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INTRODUCTION: A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. AIM: To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. METHODS: Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. RESULTS: Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. CONCLUSIONS: Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women.

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OBJECTIVE: Pre-eclampsia (PE) is a serious complication of pregnancy associated with maternal and fetal morbidity and mortality. As current prediction models have limitations and may not be applicable in resource-limited settings, we aimed to develop a machine-learning (ML) algorithm that offers a potential solution for developing accurate and efficient first-trimester prediction of PE. METHODS: We conducted a prospective cohort study in Mexico City, Mexico to develop a first-trimester prediction model for preterm PE (pPE) using ML. Maternal characteristics and locally derived multiples of the median (MoM) values for mean arterial pressure, uterine artery pulsatility index and serum placental growth factor were used for variable selection. The dataset was split into training, validation and test sets. An elastic-net method was employed for predictor selection, and model performance was evaluated using area under the receiver-operating-characteristics curve (AUC) and detection rates (DR) at 10% false-positive rates (FPR). RESULTS: The final analysis included 3050 pregnant women, of whom 124 (4.07%) developed PE. The ML model showed good performance, with AUCs of 0.897, 0.963 and 0.778 for pPE, early-onset PE (ePE) and any type of PE (all-PE), respectively. The DRs at 10% FPR were 76.5%, 88.2% and 50.1% for pPE, ePE and all-PE, respectively. CONCLUSIONS: Our ML model demonstrated high accuracy in predicting pPE and ePE using first-trimester maternal characteristics and locally derived MoM. The model may provide an efficient and accessible tool for early prediction of PE, facilitating timely intervention and improved maternal and fetal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Eficiencia de un enfoque de aprendizaje automático para la predicción de la preeclampsia en un país de ingresos medios OBJETIVO: La preeclampsia (PE) es una complicación grave del embarazo asociada a morbilidad y mortalidad materna y del feto. Dado que los modelos de predicción actuales tienen limitaciones y pueden no ser aplicables en situaciones con recursos limitados, se propuso desarrollar un algoritmo de aprendizaje automático (AA) que ofrezca una solución con potencial para desarrollar una predicción precisa y eficiente de la PE en el primer trimestre. MÉTODOS: Se realizó un estudio de cohorte prospectivo en Ciudad de México para desarrollar un modelo de predicción de la PE pretérmino (PEp) en el primer trimestre utilizando AA. Para la selección de variables se utilizaron las características maternas y los múltiplos de la mediana (MdM) obtenidos localmente para la presión arterial media, el índice de pulsatilidad de la arteria uterina y el factor de crecimiento placentario sérico. El conjunto de datos se dividió en subconjuntos de datos de entrenamiento, de validación y de test estadístico. Se empleó un método de red elástica para la selección de predictores, y el rendimiento del modelo se evaluó mediante el área bajo la curva de características operativas del receptor (ABC) y las tasas de detección (TD) con tasas de falsos positivos (TFP) del 10%. RESULTADOS: El análisis final incluyó a 3050 mujeres embarazadas, de las cuales 124 (4,07%) desarrollaron PE. El modelo de AA mostró una buena eficiencia, con un ABC de 0,897, 0,963 y 0,778 para la PEp, la PE de aparición temprana (PEat) y cualquier tipo de PE (todas las PE), respectivamente. Las TD con TFP del 10% fueron del 76,5%, 88,2% y 50,1% para la PEp, PEat y todas las PE, respectivamente. CONCLUSIONES: Nuestro modelo de AA demostró una alta precisión en la predicción de la PEp y la PEat utilizando características maternas del primer trimestre y MdM calculados localmente. El modelo puede proporcionar una herramienta eficiente y accesible para la predicción temprana de la PE, facilitando la intervención oportuna y la mejora de los resultados maternos y del feto.

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OBJECTIVES: Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR. METHODS: 276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed. RESULTS: The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP. CONCLUSION: The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.

