Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) participates in the degradation of components of the extracellular matrix and it is involved in vascular remodeling and vasomotor changes. The aim of this study was to investigate the plasma levels of MMP-9 in acute vascular alterations due to hypertensive crisis. METHODS: This cross-sectional study was performed in 40 normotensive (NT) and 58 controlled hypertensive subjects (CHyp) followed up in outpatient clinic. Moreover, 57 patients with hypertensive emergency (HypEmerg) and 43 in hypertensive urgency (HypUrg), seen in emergency department, were also included. Hypertensive crisis was divided into HypEmerg, which was characterized by levels of systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg complicated with target-organ damage (TOD), and HypUrg, defined by BP elevation without TOD. Univariate and multivariate regression analysis was performed to identify the influence of independent variables on MMP-9 levels. A p-value < 0.05 was considered statistically significant. RESULTS: The mean age was 43.5 years in the NT group (11 men); 57.7 years in the CHyp group (29 men); 59.4 years in the HypUrg group (21 men) and 62.4 years in the HypEmerg group (31 men). The age was statistically different in the NT group compared to other 3 groups. The mean BP was 116.5 ± 13.9/72.4 ± 10.6 mmHg for NT, 123.2 ± 12.6/79 ± 9.2 for CHyp, 194.1 ± 24.3/121.4 ± 17.3 for HypUrg and 191.6 ± 34.3/121.7 ± 18.8 mmHg for HypEmerg, respectively (p-value< 0.0001 between groups). MMP-9 levels were statistically different between the HypEmerg (2.31 ± 0.2 ng/mL) and HypUrg groups (2.17 ± 0.3 ng/mL) compared to the NT (1.94 ± 0.3 ng/mL) (p-value < 0.01 and p-value < 0.05, respectively) and CHyp groups (1.92 ± 0.2 ng/mL) (p-value < 0.01). Uric acid was the only independent variable for predicting MMP-9 levels (p-value = 0.001). CONCLUSION: MMP-9 concentrations are significantly higher in the hypertensive crisis groups (urgency and emergency) compared to the control groups. Therefore, MMP-9 may be a biomarker or mediator of pathophysiologic pathways in cases of acute elevations of blood pressure.

Effects of acute blood pressure elevation on biochemical-metabolic parameters in individuals with hypertensive crisis.

Hypertensive crisis is a common clinical situation that presents a high rate of morbidity and mortality and it is characterized by symptomatic rise of blood pressure (BP), systolic (SBP) ≥ 180 mmHg and/or diastolic (DBP) ≥ 120 mmHg. It is classified as emergency (HE) or hypertensive urgency (HU). There is no description of laboratory findings in patients who present acute BP elevation. Thus, this study had the objective to assess the biochemical-metabolic parameters of patients with HC. We studied 74 normotensive individuals (NT), 74 controlled hypertensive patients (ContrHT), 50 subjects with HU, and 78 with HE for evaluating biochemical-metabolic parameters. HE occurs in older individuals and more frequently in those with known hypertension. More patients with HE had dyslipidemia than those with HU (58% vs. 38%). The diastolic BP and heart rate were higher in the HE group (120 mmHg and 87 bpm) compared to ContrHT (71 mmHg and 71 bpm; p < 0.0001) and NT groups (75 mmHg and 68 bpm; p < 0.0001). Glycemia was higher in HE vs. NT and ContrHT (p < 0.05). HDL cholesterol was lower in HE than NT (p = 0.0088). Potassium was lower in HE vs. NT, ContrHT and HU groups (p < 0.05). Creatinine was higher in the HC group vs. NT and ContrHT (p < 0.05). The GFR was significantly lower in HE group vs. HU, ContrHT and NT (p < 0.001). In conclusion, individuals with HC show biochemical alterations when compared to ContrHT and NT. Acute BP elevations are associated with hyperglycemia, dyslipidemia, and higher potassium and creatinine levels and lower renal function. Abbreviations BMI = body mass index BP = blood pressure CH = hypertensive crisis ContrHT = controlled hypertensive DBP = diastolic blood pressure GFR = glomerular filtration rate HbA1c = glycated hemoglobin HDLc = high-density lipoprotein cholesterol HE = hypertensive emergency HPLC = high-performance liquid chromatography HR = heart rate HU = hypertensive urgency JNC 7 = VII Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure LDLc = low-density lipoprotein cholesterol MDRD = Modification of Diet in Renal Disease NT = normotensive RASB = renin-angiotensin system blockers SBP = systolic blood pressure TC = total cholesterol TG = triglycerides.

