Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

Abstract Background: The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective: To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods: Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results: The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). Conclusion: The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

Fractal Dimension in Quantifying Experimental-Pulmonary-Hypertension-Induced Cardiac Dysfunction in Rats

Abstract Background: Right-sided heart failure has high morbidity and mortality, and may be caused by pulmonary arterial hypertension. Fractal dimension is a differentiated and innovative method used in histological evaluations that allows the characterization of irregular and complex structures and the quantification of structural tissue changes. Objective: To assess the use of fractal dimension in cardiomyocytes of rats with monocrotaline-induced pulmonary arterial hypertension, in addition to providing histological and functional analysis. Methods: Male Wistar rats were divided into 2 groups: control (C; n = 8) and monocrotaline-induced pulmonary arterial hypertension (M; n = 8). Five weeks after pulmonary arterial hypertension induction with monocrotaline, echocardiography was performed and the animals were euthanized. The heart was dissected, the ventricles weighed to assess anatomical parameters, and histological slides were prepared and stained with hematoxylin/eosin for fractal dimension analysis, performed using box-counting method. Data normality was tested (Shapiro-Wilk test), and the groups were compared with non-paired Student t test or Mann Whitney test (p < 0.05). Results: Higher fractal dimension values were observed in group M as compared to group C (1.39 ± 0.05 vs. 1.37 ± 0.04; p < 0.05). Echocardiography showed lower pulmonary artery flow velocity, pulmonary acceleration time and ejection time values in group M, suggesting function worsening in those animals. Conclusion: The changes observed confirm pulmonary-arterial-hypertension-induced cardiac dysfunction, and point to fractal dimension as an effective method to evaluate cardiac morphological changes induced by ventricular dysfunction.

Doenças intestinais em cidades brasileiras: associação com elementos climáticos

Enteric fevers and dysenteries showed, during the period 1940-44, a summer prevalence in brazilian cities of the temperate zone. The distribu¬tion of the diseases by four-months periods, selected in acordance with the highest of lowest values of rainfall, mean temperature and absolute humidity induced to suppose that, in those cities, and also in tropical ones, both enteric fevers and dysenteries were closely associated with such climatic factors: enteric fevers mainly with absolute humidity and temperature, and dysenteries with humidity and rainfall. Correlation coefficients, statistically significant, have been obtained comparing monthly waves of climatic factors and corresponding waves of prevalence of the diseases. For enteric fevers, clear associations have been disclosed: with temperature variations in all temperate cities (coefficients ranging from + 0.42 to + 0.75, higher with mean temperature in the previous month) and in two of the four tropical cities (from + 0.26 to ± 0.30); with absolute humidity variations in cities of the first group (from + 0.51 to 0.71) and in the tropical city of Rio ( + 0.26 ± 0.12 and + 0.28 ± 0.12); and also with rainfall variations but only in two temperate cities (from + 0.28 to + 0.64). For dysenteric diseases, in cities of temperate zone similar associations have been found with absolute humidity (values of r, ranging from + 0.32 to + 0.45), with temperature (from + 0.26 to + 0.44); and with rainfall only in Curitiba ( + 0.25 ± 0.12). Recife (tropical city) yielded two significant values : r = — 0.27 ± 0.12 (correlation with mean temperature in the same month) and r = + 0.40 ± 0.11 and -h 0.37 ± 0.11 (between monthly morbidity rates and rainfall, respectively in the same month and in the previous one). Deaths by diarrhea and enteritis, in the cities of the temperate zone, prevailed in spring-summer seasons, also in four-months periods of highest temperature and humidity, for those cities and for the tropical ones, with the exception of Belem in which percentages were identical to those of opposite periods. Still with the exception of Belem, in all cities studied positive correla¬tion coefficients, statistically significant, have been obtained with temperature variations (ranging from + 0.25 to + 0.65 in tropical cities, and from + 0.47 to + 0.76 in temperate zone) and with humidity variations (from + 0.34 to + 0.44 in the first group, and from + 0.43 and + 0.74 in the second) . With rainfall, only Rio (in the tropical region) showed a significant value for r ( + 0.26 ±0:12); similarly in S. Paulo and Curitiba, the values ranged from + 0.46 to + 0.56, while in Porto Alegre there were found — 0.26 ± 0.12 and — 0.32 ± 012, for rainfall variations in the same and previous months.