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Abstract Objectives Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR. Methods 276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed. Results The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP. Conclusion The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.

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Mean arterial pressure (MAP) is a key haemodynamic variable monitored in critically ill patients. The advantages of oscillometric noninvasive blood pressure (NIBP) measurement are its easy and fast methodology; however, the accuracy and the precision of this measurement in critically ill patients is constantly debated. We performed a systematic review and meta-analysis of observational studies comparing oscillometric NIBP methods with invasive arterial pressure (IAP) measurements. We included studies of adult critically ill patients, which evaluated MAP in the same patient by both NIBP and IAP at any site. We included only studies comparing simultaneous measurements of arterial pressure by NIBP and IAP, reporting their results using mean difference and SD of agreement. The main outcome was to define the bias of the MAP measured by NIBP over the IAP measurement. The quality of the studies was analysed by the QUADAS 2 tool. Seven studies and 1593 patients were included in the main analysis. The oscillometric NIBP method had a mean value of -1.50 mmHg when compared with IAP (95% CI: -3.34 to 0.35; I2 = 96% for random effects model, P < 0.01). The limits of agreement for MAP varied between -14.6 mmHg and +40.3 mmHg. NIBP had an adequate accuracy regarding MAP measurements by oscillometry. Limits of agreement may thus narrow the clinical applicability in scenarios in which there is a need for a more precise management of blood pressure.

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The present review was carried out to describe publications on the use of methylene blue (MB) in pediatrics and neonatology, discussing dose, infusion rate, action characteristics, and possible benefits for a pediatric patient group. The research was performed on the data sources PubMed, BioMed Central, and Embase (updated on Aug 31, 2020) by two independent investigators. The selected articles included human studies that evaluated MB use in pediatric or neonatal patients with vasoplegia due to any cause, regardless of the applied methodology. The MB use and 0 to 18-years-old patients with vasodilatory shock were the adopted criteria. Exclusion criteria were the use of MB in patients without vasoplegia and patients ≥ 18-years-old. The primary endpoint was the increase in mean arterial pressure (MAP). Side effects and dose were also evaluated. Eleven studies were found, of which 10 were case reports, and 1 was a randomized clinical study. Only two of these studies were with neonatal patients (less than 28 days-old), reporting a small number of cases (1 and 6). All studies described the positive action of MB on MAP, allowing the decrease of vasoactive amines in several of them. No severe side effects or death related to the use of the medication were reported. The maximum dose used was 2 mg/kg, but there was no consensus on the infusion rate and drug administration timing. Finally, no theoretical or experimental basis sustains the decision to avoid MB in children claiming it can cause pulmonary hypertension. The same goes for the concern of a possible deleterious effect on inflammatory distress syndrome.

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Background: Severe carotid artery stenosis (sCAS) is frequently discovered at the time of evaluation for coronary arterial revascularization. However, there has been controversy regarding the optimal management of sCAS. This study evaluated the potential effects of untreated sCAS at time of coronary artery bypass grafting (CABG) in contemporary practice. Methods: This was a retrospective study from a multihospital healthcare system including patients undergoing isolated CABG between 2011 and 2018. Patients were stratified by the presence of sCAS (≥80% stenosis) in at least 1 carotid artery. Perioperative and 5-year stroke were compared, and multivariable analysis was used to identify risk-adjusted predictors of stroke and mortality. Results: A total of 5475 patients were included, 459 (8.4%) with sCAS and 5016 (91.6%) without sCAS. Patients with sCAS experienced more frequent perioperative stroke (4.4% vs 1.2%; P < .001), with most attributable to ischemic or embolic etiologies. The median duration of follow-up was 4.6 years (interquartile range, 3.0-6.5 years). One-year and 5-year survival were both lower in patients with sCAS (P < .001). In multivariable analysis, sCAS was associated with increased risk-adjusted hazard for both mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.02-1.60; P = .030) and stroke (HR, 1.76; 95% CI, 1.20-2.59; P = .004). The strongest risk-adjusted predictor for stroke was a previous history of stroke (HR, 2.51; 95% CI, 1.77-3.55; P < .001). Conclusions: This contemporary analysis of CABG procedures reveals that concurrent sCAS continues to confer a significant stroke risk, especially in those with history of previous stroke. Although whether sCAS lesions are responsible for most strokes is unclear, they likely serve as a surrogate for other stroke risk factors.

