Ronaldo D'Avila

Similaridade entre os valores da pressão arterial aferida pelo método auscultatório com aparelho de coluna de mercúrio e o método oscilométrico automático com aparelho digital

INTRODUCTION: One of the biggest challenges in the management of hypertension is adequate blood pressure (BP) control. To achieve this goal, home blood pressure measurement (HBPM) with automated devices has been encouraged. However, part of the medical community still disputes its validity, believing that HBPM may lead to incorrect readings. OBJECTIVE: To evaluate the correspondence between the simultaneous measurements of BP with the auscultatory method and an oscillometric digital method, commonly used in HBPM. METHODS: BP was determined simultaneously in 423 individuals (normotensive and hypertensive) with a validated automated digital device (ONROM 705IT) and with the auscultatory method with a mercury sphygmomanometer. Both devices were connected through a Y-shaped connection to a cuff whose size was adjusted to the arm circumference. RESULTS: The values represent mean ± SD (minimum-maximum values): age 40.8 ± 16.3 years (18-92), arm circumference 28.2 ± 3.7 cm (19-42), systolic BP (SBP) auscultatory 127.6 ± 22.8 mmHg (69-223), SBP automated 129.5 ± 23.0 mmHg (56-226), diastolic BP (DBP) auscultatory 79.5 ± 12.6 mmHg (49-135) DBP automated 79.0 ± 12.6 mmHg (48-123). The mean difference in SBP between the two methods was 1.9 mmHg (-15 to +19) and 0.5 mmHg for DBP (-19 to +13). The Bland-Altman analysis showed clinically acceptable agreement between the methods. CONCLUSION: BP measured with the automated method closely mirrors that determined with the conventional auscultatory method and should be used to improve the diagnosis and control of hypertension.

Parameters of glycemic control in type 2 diabetic patients on hemodialysis or peritoneal dialysis: implications for clinical practice

OBJECTIVE To better explore the relationship between parameters of glycemic control of T2DM in RRT, we studied 23 patients on hemodialysis (HD), 22 on peritoneal dialysis (PD), and compared them with 24 T2DM patients with normal renal function (NRF). MATERIALS AND METHODS We performed, on four consecutive days, 10 assessments of capillary blood glucose [4 fasting, 2 pre- and 4 postprandial (post-G) and average (AG)], random glycemia, and HbA1c in all patients. RESULTS Preprandial blood glucose was greater in patients on RRT compared with NRF. Correlations between AG and HbA1c were 0.76 for HD, 0.66 for PD, and 0.82 for NRF. The regression lines between AG and HbA1c were similar for patients on HD and with NFR, but they were displaced upward for PD. CONCLUSION Similar HbA1c values in PD patients may correspond to greater levels of AG than in HD or NRF patients.

Demanda variável e produtividade em medicina diagnóstica: a experiência do cliente com o agendamento de exames

INTRODUCAO: A rabdomiolise e a destruicao rapida de musculo esqueletico causada por fatores fisicos, quimicos ou biologicos. Esta lise leva a liberacao de alguns produtos, como a mioglobina, para a circulacao, podendo levar a insuficiencia renal aguda. OBJETIVO: Relatar o caso de um paciente com rabdomiolise macica secundaria a uma infeccao pelo virus da dengue em um hospital terciario. METODOLOGIA: Analise do prontuario e revisao da literatura. RELATO DO CASO: JSB, masculino, 72 anos, hipertenso, diabetico, tabagista, com DPOC, admitido no servico com historia de fraqueza generalizada associada a tosse produtiva ha um dia, sendo realizada hipotese diagnostica de DPOC exacerbada. Foi iniciado Levofloxacino, sem melhora do quadro infeccioso. Posteriormente, foram solicitados sorologias para leptospirose, hantavirose e dengue, sendo a ultima positiva. Evoluiu para insuficiencia renal aguda, com exames na entrada de CPK: 26580, ureia 219, creatinina 11. Paciente foi internado em UTI onde permaneceu por 30 dias, realizando hemodialise durante um period de 23 dias. Recebeu alta com deficit de funcao renal (CR 2,4; Ur 61) e foi encaminhado ao ambulatorio de nefrologia. CONCLUSAO: A rabdomiolise pode cursar com quedas muito abruptas da funcao renal. Em um quadro de dengue isso geralmente nao ocorre, sobretudo na intensidade vista no paciente acima. Em locais onde a dengue e comum, pacientes devem ser acompanhados de perto pois os quadros podem ser muito graves e necessitar de suporte imediato e internacao em UTI.

Educação nutricional para pacientes renais crônicos em programa de hemodiálise

Introduction: Nutritional education is an important matter for hemodialysis patients because it can change patient behavior and, therefore, improve nutritional status, decreasing risks of inadequate diets. Objectives: To evaluate the effects of a specific nutritional education program developed for patients undergoing hemodialysis and the changes that may be induced by the program. Methodology: The effects of the nutritional education program were studied in 27 hemodialysis patients (13 men) with mean age of 50.2±13 years. Before and after the nutritional program, patients answered feed surveys and had their basic nutritional knowledge, laboratory test results, and interdialytic weight gain evaluated. The educational nutrition program itself was evaluated by questioning patients on their impressions and perceptions on the course. Results: A low level of knowledge of nutritional basic aspects was observed before the course, while a significant improvement of understanding was verified after the course (24% and 60% of correct answers before and after the course, respectively; p<0.0001). It was possible to observe a significant reduction of the blood potassium level after the course (5.2±0.9 vs 4.7±0.7mEq/L; p=0.029, before and after the course, respectively), but other laboratory variables were not modified. The feed questionnaire and the interdialytic weight gain were similar in both moments: pre and post course. The evaluation of the course by the patients was extremely positive. Conclusions: The educational nutrition program promoted a gain of knowledge in nutritional aspects for dialysis patients, but it did not foster significant changes in the quality or amount of food intake, interdialytic weight gain, and laboratorial levels. A positive assessment of the program was observed. It is possible that changes in the nutritional aspects and laboratorial levels demand more monitoring time.