Comparación entre las técnicas de medición de presión arterial en uno y en dos tiempos

Medir a pressão arterial é passo inicial e indispensável para um adequado diagnóstico de hipertensão, considerando que os níveis de pressão representam importante marcador de risco para doenças cardiovasculares. Medir a pressão, entretanto, pode resultar em conclusões inapropriadas se normas técnicas básicas não forem obedecidas. Este estudo comparou o uso da técnica de mensuração da pressão arterial em um tempo com a técnica em dois tempos, recomendada pela American Heart Association em 2005. Foram realizadas medidas pelas duas técnicas em quarenta indivíduos adultos, utilizando-se como equipamentos manômetro de mercúrio e aparelho digital. Pela análise dos dados concluiu-se que a técnica em um tempo apresentou resultados similares àqueles obtidos com a técnica em dois tempos654630636Measuring blood pressure is an essential and initial step in seeking a proper diagnosis of hypertension, once blood pressure levels are an important risk marker for cardiovascular disease. Measuring blood pressure, however, can result in inappropriate conclusions if basic technical standards are not obeyed. This study compared the use of the technique for measuring blood pressure in one step with the technique in two steps, recommended by the American Heart Association in 2005. Measurements were made by both techniques in fourteen adults, using mercury sphygmomanometer and a digital device. Through analysis of the data it was concluded that the technique in one step showed similar results to those obtained with the technique in two stepsMedir la presión arterial es un paso inicial e indispensable en la búsqueda de un adecuado diagnóstico de hipertensión, ya que los niveles de presión arterial representan un importante marcador de riesgo para enfermedades cardiovasculares. Sin embargo, medir la presión puede resultar en conclusiones inapropiadas si las normas técnicas básicas no son obedecidas. En este estudio comparamos el uso de las técnicas de medición de la presión arterial a un tiempo con la técnica a dos tiempos, recomendada por la American Heart Association en 2005. Hemos realizado mediciones por las dos técnicas en 40 individuos adultos, utilizando como equipamiento tensiómetro de mercurio y dispositivos digitales. Por medio del análisis de los datos se concluyó que la medición a un tiempo mostró resultados similares a los obtenidos con la técnica a dos tiempo

Bartonella and Coxiella infective endocarditis in Brazil: molecular evidence from excised valves from a cardiac surgery referral center in Rio de Janeiro, Brazil, 1998 to 2009

SummaryPCR was used to detect Coxiella burnetii and Bartonella spp in heart valves obtained during the period 1998–2009 from patients operated on for blood culture-negative endocarditis in a cardiac surgery hospital in Brazil. Of the 51 valves tested, 10 were PCR-positive; two were positive for Bartonella and one for C. burnetii

Registros intra-arteriais da pressão versus registros indiretos em função da largura do manguito

We compared intra-arterial to auscultation blood pressure values using correct (CCW) or standard (SCW) cuff widths. Intra-arterial values were obtained from the radial artery using a digital monitor. Measurements were simultaneously made by two observers: one recorded intra-arterial values, while the other registered values by auscultation (brachial artery). Systolic intra-arterial pressure (mmHg) values were 125.04 vs. 119.75 (CCW), and 124.84 vs 116.39 (SCW). Diastolic pressure values were 68.72 vs. 73.26 (CCW), and 68.63 vs. 70,56 (SCW). Auscultation underestimated systolic pressure, particularly when SCW was used, whereas it overestimated diastolic pressure, when CCW was used. Auscultation using CCW yielded higher agreement of systolic pressure values and lower agreement of diastolic pressure values as compared to intra-arterial blood pressure measurementsComparamos valores de la presión intraarterial y auscultatoria, usando manguito rotador correcto (MLC) y patrón (MLP). Se obtuvo el valor intaarterial por punción radial y monitoreo digital. Dos observadores tomaron simultáneamente la medidas: unoregistró los valores intraarteriales, otro los auscultados (arteria braquial). La presión sistólica intraarterial (mmHg) fue de 125,04 comparada a 119,75 (MLC) y 124,84 comparada a 116,39 (MLP). La presión diastólica fue de 68,72 comparada a s 73,26 (MLC) y de 68,63 comparada as 70,56 (MLP). El método auscultatorio subestimó la presión sistólica, especialmente con el uso de MLP, y sobreestimó la diastólica, especialmente con el MLC. El MLC permitió mayor concordancia en la presión sistólica y menor en la diastólicaComparamos valores de pressão intrarteriais e auscultatórios, usando manguitos correto (MLC) e padrão(MLP). Obteve-se o valor intrarterial por punção radial e monitor digital. A medida foi feita simultaneamente por dois observadores: um registrou os valores intrarteriais, outro os auscultados (artéria braquial). A pressão sistólica intrarterial, em mmHg, foi 125,04 versus (vs) 119,75 (MLC) e 124,84 vs 116,39 (MLP). A pressão diastólica foi 68,72 vs 73,26 (MLC) e 68,63 vs 70,56 (MLP). O método auscultatório subestimou a pressão sistólica, especialmente com MLP, e superestimou a diastólica, especialmente com MLC. O MLC possibilitou maior concordância na pressão sistólica e menor na diastólic