Endothelial Changes in Individuals with Prehypertension.

INTRODUCTION: Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension. RESULTS AND DISCUSSION: The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events. CONCLUSION: The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.

Presença de sintomas musculoesqueléticos e efeitos da ginásticalaboral em funcionários do setor administrativo de um hospital público / Presence of musculoskeletal symptoms and effects of labor gymnastic in employees of the administrative sector of a public hospital

JUSTIFICATIVA E OBJETIVOS: As transformações na organização do trabalho resultaram em aumento de absenteísmo, dos acidentes e as doenças relacionadas ao trabalho. Este estudo objetivou avaliar a presença de sintomas musculoesqueléticos e os efeitos de um programa de grupo laboral (GL) em funcionários do setor administrativo do hospital Santa Casa de Misericórdia de São José do Rio Preto. MÉTODO: Participaram do estudo 15 funcionários, de ambos os sexos, para os quais foram aplicados dois questionários abordando os aspectos ergonômicos do trabalho e dados pessoais, antes e após o programa. A GL foi composta por exercícios de alongamento, voltados aos grupos musculares mais requisitados na atividade profissional e identificados pelos questionários. Foram realizadas três sessões semanais, com duração de 10 minutos, totalizando 24 sessões. RESULTADOS: Identificou-se que o segmento corporal mais utilizado eram os membros superiores, e que, previamente ao programa de ginástica, a dor musculoesquelética estava presente em 73,3% dos entrevistados, mas apenas 46,6% continuaram a apresentar sintoma doloroso após a prática de exercícios durante o trabalho. Além disso, 86,6% relataram acreditar que tal programa promoveu incrementos em seu estilo de vida.CONCLUSÃO: O programa de grupo laboral com a realização de exercícios de alongamento, voltados aos grupos musculares mais requisitados na atividade profissional, identificados pelos questionários, apresentaram resultados significativos na redução da dor musculoesquelética, durante e após a jornada de trabalho, não devendo, entretanto, ser adotado como único método preventivo e de promoção da saúde no trabalho.

BACKGROUND AND OBJECTIVES: Transformations in labor organization have resulted in a higher incidence of absenteeism, accidents and labor-related diseases. This study aimed at evaluating the presence of musculoskeletal symptoms and the effects of a labor group program (LG) on employees of the administrative sector of the Santa Casa de Misericórdia hospital, São José do Rio Preto. METHOD: Participated in this study 15 employees of both genders, for whom two questionnaires were applied addressing labor ergonomic aspects and personal data, before and after the program. LG was made up of elongation exercises aimed at muscle groups more requested during their professional activity and identified by the questionnaires. There has been three weekly sessions lasting 10 minutes in a total of 24 sessions. RESULTS: Most required body segment were arms and previously to the gymnastic program musculoskeletal pain was present in 73.3% of respondents, but only46.6% remained with pain after the practice of exercises during work. In addition, 86.6% reported believing that the program has improved their lifestyle. CONCLUSION: The labor group program with elongation exercises aimed at most required muscle groups during professional activities and identified by the questionnaires has presented significant results in decreasing musculoskeletal pain during and after work, but it should not be adopted as the single preventive method and to promote labor health.

Drenagem linfática em paciente com dermatofibrose e flebite de membro inferior: relato de caso / Lymph drainage in patients with dermatofibrosis and phlebitis of the lower limb: case report

O presente estudo objetivou avaliar a drenagem linfática como forma coadjuvante de tratamento, em uma paciente idosa com dermatofibrose, flebite de membro inferior e queixa de dores na perna, localizada em região pós-flebítica. Foi realizado tratamento clínico inicial por três meses com drogas venotônicas (diosmin), anti-inflamatórios, analgésicos e repouso, porém com pouca melhora clínica. Foi, então, associada ao tratamento clínico, a drenagem linfática manual e mecânica. Os resultados obtidos incluíram a redução dos sintomas dolorosos e da hiperpigmentação do local acometido. Este trabalho sugere que a drenagem linfática obteve melhora do quadro clínico de paciente portadora de dermatofibrose, sugerindo novas pesquisas para caracterização mais específica dessa abordagem.

