Influência da qualidade do sono no descenso noturno da pressão arterial

Orientador: Claudio L. Pereira da CunhaDissertação(mestrado)-Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: Há relatos na literatura de distúrbios na arquitetura habitual do sono decorrentes dos estímulos sonoro, tátil e compressivo, causados pela monitorização ambulatória! da pressão arterial (MAPA), inclusive recomendando-se utilizar os parâmetros tensionais noturnos com cautela. Para avaliar a influência da qualidade do sono sobre o descenso noturno da pressão arterial, por diferentes modos de determinação dos períodos de vigília e sono, foram estudados 168 pacientes. Todos foram submetidos a MAPA e a avaliação da qualidade do sono no dia do exame, informada via questionário específico, após a retirada do monitor da MAPA. O equipamento utilizado para obtenção dos parâmetros pressóricos, que permitiram quantificar o descenso pressórico noturno, foi o monitor SpaceLabs 90207. Os parâmetros obtidos pela MAPA foram analisados em separado dos dados sobre a qualidade do sono. Determinou-se como horário "real" o período de vigília e sono relatado pelo paciente em diário da MAPA e como horário "fixo", aquele das 10:00 às 20:00 horas para o período da vigília e das 24:00 às 06:00 horas para o período do sono. Os questionários da qualidade do sono foram julgados por consenso de neurologistas especialistas em Distúrbios do Sono. Quando se avaliou a qualidade do sono no dia do exame em comparação com o habitual, observou-se diferença significativa nos seguintes achados: número de pacientes que despertaram (130 vs. 113, p 0,05) entre a qualidade do sono e a apresentação do descenso noturno da pressão arterial, independentemente do modo de determinação dos períodos de vigília e sono ( horário "real" vs. "fixo", p> 0,05). Conclui-se que a MAPA gera distúrbios na arquitetura do sono em aproximadamente 1/3 dos exames, a qualidade do sono está associada ao grau de tolerância ao exame, porém não houve influência da qualidade do sono na apresentação do descenso noturno da pressão arterial, seja determinado por horário "real" ou "fixo".Abstract: As the literature reports, the ambulatory blood pressure monitoring (ABPM) may cause many sleep disorders due to sonorous, tactile, and constrictive stimulus. So, blood pressure (BP) levels at night should be considered with caution. 168 patients were studied in order to evaluate the sleep quality on nocturnal blood pressure fall. Each subject had a 24-hour blood pressure recording and was required to fulfill the questionnaire about the sleep quality. Blood pressure was monitored by use of the SpaceLabs 90207 device, and ambulatory measurements were done without the sleep questionnaire results. The awake and asleep BP were established on two basis. The "real time" was based on the patient's reports of the awake and sleep time. The "fixed" time was 10:00 a.m. to 8:00 p.m. for the awake time and 24:00 to 06:00 a.m. for the sleep time. Two qualified neurologists have analyzed the sleep questionnaire. There were remarkable differences between the normal seep quality and the sleep quality on the ABPM day, in the following aspects : the number of patients who aroused (130 vs. 113, p 0,05), both by "real and fixed" sleep time, p> 0,05. In conclusion, ABPM is responsable for sleep disorders in 1/3 of cases, and depends on ABPM tolerance, but it does not affect the nocturnal BP fall, both in "real or fixed" sleep time