Intra-arterial versus auscultation blood pressure values as a function of cuff width

Comparamos valores de pressão intrarteriais e auscultatórios, usando manguitos correto (MLC) e pa drão (MLP). Obteve-se o valor intrarterial por punção radial e monitor digital. A medida foi feita simultaneamen te por dois observadores: um registrou os valores intrarteriais, outro os auscultados (artéria braquial). A pres são sistólica intrarterial, em mmHg, foi 125,04 versus (vs) 119,75 (MLC) e 124,84 vs 116,39 (MLP). A pressão dias tólica foi 68,72 vs 73,26 (MLC) e 68,63 vs 70,56 (MLP). O método auscultatório subestimou a pressão sistólica, es pecialmente com MLP, e superestimou a diastólica, especialmente com MLC. O MLC possibilitou maior concor dância na pressão sistólica e menor na diastólica.Comparamos valores de la presión intraarterial y auscultatoria, usando manguito rotador correcto (MLC) y patrón (MLP). Se obtuvo el valor intaarterial por punción radial y monitoreo digital. Dos observado res tomaron simultáneamente la medidas: unoregistró los valores intraarteriales, otro los auscultados (arteria braquial). La presión sistólica intraarterial (mmHg) fue de 125,04 comparada a 119,75 (MLC) y 124,84 com parada a 116,39 (MLP). La presión diastólica fue de 68,72 comparada a s 73,26 (MLC) y de 68,63 comparada as 70,56 (MLP). El método auscultatorio subestimó la presión sistólica, especialmente con el uso de MLP, y so breestimó la diastólica, especialmente con el MLC. El MLC permitió mayor concordancia en la presión sis tólica y menor en la diastólicaWe compared intra-arterial to auscultation blood pressure values using correct (CCW) or standard (SCW) cuff widths. Intra-arterial values were obtained from the radial artery using a digital monitor. Measurements were simultaneously made by two observers: one recorded intra-arterial values, while the other registered values by auscultation (brachial artery). Systolic intra-arterial pressure (mmHg) values were 125.04 vs. 119.75 (CCW), and 124.84 vs 116.39 (SCW). Diastolic pressure values were 68.72 vs. 73.26 (CCW), and 68.63 vs. 70,56 (SCW). Aus cultation underestimated systolic pressure, particularly when SCW was used, whereas it overestimated diastolic pressure, when CCW was used. Auscultation using CCW yielded higher agreement of systolic pressure values and lower agreement of diastolic pressure values as compared to intra-arterial blood pressure measurements

Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review

Objective: Pregnancy and postpartum infective endocarditis (PPIE), although uncommon, is a very serious condition. To describe cases of infectious endocarditis (IE) in in a cohort of adults with IE in a Brazilian center and to review data from the recent literature on the subject. Methods: Cases of definite IE by the modified Duke criteria in adults were retrieved in a contemporary cohort of adults with IE from January 2006 to December 2020.  Literature review on the topic was carried out and case reports on PPIE from 2014 to 2020 were compiled. Results: Two cases of PPIE were found in 401 adult patients with IE, with a prevalence of 0.5% in the cohort, of 2/139 (1.4%) among women and 2/83 (2.4%) of women of reproductive age (18 -49 years) in this same cohort. The search for published case reports from 2014 to 2020 resulted in 61 episodes of PPIE; in these, 7 pregnant women (11.4%), 10 fetuses (16.4%) and 1 premature newborn (1.6%) died. There was a previous valve predisposition in 12 (19.7%) cases and intravenous drug use in 14(23%). Left-sided valves were the most frequently affected in 41 (67.2%) of the cases. The most common isolated infectious agent was methicillin sensitive Staphylococcus aureus in 18/61 (29.5%) patients, although as a group, oral viridans streptococci accounted for 16/61 (26.2%). Valve surgery was done for 70% of patients. Conclusions: Intravenous drug use remained to be the main risk factor for IE. Mortality remained high for mothers and their children, despite the fact surgery was done more frequently in the recent cases. In the case of fever without an obvious focus in pregnant or post-partum women, the diagnosis of IE must be readily considered, especially in those with prosthesis and/or intravenous drug use

Bipolar versus unipolar energy in the surgical ablation of atrial fibrillation in patients with mitral valve surgery

Objective: To evaluate the presence of sinus rhythm or atrial fibrillation (AF) in patients who had mitral valve surgery with concomitant surgical ablation of AF, by unipolar or bipolar radiofrequency. Methods: Adults patients who had mitral valve replacement or mitral valvuloplasty with concomitant surgical ablation of AF, either by unipolar or bipolar radiofrequency, were consecutively included between the 2008 and 2012. Surgery was done by conventional median sternotomy. Results: A total of 99 patients were included; 20 (20.2%) had surgical ablation by unipolar energy and 79 (79.8%) by bipolar energy. There were 76 (76.8%) women, and mean age± SD was 51 ±11 years.  The median duration of AF before surgery was 41 months. Type of AF was paroxysmal in 21 (21%), persistent in 11 (11%), and long-standing persistent in 67 (67%). Mean left atrium size in the preoperative period was 5.54 ± 0.82 cm. Mean left ventricular ejection fraction was 58±12.4%. Types of mitral valve surgery were valvuloplasty (n=10), mechanical valve replacement in 30, and bioprosthesis replacement in 59. Concomitant tricuspid annuloplasty was performed in 39 patients. Thirty- day mortality was 8/99 (8%). Mean follow-up time was 1274 days (3.49 years). Survival was 92%. After 4 years no patient who had had unipolar ablation was in sinus rhythm, whilst 67% of those who had bipolar energy ablation were in sinus rhythm (p<0.001). Conclusion: The use of bipolar energy is superior to unipolar energy in the surgical ablation of atrial fibrillation in patients submitted to mitral valve surgery

Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance

Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p &lt; 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality

The occurrence of antimicrobial residues and antimicrobial resistance genes in urban drinking water and sewage in Southern Brazil

Antimicrobial resistance (AMR) is currently discussed as an important issue worldwide, and the presence of antimicrobial residues (ARs) and antimicrobial resistance genes (ARGs) in the environment, especially in the water sources, is a challenge for public health. This study was conducted to evaluate the occurrence and diversity of AR and ARG in water sources from an urban center, in Southern Brazil. A total of thirty-two water samples from drinking water treatment plants (24) and sewage systems (8) were collected during two annual samplings, winter and summer. The PCR was performed by 18 ARGs, and the detection of 47 ARs was performed by LC–MS/MS. All sewage samples presented carbapenemases, ESBL, and mcr-1 genes as well as quinolones and sulfamethoxazole residues. In drinking water, we just detected blaTEM and tetB genes and doxycycline residues in samples before treatment. This study provides data about AR and ARG in drinking water and sewage systems showing that these sources are important reservoirs of both. The limited effectiveness of wastewater treatment processes to remove mainly AR demonstrates the need to implement better protocols of disinfection, in order to limit the spread of AMR in the environment