This study aimed at evaluating lymphatic drainage as a complementary form of treatment in an elderly patient with dermatofibrosis and phlebitis of the lower limb. The patient complained of pain in the post-phlebitic region. Initially three months of clinical treatment was performed using vasotonic(diosmine), anti-inflammatory and analgesic drugs and the patient was told to rest. However this treatment was not very effective. Manual and mechanical lymph drainage was associated to the clinical treatment. The results gave a significant improvement in the symptoms and the hyperpigmentation of the affected area. This study suggests that lymph drainage obtained improves the clinical of patient with dermatofibrosis, suggesting new research for more specific characterization of this approach.

Fatores de risco para distúrbios osteomusculares relacionados ao trabalho em funcionários de centro comercial / Risk factors for work related upper limb musculoskeletal disorders in employees of a trade center

Introdução - A reestruturação produtiva do trabalho decorrente das inovações tecnológicas gerou constantes transformações econômicas e sociais que refletem a condição laboral atual. As mudanças na organização do trabalho foram precursoras dos Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) que, segundo a Organização Mundial de Saúde (OMS), é a doença ocupacional em maior evidência no mundo e considera a situação epidêmica, responsável pelo crescente número de indivíduos com incapacidades que não se restringem ao ambiente de trabalho, constituindo um grave problema de saúde de difícil abordagem, reabilitação e prevenção. Este estudo teve como objetivo realizar um levantamento dos fatores de risco para DORT em funcionários de centro comercial. Material e Métodos - Participaram do estudo, voluntariamente, 63 funcionários, independentemente do cargo ocupado. O levantamento de fatores de risco foi realizado pela aplicação de dois questionários, sendo um preditivo para DORT, e outro abrangendo aspectos organizacionais, ergonômicos e psicossociais. As questões foram respondidas verbalmente no próprio ambiente de trabalho, na ausência de qualquer supervisor. Ao término das entrevistas os dados levantados foram submetidos à análise para determinação das porcentagens de cada fator avaliado. Resultados - Os resultados não apontaram nenhum fator de risco específico no trabalho executado em centro comercial, entretanto, o questionário preditivo para DORT identificou a ocorrência de DORT em estágio inicial em 52,38% dos entrevistados, e DORT em estágio avançado em 6,34%. Conclusão - Concluiu-se com este trabalho que existem fatores de risco que podem desencadear DORT em colaboradores de centro comercial, sugerindo estudos mais aprofundados para eleger fatores de risco específicos, para posterior implantação de programa de prevenção para DORT.

Introduction - The productive rearrangement of work resulting from technological innovation produced unchangeable social and economic transformations which reproduce the present working conditions. The changes in the organization of work have been the forerunner to Work Related Upper Limb Disorders (WRULD), also known as Repetitive Strain Injury (RSI), which according to World Health Organization (WHO), has become the most prominent occupational disease in the world, and the epidemic situation is hold responsible by the increasing number of individuals with disabilities. WRULD has become a severe health problem which presents a difficult approach, rehabilitation, and prevention. The aim of this study was to carry out a survey of the risk factors for WRULD in employees of a shopping mal. Material and Methods - Sixty-three employees voluntarily participated in the study regardless his/her job position. A survey of predictive risk factors for WRULD was carried out using a questionnaire. Another questionnaire was carried out comprising the organizational, ergonomic, and psychosocial aspects. The questions were answered orally in their own working environment without the presence of any supervisor. At the end of the interviews the data were analyzed to determine the percentages of each factor assessed. Results - The results did not show any specific risk factor related to the work carried out at the shopping mall. However, WRULD has been identified in early stage in 52.38% and in advanced stage in 6.34% of the interviewees. Conclusion - Our study demonstrated the existence of risk factors that can trigger WRULD in employees of a shopping mall. We suggest deeper studies to select specific risk factors to further introduce a prevention program for WRULD.

Linfedema factício: relato de caso e revisão de literatura / Factitious lymphedema: case report and literature review

O linfedema factício constitui uma causa de linfedema pouco descrita na literatura e associa-se à auto-agressão. Relata-se o caso de uma paciente de 40 anos de idade, sexo feminino, que foi encaminhada devido a edema em membro inferior direito hà 2 anos. Descreve que passou por vários tratamentos, porém, não soube especificar quais foram, contudo queixava-se de dores no membro que limitavam sua capacidade de trabalho. Ao exame físico foi constatado edema significante no membro e presença de pulsos. Foi solicitado dúplex e a linfocintilografia, que foram normais, e optou-se pela manutenção dos analgésicos e associação de drenagem linfática. Em uma das sessões de drenagem, foi observado que a paciente estava fazendo uso de um garrote que confirmou a causa do derrame.