EVALUATION OF THE BLOOD PRESSURE DETERMINATION TROUGH SMARTPHONE LINKED EQUIPMENT IN HEALTHY YOUNG INDIVIDUALS

Na era atual, em que os smartphones vêm ganhando espaço no meio médico, é fundamental a avaliação científica da real eficácia e reprodutibilidade dessas novas tecnologias. Nesse contexto, nosso objetivo foi avaliar, de forma inédita no nosso país, o esfigmomanômetro acoplado ao smartphone (Withings Blood Pressure Monitor) em comparação com outros métodos (esfigmomanômetros de mercúrio, aneróide e digital). Foram selecionados de forma aleatória 45 alunos sadios do curso de Medicina da UFPR e realizadas três medidas por aparelho, sendo comparadas entre as quatro modalidades, em ordem aleatória e em cada aluno. Também foi avaliada a preferência de método entre smartphone e digital. Os dados obtidos foram analisados nos modelos t-Student pareado e oneway Anova, com significância de p 0,05), seja em cada leitura por aluno ou entre os diferentes métodos. Quanto à pressão arterial diastólica (PAD), houve diferença significativa entre o smartphone e os demais aparelhos (p0,05), be in each measure by student or between methods. Regarding diastolic blood pressure (DBP), there was significant difference between smartphone’s measurements in relation to all other equipments (p<0,05). In the specific analysis of the repeated means in each student by each method, the smartphone was the only one to significantly differ of the other techniques, existing variability among each measure. Concerning the preference analysis, the matters of measurement time, discomfort of the compressive cuff and visual presentation didn’t significantly influence the final choice, in which 51,9% chose the smartphone and 29,6% the digital

Effects of rosiglitazone on contralateral iliac artery after vascular injury in hypercholesterolemic rabbits

<p>Abstract</p> <p>Background</p> <p>The objective was to evaluate the effects of rosiglitazone on iliac arteries of hypercholesterolemic rabbits undergoing balloon catheter injury in the contralateral iliac arteries.</p> <p>Methods</p> <p>White male rabbits were fed a hypercholesterolemic diet for 6 weeks and divided into two groups as follows: rosiglitazone group, 14 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during 6 weeks; and control group, 18 rabbits without rosiglitazone treatment. All animals underwent balloon catheter injury of the right iliac artery on the fourteenth day of the experiment.</p> <p>Results</p> <p>There was no significant difference in intima/media layer area ratio between the control group and the rosiglitazone group. Rosiglitazone did not reduce the probability of lesions types I, II, or III (72.73% vs. 92.31%; <it>p </it>= 0.30) and types IV or V (27.27% vs. 7.69%; <it>p </it>= 0.30). There were no differences in the extent of collagen type I and III deposition or in the percentage of animals with macrophages in the intima layer. The percentage of rabbits with smooth muscle cells in the intima layer was higher in rosiglitazone group (<it>p </it>= 0.011).</p> <p>Conclusion</p> <p>These findings demonstrate that rosiglitazone given for 6 weeks did not prevent atherogenesis at a vessel distant from the injury site.</p

Genetics of venous thrombosis: insights from a new genome wide association study

Background: Venous Thrombosis (VT) is a common multifactorial disease associated with a major public health burden. Genetics factors are known to contribute to the susceptibility of the disease but how many genes are involved and their contribution to VT risk still remain obscure. We aimed to identify genetic variants associated with VT risk. Methodology/Principal Findings: We conducted a genome-wide association study (GWAS) based on 551,141 SNPs genotyped in 1,542 cases and 1,110 controls. Twelve SNPs reached the genome-wide significance level of 2.0×10−8 and encompassed four known VT-associated loci, ABO, F5, F11 and FGG. By means of haplotype analyses, we also provided novel arguments in favor of a role of HIVEP1, PROCR and STAB2, three loci recently hypothesized to participate in the susceptibility to VT. However, no novel VT-associated loci came out of our GWAS. Using a recently proposed statistical methodology, we also showed that common variants could explain about 35% of the genetic variance underlying VT susceptibility among which 3% could be attributable to the main identified VT loci. This analysis additionally suggested that the common variants left to be identified are not uniformly distributed across the genome and that chromosome 20, itself, could contribute to ∼7% of the total genetic variance. Conclusions/Significance: This study might also provide a valuable source of information to expand our understanding of biological mechanisms regulating quantitative biomarkers for VT

Retroperitoneal fetus in fetu in a 65-year-old man.

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus grows within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. The diagnosis is established in infancy or young adults in most cases. The oldest patient reported so far was a 47-year-old patient. We described the case of a 65-year-old patient with FIF, the oldest reported in the literature. Our patient meets all criteria for the diagnosis of FIF, with the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF must be considered in the differential diagnosis of an abdominal mass, typically recognized in infancy. Symptoms arise from the mass effect and treatment is surgical resection due to the potential for malignancy

A rare coding mutation in the MAST2 gene causes venous thrombosis in a French family with unexplained thrombophilia: The Breizh MAST2 Arg89Gln variant.

