Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan – amlodipine combination

Although the awareness and control of hypertension has increased, only 37% of hypertensive patients in the US achieve the conservative goal of <140/90 mmHg. Achieving optimal blood pressure (BP) control is the most important single issue in the management of hypertension, and in most hypertensive patients, it is difficult or impossible to control BP with one drug. Blocking two or more BP regulatory systems provides a more effective and more physiologic reduction in BP, and current guidelines have recommended the use of combination therapy as first-line treatment, or early in the management of hypertension. Fixed combination therapy is an efficacious, relatively safe, and may be cost-effective method of decreasing BP in most patients with essential hypertension. Similar to other combinations, fixed-dose combination tablets containing the dihydropyridine calcium channel blocker amlodipine and the angiotensin II receptor blocker olmesartan bring together two distinct and complementary mechanisms of action, resulting in improved BP control and potential for improved target organ protection relative to either class of agent alone

Impact of olmesartan on blood pressure, endothelial function, and cardiovascular outcomes

The vascular endothelium, the largest “organ” in the body, synthesizes and releases a wide spectrum of vasoactive substances into the circulation. Endothelial dysfunction links hypertension and other cardiovascular (CV) risk factors that promote the development of atherosclerotic plaque, CV disease, and fatal and nonfatal CV events. Blood pressure (BP) reduction is the most effective way to reduce CV risk in patients with hypertension, but it is unknown whether endothelial dysfunction is a cause or consequence of hypertension. Renin–angiotensin–aldosterone system blockers improve endothelial function and have favorable vascular, metabolic, cardiac, and renoprotective effects that are independent of BP reduction. Olmesartan effectively reduces BP and also has vasoprotective properties, including reductions in endothelial dysfunction and inflammation, prevention of microalbuminuria, and reversal of vascular remodeling. Large-scale, long-term studies are needed to confirm that olmesartan has vasoprotective effects that are independent of BP control and to determine whether these pleiotropic effects translate into improved CV disease outcomes

Role of aliskiren in cardio-renal protection and use in hypertensives with multiple risk factors

The renin-angiotensin-aldosterone system (RAAS) is an important mediator of blood pressure (BP) and volume regulation in both normotensive and hypertensive persons and is a major contributor to hypertension-related target organ damage. The concept of renin inhibition for managing hypertension by blocking the RAAS pathway at its point of activation is very attractive since the renin-angiotensinogen reaction is the first and rate-limiting step in the generation of angiotensin II (Ang II). Aliskiren, the first in a new class of orally effective direct renin inhibitors (DRIs), is approved for the treatment of hypertension. It is effective in reducing BP in the general population of hypertensive patients and in special patient groups such as obese persons, and has a tolerability and safety profile similar to placebo. Aliskiren has renoprotective, cardioprotective and anti-atherosclerotic effects in animal models that appear to be independent of BP lowering. It reduces proteinuria in diabetic patients and has favorable neurohumoral effects in patients with symptomatic heart failure. Additional outcome trials are needed to establish the role of this novel class of antihypertensive medication in the therapeutic armamentarium

Course designing and content reusing and integration

The EGreen project (EGREEN Project Number: 573927-EPP-1-2016-1-JO-EPPKA2-CBHE-JP) aims to ensure that the universities in Jordan and Syria can offer a high-quality education compatible with European standards and meets the market needs of the emerging knowledge-based society by modernising their ‘environment’ curricula, developing and implementing a sustainable bachelor's degree programme. In this context, its foreseen the development of a set of e-learning based short courses in order to ease the access to selected materials and promote the scaffolding of a community of interest among teachers and students. This paper presents a set of guidelines for the structure of these courses, covering two main topics, viz - i) general course unit requirements; ii) reusing of contents ('resources') and structuring of contents and activities.info:eu-repo/semantics/publishedVersio

