Ronaldo Altenburg Odebrecht Curi Gismondi

Left atrial myxoma associated with obstructive coronary artery disease

We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

Artificial neural networks for infant mortality modelling

This work aims to investigate a simple to use and easy to interpret methodology for assessing the relative importance of input variables in artificial neural networks (ANNs) applied to epidemiological modelling. The independent variables were 43 variables of the social, economic, environmental and health sector of 59 Brazilian municipalities, and the outcomes were infant mortality rates from these municipalities. Two assays were developed for the ANN modelling. On the first, all 43 variables were taken as input; and on the second, input variables were chosen with the help of factor analysis (FA). The relative importance of the input variables was investigated by means of bootstrap replications of the ANN model on the second assay. Further, multiple linear regression models (LRMs) were developed with the same data set and compared to the ANN models. The FA analysis allowed the selection of eight variables for the second assay. The percent of explained variance R(2) on the ANNs was in the range 0.74-0.80, while linear models had R(2)=0.4-0.5. These findings were validated by the bootstrap replications, in which the ANN models remained with higher R(2) and lower mean square error than the LRMs. The analysis of the best (second) ANN model indicated the highest ranking of importance for the variables literacy, agricultural and livestock sector jobs, number of commercial establishments and telephones. The approach presented here successfully integrated a data-oriented model with expert knowledge, indicating the potentiality of ANN modelling in the prediction, planning and assessment of public health actions.

Perfil antropométrico de crianças de 0 a 5 anos do Município de Niterói, Rio de Janeiro, Brasil

The Niterói-based Nutritional and Food Surveillance System (SISVAN Niteroi, RJ, Brazil) performed an anthropometric survey which included 2,248 children from zero to 60 months of age in September 1992, during a mass vaccination day program. The purpose was to determine the nutritional status of children from that city. The indexes used were Weight for Age (WA), Weight for Height (WH), and Height for Age (HA), and the reference population was that of the NCHS (National Center for Health Statistics, USA), adopted and recommended by the WHO. The indexes were analyzed using the classifications by Gomez and Z-Scores. Prevalence of undernutrition was calculated on the basis of the proportion of children with Z-scores under -2.00, using HAZ to stabilish chronic forms and WHZ for acute ones. A data base was built using Epi Info, version 5.0 1b, and a special program from CDC (Centers for Disease Control) was used to calculate anthropometric indexes. The results showed as much as 20.1 % of undernutrition, including all forms from the Gomez classification. In the city as a whole, 6.8% had HAZ under -2.00. The results indicated a serious situation of chronic undernutrition that demands continuous nutritional surveillance in Niteroi, and especially in the citys Eastern District.

Functional Vascular Study in Hypertensive Subjects with Type 2 Diabetes Using Losartan or Amlodipine

Background Antihypertensive drugs are used to control blood pressure (BP) and reduce macro- and microvascular complications in hypertensive patients with diabetes. Objectives The present study aimed to compare the functional vascular changes in hypertensive patients with type 2 diabetes mellitus after 6 weeks of treatment with amlodipine or losartan. Methods Patients with a previous diagnosis of hypertension and type 2 diabetes mellitus were randomly divided into 2 groups and evaluated after 6 weeks of treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient evaluation included BP measurement, ambulatory BP monitoring, and assessment of vascular parameters using applanation tonometry, pulse wave velocity (PWV), and flow-mediated dilation (FMD) of the brachial artery. Results A total of 42 patients were evaluated (21 in each group), with a predominance of women (71%) in both groups. The mean age of the patients in both groups was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9 years), with no significant difference in the mean BP [amlodipine group: 145 ± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19 mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ± 9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ± 8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the losartan group. PWV and FMD were similar in both groups. Conclusions Hypertensive patients with type 2 diabetes mellitus treated with amlodipine exhibited an improved pattern of pulse wave reflection in comparison with those treated with losartan. However, the use of losartan may be associated with independent vascular reactivity to the pressor effect.