Temperatura, humidade e pluviosidade nas suas relações com doenças respiratórias, em cidades brasileiras

During the period 1940-44, deaths by respiratory diseases and particularly by influenza and pneumonias prevailed during the winter in brazilian cities of the temperate zone (S. Paulo, Curitiba, Porto Alegre) and, with the exception of Rio de Janeiro, in tropical ones (Belem, Recife, Salvador) particularly during the four-months period of highest absolute humidity. For the first group of cities, negative correlation coefficients, statistically significant, have been uniformly obtained comparing monthly death-rates both with temperature - in the same month and in the previous one (values of r ranging from - 0.36 to - 0.640 - and with similar humidity variations (values of r from - 0.33 to - 0.59); also with rainfall, but only in S. Paulo and Curitiba (values of r from - 0.33 to - 0.61). Such associations have been disclosed irregularly and less frequently for the group of tropical cities: statistically significant values of r, in the death-rates correlations with temperature and humidity variations, have been eventually either positive (Recife, Salvador) or negative (Belem, Rio). Whooping cough showed during the same period a winter incidence in Curitiba and Porto Alegre: the compulsory notification of the disease is not required in S. Paulo, a third one brazilian city of the temperate zone. In the brazilian tropical cities of Belem, Recife, Salvador and Rio, the whooping cough distribution by four-months periods - selected in accordance with the highest or lowest values of rainfall, mean temperature and absolute humidity - induced to suppose that the disease was associated more uniformly with a high rainfall than with a low temperature or a low absolute humidity. However, only a few correlation coefficients statistically significant have been found out: between monthly morbidity rates and mean humidity in the same month and in the previous one in recife (-0.43 and - 0.39), and in Porto Alegre (-0.35 and - 0.46); and between the same rates and temperature variations in this last city (-0.28 and - 0.43).

Endogenous and exogenously-induced immunomodulation of tumour-host responsiveness

In spite of the availability of multiple effector mechanisms of the immune system to combat tumour growth and metastases, their impairment frequently accompanies the appearance of cancer. Factors contributing to this impairment may be related to properties of the host and/or the tumour itself and may be with respect to their origin -endogenous or exogenour. Based on the unique biological behavior of prostate cancer (PCa), and its apparent escape from immune surveillance in the presence of tumour immuno genicity, continuing investigation of endogenous and exogenous factors thought to be relevant to its pathogenesis have been made. For this purpose further studies of the suggested role of human seminal plasma (SePl) and the synthetic oestrogen, diethylstiboestrol (DES), as representative endogenous and exogenous immunomodulatory factors (IMF) of tumour-host responsiveness, together with evaluation of human prostatic tissue extracts and leuprolide (the luteinizing-hormone-releasing-hormone proposed as an alternate to DES therapy) have been made by evaluating their effect on the lytic activity of natural killer (NK) cells. SePl and prostate extracts significantly suppressed NK cell lysis. Physicochemical studies suggest SePl and prostate IMF to be associated with high and low molecular weight macromolecules; and implicate the participation of transglutaminase and prostaglandins. Comparative study of therapeutic levels of DES vs. leuprolide on NK cell lysis demonstrated significant suppression by DES vs. a negligible effect of leuprolide. Metastases are highly prevalent in PCa, and contribute significantly to its morbidity and mortality. Further knowledge of the range of effects of endogenous and exogenous IMF on effector mechanisms of tumour-host responsiveness, to include suppression of NK cells, and elucidation of their nature, may contribute toward our understanding of the unique biological behavior of tumours of the prostate, in addition to improvement in their clinical management.

The Venezuelan experience in the control of Schistosomiasis mansoni

Schistosomiasis mansoni endemic zone of Venezuela is located in the valleys of the north central mountain region, with an extension of 15,000 km2 and inhabited by 5.1 million persons. The disease was discovered in 1906, but an organized Control Program was not established until 1943. Its basic activity has been the control of the snail vector, but prevention of man-water contact, prevention of snail infection, treatment of infected people and sanitary instruction, have also been carried out. Prevalence has diminished from 14.7% (1943-60) to 0.9% (1981-84). At present few active foci still persist, but a low transmission rate and low morbidity makes it difficult to know the exact number of infected people, which has been estimulated to be about 50,000.

The intermediate snail-host: an agenda for future study

The strategy for the control of schistosomiasis has shifted from one directed towards the interruption of transmission to one of reducing morbidity. As a consequence of this change, it appears prudent to reassess the role of the malacologist and malacology and identify the future direction to be taken by the discipline. The present paper addresses these concerns; first, by reviewing the role of the snail-hosts in the epidemiology and control of schistosomiasis, and, secondly, by suggesting areas for future study. The possible application of newer methods in biotechnology for the resolution of malacological problems are discussed.

