. Of the three, morning surge of BP at the moment of rising is more strongly related to organ damage than MR-BP, perhaps because unlike MR-BP, BP surge is independent of night-time BP values.

Prognostic markers in treated hypertensive diabetic patients. 28-month follow-up.

INTRODUCTION: Diabetes mellitus has a prevalence of about 6 to 10% in western populations, with a rising tendency due to inappropriate increases in calorie intake and decreased physical activity. In diabetic patients hypertension (HT) has a prevalence of over 60% and cerebro- and cardiovascular disease is responsible for two-thirds of the mortality in these patients. PATIENTS AND METHODS: We studied prospectively and consecutively 97 patients (age 63 +/- 8; 39-89) with treated type 2 diabetes and HT. The objective was to identify cardio- and cerebrovascular risk markers. The majority of the patients were evaluated by clinical and laboratory examination, 24h ambulatory blood pressure monitoring (ABPM), HbA1c, total cholesterol, HDL-C and triglycerides, microalbuminuria, echocardiogram (left ventricular mass index) and carotid-femoral pulse wave velocity. Later, the patients were re-evaluated using the same diagnostic methodology after a mean follow-up of 28 months. RESULTS: The population was at high risk for cardio- and cerebrovascular disease (60% dyslipidemic, 39% with previous cerebro- or cardiovascular accidents, 73% nondipper, 69% with decreased vascular distensibility [<12 m/sec] and 35% with microalbuminuria) despite treatment. Diabetes was controlled in only 55% of cases and blood pressure (BP) in 10%, although by ABPM it was controlled in 40% of cases. Simultaneous control of diabetes and HT was present in only one third of the patients. At the end of follow-up these values had not changed significantly, which can only be considered positive in respect of reduction in microalbuminuria (due to ACEIs and AIIRAs). Thirty cardio- and cerebrovascular events occurred (5 deaths), related to inadequate control of diabetes at initial evaluation (p=0.012), night-time systolic BP (SBP) and nondipper status (p=0.02) and vascular distensibility at the end of the study (p=0.03). On multiple linear regression (stepwise) analysis the only variable which was significantly associated with cardio- and cerebrovascular mortality and morbidity was night-time SBP. CONCLUSIONS: Overall analysis of the data confirmed the elevated risk of these patients and the importance of more frequent and aggressive control. The study also confirms the importance of evaluation by ABPM in these patients, which may lead to more efficacious, tailor-made treatment.

Does orthostatic hypotension predict the occurrence of nocturnal arterial hypertension in the elderly patient?

OBJECTIVE: To determine whether the presence of orthostatic hypotension--which, in this age-group, could be due to varying degrees of autonomic dysfunction--is an indicator of nocturnal arterial hypertension. PATIENTS: Between 1999 and 2001 we prospectively and consecutively studied 93 elderly patients with untreated (office) arterial hypertension, 65 (70%) of whom were true hypertensives according to 24 h ambulatory blood pressure monitoring (ABPM). INTERVENTIONS: The patients were studied by clinical examination including blood pressure (BP) measurement in dorsal decubitus and orthostatic position, 24 h ABPM, evaluation of vascular distensibility by carotid-femoral pulse wave velocity (PWV) and Doppler echocardiography. For this study we analyzed especially the ambulatory behavior of BP, so we could relate the variation of systolic blood pressure (SBP) during orthostatism with non-dipper status for SBP and absolute nocturnal values of SBP. MEASUREMENTS AND RESULTS: The results indicated that a greater decrease of blood pressure with orthostatism corresponded to a greater probability of nocturnal hypertension (p = 0.005) and of non-dipper status (p = 0.02). These results are in agreement with those subsequently found by other authors (Kario et al., 2002). CONCLUSIONS: In this way, by means of a simple clinical maneuver that should always be performed in an elderly hypertensive patient, we can suspect the presence of nocturnal hypertension--which is a high-risk cardiovascular situation--and use this information to help select patients to undergo 24 hour-ABPM.

[Pulmonary hypertension. Topic review. 2 clinical cases]. / Hipertensão pulmonar. Revisão do tema. A propósito de dois casos clínicos.

The authors describe two cases of pulmonary hypertension (PHT). In the first case it is secondary to pulmonary thromboembolism, a frequent and serious occurrence, witch is well known as a cause of PHT. In the second case the PHT is probably secondary to infection by human immunodeficiency virus, also a serious and frequent condition in clinical practice but which was only recently identified as a cause of PHT. Formerly these patients were considered as suffering from primary PHT. The authors make a brief review of the literature on pulmonary hypertension.