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Both the autonomic nervous system and the neuroendocrine system are activated by osmotic stimulation (OS) evoking cardiovascular effects. The current study investigated the mechanisms involved in the cardiovascular responses evoked by an acute osmotic stimulus with intraperitoneal (i.p.) injection of either isotonic (0.15 M NaCl) or hypertonic saline (0.6 M NaCl) in conscious rats. Hypertonic saline increased mean arterial pressure (MAP) and heart rate (HR) for 30 min, as well as plasma osmolality and sodium content. Urinary sodium and urinary volume were also increased. Pretreatment with the ganglion blocker pentolinium (i.v.) did not affect the pressor response, but significantly decreased the tachycardic response caused by OS. Pretreatment with the V1-vasopressin receptor antagonist dTyr(CH2)5(Me)AVP (i.v.) reduced the pressor response, without affecting the tachycardic response evoked by the hypertonic OS. Neither the pressor nor the tachycardic response to OS was affected by pretreatment with either the oxytocin receptor antagonist atosiban or the α1-antagonist prazosin. Pretreatment with the ß1-antagonist atenolol had no effect on the pressor response, but markedly decreased the tachycardic response evoked by OS. Results indicate that i.p. hypertonic OS-evoked pressor response is mediated by the release of vasopressin, with a minor influence of the vascular sympathetic input.LAY SUMMARYIncreased plasma osmolality, such as that observed during dehydration or salt intake, is a potent stimulus yielding to marked cardiovascular and neuroendocrine responses. The intraperitoneal (i.p.) injection of hypertonic saline solution is a commonly used animal model to cause a sustained increase in plasma osmolality, leading to a cardiovascular response characterized by sustained blood pressure and heart increases, whose systemic mechanisms were presently studied. Our findings indicate that the pressor response to the i.p. osmotic stimulus (OS) is mediated mainly by the release of vasopressin into the blood circulation with a minor or even the noninvolvement of the vascular sympathetic nervous system, whereas activation of the sympathetic-cardiac system mediates the tachycardic response to OS.

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Resumen: Introducción: Las variables hemodinámicas nos informan sobre la progresión de lesión renal aguda (AKI por sus siglas en inglés). Material y métodos: Estudio prospectivo, observacional, longitudinal, de pacientes ingresados a la Unidad de Terapia Intensiva del 2017 al 2018. Se incluyeron mayores de 18 años, con lesión renal aguda (AKI 1 o 2), monitoreo hemodinámico de tensión arterial media (TAM), tensión arterial diastólica (PAD), frecuencia cardiaca (FC) y de presión venosa central (PVC). Determinados desde las 24 horas del diagnóstico hasta el egreso. Resultados: Fueron 164 pacientes, 105 (64%) presentaron progresión de AKI cuando TAM < 75.98 mmHg. PAD < 61, PVC >8 cm H2O, FC > 90 x', TAM-PVC < 67.64 mmHg, PAD-PVC < 53.28 mmHg. Conclusiones: La TAM, PAD y la PVC tienen el mayor impacto en el riesgo de progresión de AKI cuando se calcula la presión de perfusión media con estas variables.