The irregular populist: André Ventura: the lider of Chega

This paper aims to measure, for the first time, the level of populist rhetoric of André Ventura – the leader of the Chega party. We did so by analyzing a total of sixteen discursive elements (selected speeches, interviews and tweets, between 2020 and 2022), using the holistic grading method with two graders. Despite a total average of 1.14 (on a scale ranging from 0 to 2), which would suggest mild populism, we managed to identify several features of manifest populist rhetoric, such as a dualistic framework of politics, an agonistic dichotomy between Chega and the political and economic establishment – the “system” –, and an attempt to rekindle political conflict seen as a moral battle where Chega would act as the sole instrument to save Portugal from its enemies and problems. Taking this into consideration, the main conclusion of this paper is the classification of André Ventura as an irregular populist, considering the constant fluctuation of his populist rhetoric in order to adapt to the place, the audience, and, most likely, the political moment and the intended consequences of the speech itselfinfo: https://populism.byu.edu

The domestic kitchen design as a tool to reduce food waste

This paper describes broader research undertaken for a master’s degree in product and space design at IADE, Universidade Europeia, Lisbon, Portugal. It aims to define guidelines for the development of domestic kitchen projects that contribute to reducing food waste. After this research, our goal is to further develop its outcomes through future research and the implementation of the resulting guidelines in a lifesize field experiment. We departed with the hypothesis that space design may influence users’ behaviour; therefore, it can be used as an active tool in favour of sustainability. We defined a methodology that informed a review of the literature, case studies and surveys. We analysed comprehensive themes regarding the problem, which enabled a holistic approach to the issue. We conclude this paper by showing the pertinence of our research proposal, a novel way of combining specific strategies from three primary areas of knowledge (design for behavioural change, food waste and interior design) to achieve our goals of reducing food waste in domestic kitchens and contributing in this way to a more sustainable society.info:eu-repo/semantics/publishedVersio

Polimorfismos genéticos para alfa actinina 3 e sua relaçao com dano muscular e capacidades funcionais em atletas de futebol

193 p.La presente Tesis se compone de dos estudios independientes sobre comportamientos fisiológicos en atletas de fútbol con diferentes genotipos para el gene de la ACTN3. ESTUDIO 1 En este estudio investigamos el efecto de la ACTN3 o la ausencia de la ACTN3 en el desempeño físico de atletas de fútbol. Los autores evaluaron 200 atletas profesionales de fútbol en cuatro diferentes pruebas físicos que evalúan tanto a potência/força y resistencia. Fueron realizados dos variaciones de un salto (Squat Jump y Counter Movement Jump), un sprint de 30m y una prueba de resistencia aeróbica (YoYo Endurance Test-nivel 2). El tiempo de sprint y altura de salto fueron medidos a través de instrumentación adecuada y la prueba de resistencia fue evaluado usando una prueba de VO2 Max. ESTUDIO 2 Factores genéticos pueden interferir con el desempeño desportivo. La identificación de la predisposición genética de futbolistas trae informaciones importantes para entrenadores y técnicos para el ajuste individual de las cargas de entrenamiento. Respuestas diferentes para el entrenamiento excéntrico fueron observadas en función del genotipo conocido como Á-actinina-3 (ACTN3) en biomarcadores de lesión muscular, hormonas y respuestas inflamatorias. Comparamos la reacción inflamatoria aguda, lesión muscular y variaciones hormonales de acuerdo con el entrenamiento excéntrico en 37 atletas de fútbol profesionales con diferentes perfiles genéticos de ACTN3 (XX, RX y RR). CONCLUSIONES: Primera: los jugadores de futbol con genotipo ACTN3 RR y ACTN3 RX muestran una mayor aptitud para la fuerza y la velocidad en comparación con los que presentan un genotipo ACTN3 XX, sin embargo estos últimos muestran una mejor aptitud para la resistencia aeróbica. Segunda: los jugadores de fútbol profesional homocigotos para el gen ACTN3 XX presentan un mayor estado catabólico evidenciado por las respuestas metabólicas, hormonales e inmunes después de un entrenamiento de carácter excéntrico en comparación con los grupos ACTN3 RR y ACTN3 RX. Tercera: los entrenamientos excéntricos agudos promueven un aumento significativo en las variables hormonales e inmunológicas evidenciado por la alteración de la concentración de testosterona, cortisol y citoquinas IL6 tras el entrenamiento Cuarta: la realización de entrenamiento excéntrico en las condiciones propuestas promueven una elevación en las actividades de las enzimas marcadores de daño muscular, especialmente la CK y la alfa-actina. Sin embargo la alfa-actina se muestra como un marcador más precoz debido a una liberación más rápida que la de la CK. Creemos que se necesitan más investigaciones sobre el uso como marcador de daño muscular en entrenamientos excéntricos y como posible variable para el control y planificación de las cargas del entrenamiento. Quinta: nuestros hallazgos, al igual que la literatura científica, muestran que el entrenamiento intenso excéntrico produce daño muscular, lo que refuerza la importancia de la monitorización del entrenamiento deportivo mediante el uso de biomarcadores que permitan ajustar las cargas de entrenamiento de manera individualizada para aumentar los beneficios y disminuir las lesiones, mejorando el desempeño así como la salud y la calidad de vida de los deportista