Control of schistosomiasis in the Gezira

For the control of schistosomiasis in irrigated agricultural schemes, the inhabitants must have: 1) Enough potable water. 2) Latrines. 3) Proprer health education to motivate the community to participate in the control. 4) Proper diagnostic facilities. 5) Proper availabel chemotherapy. 6) Focal mullusciciding. 7) If possible trial of biological and environmental methods control. Following the above methods, we could reduce the prevalence of schistosomiasis from over 50% to about 13%. The important achievement, is the improvement of the health of the community; therefore more production and reduced morbidity and mortality.

The feasibility of forecasting influenza epidemics in Cuba

A large influenza epidemic took place in Havana during the winter of 1988. The epidemiologic surveillance unit of the Pedro Kouri Institute of Tropical Medicine detected the begining of the epidemic wave. The Rvachev-Baroyan mathematical model of the geographic spread of an epidemic was used to forecast this epidemic under routine conditions of the public health system. The expected number of individuals who would attend outpatient services, because of influenza-like illness, was calculated and communicated to the health authorities within enough time to permit the introduction of available control measures. The approximate date of the epidemic peak, the daily expected number of individuals attending medical services, and the approximate time of the end of the epidemic wave were estimated. The prediction error was 12%. The model was sufficienty accurate to warrant its use as a pratical forecasting tool in the Cuban public health system.

Forecast of acute respiratory infections: expected nonepidemic mobidity in Cuba

A forecast of nonepidemic morbidity due to acute respiratory infections were carry out by using time series analysis. The data consisted of the weekly reports of medical patient consultation from ambulatory facilities from the whole country. A version of regression model was fitted to the data. Using this approach, we were able to detect the starting data of the epidemic under routine surveillance conditions for various age groups. It will be necessary to improve the data reporting system in order to introduce these procedures at the local health center level, as well as on the provincial level.

Household-based malaria control in a highly endemic area of Africa (Tanzania): determinants of transmission and disease and indicators for monitoring - Kilombero Malaria Project

The Kilombero Malaria Project (KMP) attemps to define opperationally useful indicators of levels of transmission and disease and health system relevant monitoring indicators to evaluate the impact of disease control at the community or health facility level. The KMP is longitudinal community based study (N = 1024) in rural Southern Tanzania, investigating risk factors for malarial morbidity and developing household based malaria control strategies. Biweekly morbidity and bimonthly serological, parasitological and drug consumption surveys are carried out in all study households. Mosquito densities are measured biweekly in 50 sentinel houses by timed light traps. Determinants of transmission and indicators of exposure were not strongly aggregated within households. Subjective morbidity (recalled fever), objective morbidity (elevated body temperature and high parasitaemia) and chloroquine consumption were strongly aggregated within a few households. Nested analysis of anti-NANP40 antibody suggest that only approximately 30% of the titer variance can explained by household clustering and that the largest proportion of antibody titer variability must be explained by non-measured behavioral determinants relating to an individual's level of exposure within a household. Indicators for evaluation and monitoring and outcome measures are described within the context of health service management to describe control measure output in terms of community effectiveness.

Efficacy of insecticide impregnated bed-nets to control malaria in a rural forested area in Southern Cameron

Due to current spreading of chemoresistant strains of Plasmodium falciparum malaria control must incorporate vector control programmes. Due to well known constraints house sprayings cannot be performed as before. Personal protection can be developed and a large scale use of insecticide treated bed-nets appeared to be very useful to reduce man-vector contact in Asia, South America and West and East Africa. No trial has done is forest Central Africa where transmission is permanent. We performed such a trial in the southern part of Cameroon (using deltamethrin, at 25mg/m*) and obtained similar data to those observed in the Gambia Burkina Faso and Tanzania with a noteworthy reduction of both transmission and high parasitaemia of P. falciparum (respectively 78% and 75%) meaning a drop of malaria morbidity.

Transmission factors in malaria epidemiology and control in Africa

Genetic and environmental components of factors contributing in malaria transmission are reviewed. Particular attention is given to density dependent regulation of vector populations in relation to the survival rate anophelines. The expectation of vector activities are different according to the epidemiological characteristics of malaria, mainly its stability. In areas with perennial and high transmission (stable malaria) vector control could reduce malaria related morbidity and mortality, whithout any effect on the endemicity. However this need further investigations. In areas where the transmission period is very short (unstable malaria), vector control will have an important impact on the disease and the endemicity. Control projects using indoor spraying with insecticide and impregnated bed nets are discussed.

Brazilian contributions to epidemiological aspects of schistosomiasis mansoni

A review of epidemiological aspects of endemic areas for schistosomiasis, especially in Brazil, will be presented. These studies, performed by several authors from different states of the country, have been very useful in indicating the relative efficacy of control measures. For example quoting only one aspect, specific treatment was demonstrated by Brazilian researches to be the most important individual tool for morbidity control. More recently the study of risk factors in endemic areas has been seen to be a very important approach when transmission control is the final goal.