Abstract: Introduction: Haemodynamic variables inform us about the progression of acute kidney injury (AKI). Material and methods: Prospective, observational and longitudinal study of patients admitted to Intensive Care (ICU) from 2017-2018. patients over 18 years were included, with acute kidney injury (AKI 1, 2), and hemodynamic monitoring of mean arterial blood pressure (MAP), diastolic blood pressure (DBP), heart rate (HR) and central venous pressure (CVP). Determined from 24 hours after diagnosis and its evolution was recorded until discharge. Results: A total of 164 patients were included, progression of AKI presented when MAP < 75.98 mmHg, DBP < 61 mmHg, CVP < 8 cmH2O, FC 90 x', MAP-CVP 67.64 mmHg, DBP-CVP 53.28 mmHg, HR > 90 beats/minute. Conclusions: MAP, DBP and CVP have the greatest impact on the risk of AKI progression, especially when the mean perfusion pressure (PPM) is calculated with these two variables.

Resumo: Introdução: As variáveis hemodinâmicas informam sobre a progressão da lesão renal aguda (LRA). Materiais e métodos: Estudo prospectivo, observacional, longitudinal de pacientes admitidos em terapia intensiva (UTI) de 2017-2018. Foram incluídos pacientes maiores de 18 anos, com lesão renal aguda (LRA 1 ou 2), monitorização hemodinâmica da pressão arterial média (TAM), pressão arterial diastólica (PAD), freqüência cardíaca (FC) e pressão venosa central (PVC). Determinada a partir de 24 horas de diagnóstico até a alta. Resultados: 164 pacientes (p), 105 p (64%) apresentaram progressão da LRA quando TAM < 75.98 mmHg, PAD < 61 mmHg, PVC > 8 cmH2O, FC > 90 x´, TAM-PVC < 67.64 mmHg, PAD- PVC < 53.28 mmHg. Conclusões: TAM, PAD e PVC têm o maior impacto no risco de progressão da LRA quando a pressão média de perfusão (PMP) é calculada com essas variáveis.

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Fruit peels of Plinia cauliflora (Mart.) Kausel are widely used in Brazilian traditional medicine, but no studies have proved the safety of its pharmacological effects on the respiratory, cardiovascular, and central nervous systems. The present study assessed the safety pharmacology of P. cauliflora in New Zealand rabbits. First, an ethanol extract (EEPC) was selected for the pharmacological experiments and chemical characterization. Then, different groups of rabbits were orally treated with EEPC (200 and 2000 mg/kg) or vehicle. Acute behavioral and physiological alterations in the modified Irwin test, respiratory rate, arterial blood gas, and various cardiovascular parameters (i.e., heart rate, blood pressure, and electrocardiography) were evaluated. The main secondary metabolites that were identified in EEPC were ellagic acid, gallic acid, O-deoxyhexosyl quercetin, and the anthocyanin O-hexosyl cyanidin. No significant behavioral or physiological changes were observed in any of the groups. None of the doses of EEPC affected respiratory rate or arterial blood gas, with no changes on blood pressure or electrocardiographic parameters. The present study showed that EEPC did not cause any significant changes in respiratory, cardiovascular, or central nervous system function. These data provide scientific evidence of the effects of this species and important safety data for its clinical use.

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OBJECTIVE: The aim of the study was to examine the combined associations between handgrip strength (HGS) and adherence to a Mediterranean diet with blood pressure (BP) in Chilean children. METHODS: This cross-sectional study enrolled 1140 children (794 boys and 346 girls) 8 to 12 y of age. HGS was measured using a hand dynamometer with an adjustable grip. Adherence to a Mediterranean diet was assessed with the Kidmed score. Resting BP was measured by an automated monitor using an appropriately sized cuff. Elevated BP was defined as ≥90th percentile, and high HGS was defined as sex- and age-specific normative ≥80th percentile for the HGS. RESULTS: The prevalence of elevated systolic BP, diastolic BP, and overall BP were 16.6%, 12.9%, and 8.1%, respectively. HGS was negatively associated with BP parameters in an unadjusted and adjusted model after considering potential confounders (age, sex, body mass index z-score, and HGS). Regarding diet adherence, the unadjusted model reveals that children with high adherence to the Mediterranean diet showed lower BP levels (systolic, diastolic, and mean arterial pressure) compared with children with low-medium adherence; however, these differences disappear after considering potential confounders. The combination of high HGS and optimal adherence to a Mediterranean diet was negatively associated with BP. CONCLUSIONS: Children with a high HGS levels (i.e., ≥80th percentile) may somewhat overcome the deleterious effects of low adherence to a Mediterranean diet. Therefore, these findings suggest that the combination of these two components of a healthy lifestyle, especially HGS may be beneficial to children's BP.