OS LIMITES JURISDICIONAIS DO DIREITO DE VOTO EM RECUPERAÇÃO DE EMPRESAS

O texto estuda, com base em duas decisões judiciais particularmente relevantes, o Cram Down e o direito de voto do credor no processo de recuperação de empresas no direito brasileiro. O objetivo é demonstrar que os limites ao exercício deste direito de voto podem, à luz da análise econômica do Direito, ser definidos sem comprometer a eficiência da recuperação de empresas ou o direito dos credores. Comprova-se que tal direito de voto pode ser usado abusivamente, mas apenas quando o voto é dado com objetivo outro que não o da maximização do direito de crédito envolvido no processo de recuperação.PALAVRAS-CHAVE: Recuperação de Empresas. direito de voto. Cram down

Recuperar a expressão facial após parésia facial central: implicações na prática de enfermagem de reabilitação

Em Portugal, verifica-se a diminuição da incidência de Acidente Vascular Cerebral. No entanto as incapacidades e desvantagens dele resultantes continuam a ter um grande impacto na vida das pessoas, entre as alterações destacamos a Parésia Facial do Tipo Central. Este relatório explana o desenvolvimento das competências no âmbito do curso de mestrado na área específica da Enfermagem de Reabilitação. O percurso permitiu-nos colocar em ação as competências gerais de especialista e específicas da área de reabilitação. Partimos de um projeto, que permitiu dar corpo e linha de continuidade ao estágio, mas não nos limitamos a ele. Focamo-nos na recuperação da expressão facial após parésia facial central destacando as implicações para Enfermagem de Reabilitação. Segundo o pressuposto que as estratégias utilizadas podem ser aplicadas numa fase precoce, o projeto demonstra que a instrução precoce diminui a assimetria facial e consequências como disfagia, disartria e alteração da imagem corporal; Recovering facial expression after central facial paresis- Implications in Rehabilitation Nursing practice ABSTRACT: In Portugal, there is a decrease in the Stroke. However, the resulting disabilities and disadvantages continue to have a great impact in the people's life, as harshly point out Central Facial Paresis. This report explores the development of competences in the field, of master's degree course, in the specific area of Rehabilitation Nursing. The course allowed to put us in action specialist's general competences and specific of the rehabilitation area. We start from a project that allowed to give body and continuity line to the stage, but we didn't limit ourselves to him. We focused on the recovery of the facial expression after central facial paresis emphasizing as implications for Rehabilitation Nursing. According to the presupposition that the used strategies can be applied in a precocious phase, the project demonstrates that the precocious instruction reduces the facial asymmetry and consequences as dysphagia, dysarthria and altered body image