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Luiz Tadeu Giollo-Junior,1,2 Luciana Neves Cosenso-Martin,2 Valquiria da Silva Lopes,2 Manoel Paz Landim,2 Leticia Aparecida Barufi Fernandes,2 Kleber Aparecido de Oliveira,2 Amanda Oliva Spaziani,2 Aleandra Polegati Santos,2 Marco Antonio Silva,2 Juan Carlos Yugar-Toledo,2 Jose Fernando Vilela-Martin2 1General Hospital at Brazilian Army, Curitiba, Parana, Brazil; 2Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, BrazilCorrespondence: Jose Fernando Vilela-Martin, Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São Jose do Rio Preto, 15090-000, São Paulo, Brazil, Email vilelamartin@uol.com.brAbstract: Resistant hypertension (RH) is characterized by being difficult to control, even with the use of various antihypertensive drugs and is associated with target organ lesions and other comorbidities. Thus, new treatment alternatives such as transcutaneous electrical nerve stimulation (TENS) can offer benefits to resistant hypertensive patients by reducing blood pressure (BP) in a non-invasive way and without the need for the association of more antihypertensive drugs. In this case, a patient with RH was submitted to three weekly applications of TENS on the stellate ganglion lasting 40 min each for 1 month. Peripheral and central hemodynamic assessments were performed by 24-h ambulatory BP monitoring (ABPM) before and after TENS applications. After completion of the TENS applications, significant reductions in office systolic (SBP) and diastolic BP (DBP) were observed. There was also a decrease in peripheral SBP and DBP in the 24‐h ABPM and sleep and SBP during wakefulness. Additionally, central parameters including central SBP and pulse wave velocity presented a significant reduction in the 24‐h ABPM, during the wakefulness and sleep. TENS is able to attenuate the sympathetic hyperactivity present in RH cases and decrease the peripheral and central hemodynamic parameters of a resistant hypertensive patient.Keywords: resistant hypertension, blood pressure, central hemodynamic, arterial stiffness, non-pharmacological therapy

Elizabeth do Espirito Santo Cestario,1,&ast; Jose Fernando Vilela-Martin,1,&ast; Luciana Neves Cosenso-Martin,1 Tatiane Azevedo Rubio,1 Jessica Rodrigues Roma Uyemura,1 Valquiria da Silva Lopes,1 Letícia Aparecida Barufi Fernandes,1 Lucia Helena Bonalume Tacito,2 Heitor Moreno Junior,3 Juan Carlos Yugar-Toledo1,&ast; 1Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil; 2Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil; 3Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil&ast;These authors contributed equally to this workCorrespondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email vilelamartin@uol.com.brIntroduction: Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern.Objectives: The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment.Material and Methods: This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals.Results: The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5± 21.0 to 127.0± 14.74 mmHg (p< 0.0001), and DBP decreased from 105.3± 15.5 to 78.11± 9.28 mmHg (p< 0.0001). DRASB group, SBP decreased from 178.4± 21.08 to 134.4 ± 23.25 mmHg (p< 0.0001) and DBP decreased from 102.7± 11.07 to 77.33± 13.75 mmHg (p< 0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p< 0.0001).Conclusion: In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.Keywords: resistant hypertension, natriuretic agents, dual blockade of the renin-angiotensin system, bisoprolol

João Marcos de Menezes Zanatta, Luciana Neves Cosenso-Martin, Valquíria da Silva Lopes, Jéssica Rodrigues Roma Uyemura, Aleandra Marton Polegati Santos, Manoel Ildefonso Paz Landim, Juan Carlos Yugar-Toledo, José Fernando Vilela-Martin Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, BrazilCorrespondence: José Fernando Vilela-MartinInternal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), 5416 Avenida Brigadeiro Faria Lima, Sao Jose Do Rio Preto, SP, 15090-000, BrazilTel +55 17 3201-5727Email vilelamartin@uol.com.brAbstract: Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.Keywords: hypertension, resistant hypertension, medication adherence

BackgroundElectronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients’ medication management. ObjectiveTo assess evidence on (1) whether eHealth for patients’ medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. MethodsWe searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration’s Risk of Bias (RoB) tool. ResultsOur initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P

The Atmospheric Boundary Layer (ABL) is the lowermost part of the troposphere. In this work, we analysed the combination of ABL height estimated continuously by three different remote sensing systems: a ceilometer, a Doppler lidar and a passive Microwave Radiometer, during a summer campaign, which was held in Granada from June to August 2016. This study demonstrates as the combined utilization of remote sensing systems, based on different tracers, can provide detailed information about the height of ABL and their sublayers.

A pesquisa teve por objetivo avaliar os componentes de produção e a produtividade do cultivar de arroz híbrido de sequeiro Ecco comparado as cultivares convencionais BRS Primavera, BRS Sertaneja e Cambará nos municípios de Vilhena e Cerejeiras-RO. O delineamento experimental utilizado foi inteiramente ao acaso com quatro repetições. Os experimentos foram instalados no mês de novembro de 2009, sendo um na Fazenda Experimental da Faculdade da Amazônia, no município de Vilhena-RO, localizada a uma latitude S 12º44'26" e a uma longitude 60º08'45" W, e o outro, também em Campo experimental da Faculdade da Amazônia no município de Cerejeiras-RO localizadoS 13°11'19.6" de latitude e W 060°51'43,9" de longitude.As variáveis avaliadas foram: perfilhamento, número de grãos inteiros e chochos por panícula, peso de 1000 grãos, produtividade em sacas de 60 kg por hectare e rendimento de grãos inteiros.O cultivar híbrido Ecco é o mais indicado para o cultivo nas duas regiões, pois apresentou melhor perfilhamento, maior eficiência no enchimento de grãos, maior peso de 1000 grãos e consequentemente maior produtividade nos dois municípios, além de um alto rendimento de grãos inteiros em relação aos outros cultivares

The Latin American Lidar Network, ALINE a.k.a LALINET is a federation lidar network established in 2008 which became a member of GALION/GAW program in 2013. Currently the network consists of 9 operational stations with the perspective of two more stations to be included. The network today covers more than 18 million Km2 and spans in latitude from -52° to 21° and in longitude from -78° to -47°. It should cover a larger area in the future as planned with the inclusion of more active stations.