Rare variants outside the classical coagulation cascade might cause inherited thrombosis. We aimed to identify the variant(s) causing venous thromboembolism (VTE) in a family with multiple relatives affected with unprovoked VTE and no thrombophilia defects. We identified by whole exome sequencing an extremely rare Arg to Gln variant (Arg89Gln) in the Microtubule Associated Serine/Threonine Kinase 2 (MAST2) gene that segregates with VTE in the family. Free-tissue factor pathway inhibitor (f-TFPI) plasma levels were significantly decreased in affected family members compared to healthy relatives. Conversely, plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in affected members than in healthy relatives. RNA sequencing analysis of RNA interference experimental data conducted in endothelial cells revealed that, of the 13,387 detected expressed genes, 2,354 have their level of expression modified by MAST2 knockdown, including SERPINE1 coding for PAI-1 and TFPI. In HEK293 cells overexpressing the MAST2 Gln89 variant, TFPI and SERPINE1 promoter activities were respectively lower and higher than in cells overexpressing the MAST2 wild type. This study identifies a novel thrombophilia-causing Arg89Gln variant in the MAST2 gene that is here proposed as a new molecular player in the etiology of VTE by interfering with hemostatic balance of endothelial cells

Pharmacological Analyses of Protein Kinases Regulating Egg Maturation in Marine Nemertean Worms: A Review and Comparison with Mammalian Eggs

For development to proceed normally, animal eggs must undergo a maturation process that ultimately depends on phosphorylations of key regulatory proteins. To analyze the kinases that mediate these phosphorylations, eggs of marine nemertean worms have been treated with pharmacological modulators of intracellular signaling pathways and subsequently probed with immunoblots employing phospho-specific antibodies. This article both reviews such analyses and compares them with those conducted on mammals, while focusing on how egg maturation in nemerteans is affected by signaling pathways involving cAMP, mitogen-activated protein kinases, Src-family kinases, protein kinase C isotypes, AMP-activated kinase, and the Cdc2 kinase of maturation-promoting factor

Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after COVID-19 hospitalization: an international multicenter prospective observational study

Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39–1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60–0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC

Uranium mobility in organic matter-rich sediments: A review of geological and geochemical processes

Uranium (U) is of enormous global importance because of its use in energy generation, albeit with potential environmental legacies. While naturally occurring U is widespread in the Earth's crust at concentrations of ~1 to 3 ppm, higher concentrations can be found, includingwithin organicmatter (OM)-rich sediments, leading to economic extraction opportunities. The primary determinants of U behaviour in ore systems are pH, Eh, U oxidation state (U(IV), U(VI)) and the abundance of CO3 2– ions. The concentration/availability and interrelationships among such determinants vary, and the solubility and mobility of ions (e.g. OH-, CO3 2–, PO4 3-, SiO4 4-, SO4 2-) that compete for U (primarily as U(VI)) will also influence the mobility of U. In addition, the presence of OM can influence U mobility and fate by the degree of OMsorption to mineral surfaces (e.g. Fe- and Si- oxides and hydroxides). Within solid-phase OM, microbes can influence U oxidation state and U stability through direct enzymatic reduction, biosorption, biomineralisation and bioaccumulation. The biogenic UO2 product is, however, reported to be readily susceptible to reoxidation and therefore more likely remobilised over longer time periods. Thus several areas of uncertainty remain with respect to factors contributing to U accumulation, stability and/or (re)mobilisation. To address these uncertainties, this paper reviews U dynamics at both geological and molecular scales. Here we identify U-OMbond values that are in agreement, relatively strong, independent from ionic strength and which may facilitate either U mobilisation or immobilisation, depending on environmental conditions. We also examine knowledge gaps in the literature, with U-OM solubility data generally lacking in comparison to data for U sorption and dissolution, and little information available on multi-component relationships, such as UOM-V (V as vanadate). Furthermore, the capability ofOMto influence the oxidation state of U at near surface conditions remains unclear, as it can be postulated that electron shuttling by OM may contribute to changes in U redox state otherwise mediated by bacteria. Geochemical modelling of the environmental mobility of U will require incorporation of data from multi-corporation studies, as well as from studies of U-OM microbial interactions, all of which are considered in this review