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AIM: To develop a combined predictive model for preterm and term pre-eclampsia (PE) during the first trimester of pregnancy. METHODS: This investigation was a nested case-control study in singleton pregnancies at the Maternal-Fetal Medicine Unit, University of Chile Hospital. A priori risks for preterm and term PE were calculated by multivariate logistic regression analyses. Biophysical markers were log10 -transformed and expressed as multiples of the median. A multivariate logistic regression analysis was used to estimate a combined predictive model of preterm and term PE. Detection rates at different cut-off points were determined by a receiver operator curve analysis of a posteriori risks. RESULTS: First trimester mean arterial pressure and uterine artery Doppler pulsatility index were significantly higher in women who develop PE than in the unaffected group. The detection rate of preterm PE based on maternal characteristics and biophysical markers was 72% at a 10% false-positive rate, corresponding to a cut-off risk of 1 in 50. The detection rate for term PE was 30% at a 10% false-positive rate. CONCLUSION: Preterm PE can be predicted by a combination of maternal characteristics and biophysical markers. However, first trimester screening is less valuable for term PE.

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OBJECTIVES: To investigate the effects of the intracameral injection of epinephrine and two doses of 2% lidocaine on pupil diameter (PD), intraocular pressure (IOP), heart rate (HR), and mean arterial pressure (MAP) in healthy cats. METHODS: Five treatment groups were formed (10 cats/each). Animals received 0.2 mL of epinephrine, 0.2 or 0.3 mL of 2% lidocaine, or 0.2 mL of BSS. Cats were anesthetized, and all solutions were injected intracamerally. PD, IOP, HR, and MAP were assessed at baseline, following anterior chamber paracentesis (T0), and at every 5 minutes, until anesthesia was terminated (T60). PD and IOP continued to be assessed for 2 additional hours during recovery from anesthesia. In another group, cats were not anesthetized and one of the eyes was treated with one drop of 0.5% tropicamide to check for maximal pupil diameter. RESULTS: Faster onset and longer duration of sufficient mydriasis (>10 mm) were observed in epinephrine treatment group, when comparing with cats treated with both doses of lidocaine. Eyes treated with epinephrine achieved the largest maximum pupil diameter (mm) when comparing with eyes treated with 0.3 mL of lidocaine (11.01 ± 0.16), tropicamide (10.66 ± 0.17), and 0.2 mL of lidocaine (10.23 ± 0.12) (P < .0001). In all groups, IOP decreased significantly at T0, but tended to return to baseline at T60. HR and MAP did not change significantly during time and among treatments. CONCLUSIONS: The intracameral injection of 0.2 mL of 1:100 000 epinephrine and 0.3 mL of 2% lidocaine can be used as an alternative to tropicamide in healthy cats. Both treatments produced satisfactory and long-lasting mydriasis without adverse effects on IOP, HR, and MAP.

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IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.Case ReportTwo critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.DiscussionThe novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.Conclusion:Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations. HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field expedient vasopressors during aeromedical evacuation: a case series from the Puerto Rico disaster response. Prehosp Disaster Med. 2018;33(6):668-672.