Implementation of a fault-tolerant PACS over a grid architecture

The goal of this paper is to describe the experience of the Heart Institute (InCor) on the implementation of a fault-tolerant Picture Archiving and Communication System (PACS) over a data grid architecture. The system is centered on a DICOM image server with a distributed storage and failover capability. The proposed data grid architecture is deployed over a gigabit Ethernet network which integrates the two main public Hospitals in Sao Paulo and one University Hospital in Rio de Janeiro, both in Brazil. Distributed data storage in the three sites is managed by the Storage Resource Broker (SRB) developed at the University of California at San Diego. The architecture of the implemented PACS image server can be divided into two major functional modules: a) DICOM protocol handler; b) Distributed storage of image data. Fault-tolerance is achieved by injecting redundancy into the modules, which are provided with failover capability. The DICOM protocol handler comprises a series of server processes hosted by different machines and a load-balancer node which distributes the computational load among the servers. The load balancer is provided with a backup node which is triggered in case of failure, thus assuring the continuous operation of the system. Distributed storage of image data is implemented as a thin software layer over the SRB. Image data are replicated at the three sites, so the PACS server is able to retrieve image data even when only a single site is available. A prototype of the DICOM image server has been deployed in this environment and is currently under evaluation.

Endothelial Dysfunction and Pulse Wave Reflection in Women with Polycystic Ovarian Syndrome

Mailing Address: Ana Rosa Cunha Boulevard 28 de Setembro, 77. Sala 329. Departamento de Clínica Médica. Postal Code: 20551-030, Vila Isabel, Rio de Janeiro, RJ Brazil. E-mail: anarosacunha@gmail.com, anarosacunha@yahoo.com.br Endothelial Dysfunction and Pulse Wave Reflection in Women with Polycystic Ovarian Syndrome Marcelo Burlá,1 Ana Rosa Cunha,1 Ronaldo Gismondi,2 Wille Oigman,1 Mario Fritsch Neves,1 Fernanda Medeiros3 Universidade do Estado do Rio de Janeiro,1 Rio de Janeiro, RJ Brasil Universidade Federal Fluminense,2 Niterói, RJ Brasil Universidade Federal do Estado do Rio de Janeiro,3 Rio de Janeiro, RJ Brasil

Ventricular mass and atrial size in diabetic hypertensive patients using losartan or benazepril

In addition to the cardiovascular complications of atherosclerosis, diabetic patients are also more likely to develop left ventricular hypertrophy and atrial fibrillation (AF). The pathophysiology of these alterations is poorly defined and seems to be multifactorial, involving the coexistence of hypertension, coronary heart disease, increased sympathetic autonomic tone and possibly the direct action of diabetes on the heart.1-3 Studies have shown changes in the left atrium (LA) mechanical function in diabetic patients, before the increase in diameter,4 even without systemic arterial hypertension (SAH)5,6 and alterations in LA dimensions and in the absence of diastolic dysfunction or ventricular hypertrophy,7 suggesting that Diabetes Mellitus (DM) alone leads to structural changes in the LA. Additionally, diabetic hypertensive patients have worse diastolic function than nondiabetic hypertensive ones.3 181 International Journal of Cardiovascular Sciences. 2016;29(3):181-188

Direitos humanos: a diversidade de questões e tensões

ambientes coletivos e nas reivindicacoes politicas, incluem-se as questoes da diversidade, caracteristica da sociedade plural, da dialetica inclusao/exclusao, do enfrentamento e superacao da xenofobia, como tambem da resiliencia, como condicao de enfrentamento de situacoes adversas. Na abordagem da dialetica da inclusao/exclusao, realcam-se o principio de consideracao ao outro, e portanto, a alteridade, assim como o movimento em prol da superacao de preconceitos, que geram atitudes discricionarias e excludentes sobre as diversas manifestacoes das diferentes nuances do mundo e suas expressoes humanas, sejam de natureza etnico-racial, sejam de genero, ou de religiao, ou de cultura, ou de condicoes fisicas ou cognitivas. Assim, o empenho pela inclusao requer compreender o alcance amplo dos focos de exclusao a serem conhecidos, discutidos, visibilizados. Os processos e atitudes de exclusao estao tambem subjacentes ao abuso, cuja discussao tem se incrementado nos estudos academicos, com especial enfase nas areas de educacao, sociologia, psicologia e direito. Os abusos sao expressoes de