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OBJECTIVE: To compare a new simple algorithm for preeclampsia (PE) prediction among Brazilian women with two international guidelines - National Institute for Clinical Excellence (NICE) and American College of Obstetricians and Gynecologists (ACOG). METHODS: We performed a secondary analysis of two prospective cohort studies to predict PE between 11 and 13+6weeks of gestation, developed between August 2009 and January 2014. Outcomes measured were total PE, early PE (<34weeks), preterm PE (<37weeks), and term PE (≥37weeks). The predictive accuracy of the models was assessed using the area under the receiver operator characteristic curve (AUC-ROC) and via calculation of sensitivity and specificity for each outcome. RESULTS: Of a total of 733 patients, 55 patients developed PE, 12 at early, 21 at preterm and 34 at term. The AUC-ROC values were low, which compromised the accuracy of NICE (AUC-ROC: 0.657) and ACOG (AUC-ROC: 0.562) algorithms for preterm PE prediction in the Brazilian population. The best predictive model for preterm PE included maternal factors (MF) and mean arterial pressure (MAP) (AUC-ROC: 0.842), with a statistically significant difference compared with ACOG (p<0.0001) and NICE (p=0.0002) guidelines. CONCLUSION: The predictive accuracies of NICE and ACOG guidelines to predict preterm PE were low and a simple algorithm involving maternal factors and MAP performed better for the Brazilian population.

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The present study evaluated the effects of maternal dyslipidaemia on blood pressure (BP), cardiorespiratory physiology and biochemical parameters in male offspring. Wistar rat dams were fed either a control (CTL) or a dyslipidaemic (DLP) diet during pregnancy and lactation. After weaning, both CTL and DLP offspring received standard diet. On the 30th and 90th day of life, blood samples were collected for metabolic analyses. Direct measurements of BP, respiratory frequency (RF), tidal volume (VT) and ventilation (VE) under baseline condition, as well as during hypercapnia (7 % CO2) and hypoxia (KCN, 0·04 %), were recorded from awake 90-d-old male offspring. DLP dams exhibited raised serum levels of total cholesterol (TC) (4·0-fold), TAG (2·0-fold), VLDL+LDL (7·7-fold) and reduced HDL-cholesterol (2·4-fold), insulin resistance and hepatic steatosis at the end of lactation. At 30 d of age, the DLP offspring showed an increase in the serum levels of TC (P<0·05) and VLDL+LDL (P<0·05) in comparison with CTL offspring. At 90 d of age, DLP offspring exhibited higher mean arterial pressure (MAP, approximately 34 %). In the spectral analysis, the DLP group showed augmented low-frequency (LF) power and LF:high-frequency (HF) ratio when compared with CTL offspring. In addition, the DLP animals showed a larger delta variation in arterial pressure after administration of the ganglionic blocker (P=0·0003). We also found that cardiorespiratory response to hypercapnia and hypoxia was augmented in DLP offspring. In conclusion, the present data show that maternal dyslipidaemia alters cardiorespiratory physiology and may be a predisposing factor for hypertension at adulthood.

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The purpose of this study was to determine the association between cardiometabolic risk with body mass index and skinfold independently or in combination in youth. This cross-sectional study comprised a convenience sample of 450 children and adolescents (255 girls), aged 10 to 18 years old. Indicators of body composition were measured, and hemodynamic assessment completed. The association between body mass index and/or sum of skinfolds and cardiometabolic risk (z score of the sum of triglycerides/high density lipoprotein cholesterol, waist circumference, and mean blood pressure), was calculated using Generalized Linear Models Regression. The results showed that youngsters classified as overweight or obese with the highest skinfold measurements had the strongest association with cardiometabolic risk (< beta >: 2.60; IC 95%: 2.25-3.0) when compared with those exhibiting normal skinfold thickness (< beta >: 1.78; IC 95%: 1.30-2.20). Body mass index was most strongly associated with cardiometabolic risk (< beta >: 1.78; IC 95%: 1.3-2.2), in comparison to skinfold thickness, which was associated to a lesser extent (< beta >: 0.41; IC 95%: 0.34-0.49). Results of this cross-sectional study indicate that body mass index is more strongly associated with cardiometabolic risk than skinfold thickness. However when these two measures of overweight/obesity are combined, prediction of cardiometabolic risk is further improved. It is therefore important that public health professionals consider both body mass index and sum of skinfolds to better predict cardiometabolic risk in overweight and obese youth. Implications for future research include the use of longitudinal designs and inclusion of children from other racial/ethnic groups.

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AIM: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). METHODS: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. RESULTS: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76-0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81-0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72-0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. CONCLUSION: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.

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Abstract:AimTo describe a simple and efficacious monitoring system for patients presenting with severe dengue with severe plasma leakage.Method: We reviewed sixty-one out of 110 records of patients presenting with dengue in August and September of 1999 at the Hospital Tony Facio, Limón province, Costa Rica.Results: Dengue virus 3 was the cause of the epidemic. Thirty one (51%) patients presented with warning sings, and thirty (49%) had severe dengue with severe plasma leakage. Those patients presenting with hypotension (low mean arterial blood pressure) were treated with an intravenous polyelectrolyte solution in order to maintain the mean arterial pressure between the lower and mean range. When the mean arterial pressure presented a tendency to rise over the normal range, the infusion was withdrawn. The hematocrit was not the parameter used to monitor the treatment of the patients. There were no deaths.Conclusions: Monitoring the mean arterial blood pressure instead of the hematocrit values in patients with severe dengue with severe plasma leakage represents an easier and more efficacious way of treating this patient population.

Resumen:Objetivo:describir un sistema de monitoreo más simple y eficiente para pacientes con dengue grave con extravasación de plasma severa.Método:se revisaron 61 de 110 expedientes de pacientes que presentaban dengue, entre agosto y setiembre de 1999, en el Hospital Tony Facio de la provincia de Limón en Costa Rica.Resultados:el virus de dengue tipo 3 causó la epidemia. Treinta y uno (51%) de los pacientes presentaron signos de alarma, treinta (49%) presentaron dengue grave con extravasación de plasma severa. Los pacientes que presentaban hipotensión (baja presión sanguínea media) fueron tratados con solución de polielectrolitos intravenosa para mantener la presión arterial media entre el rango inferior y la media. En cuanto la presión arterial media presentaba una tendencia a incrementar sobre el rango normal, la infusión era retirada. El hematocrito no fue un parámetro para monitorear el manejo de los pacientes. No hubo muertes.Conclusiones:El monitorear la presión arterial media, en lugar de los valores de hematocritos, en pacientes con dengue grave con extravasación severa representa una manera más fácil y eficiente de tratar a esta población de pacientes.

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BACKGROUND: It has been proposed that sildenafil citrate can increase ocular blood flow, and that this property can be used to treat ocular disorders that involve reflex vasoconstriction. This study therefore proposes to ascertain the vasodilator effect of the drug on retrobulbar circulation in healthy rabbits. For this matter rabbits treated with sildenafil citrate or saline solution had their intraocular pressure (IOP), mean arterial pressure (MAP), ocular perfusion pressure (OPP) and color Doppler imaging of the external ophthalmic artery measured prior to treatment and on days one (moment M1), seven (when M2), fourteen (moment M3), twenty-one (moment M4), and thirty (moment M5) of treatment. RESULTS: The MAP and OPP values of treated group were lower than those of control group at all times, and the mean values differed statistically at moments M1 (S = 71.52 mmHg, C = 84.76 mmHg, p = 0.0356) and M5 (S = 71.38 mmHg, C = 85.52 mmHg, p = 0.0252). The IOP and color Doppler values of the external ophthalmic artery did not differ between tested groups. CONCLUSIONS: The dose of 10 mg of sildenafil citrate administered to healthy rabbits causes systemic vasodilation and consequently lower values of MAP and OPP. However, it does not induce changes in IOP and retrobulbar hemodynamics identifiable by color Doppler assessment of the external ophthalmic artery.

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