Desempenho e gastos do SUS com revascularizações do miocárdio no Estado do Rio de Janeiro, de 1999 a 2008

FUNDAMENTO: Os gastos com cirurgia de revascularização do miocárdio (RVM) e angioplastia coronariana (AC), representaram importante ônus para o SUS. OBJETIVO: Analisar gastos do SUS com RVM e AC e sua performance nos hospitais do Estado do Rio de Janeiro (ERJ), de 1999 a 2008. MÉTODOS: As informações provieram das AIH pagas dos hospitais com mais de 100 revascularizações. As taxas de letalidade foram ajustadas por modelos Poisson (covariáveis idade, dias de permanência no hospital e gasto em UTI). Foram construídos índices de gasto médio relativo, dividindo-se o valor médio da fração de gasto em cada hospital pelo gasto médio no ERJ, em dólares. Para análise estatística empregou-se o Stata. RESULTADOS: Foram pagas 10.983 RVM e 19.661 AC em 20 hospitais nos 10 anos, com valores médios de US$ 3.088,12 e 2.183,93, respectivamente. A taxa de letalidade nas RVM flutuou de 9,2%-1999 para 7,7%-2008, com valores extremos de 5,0%-9,2% e nas AC de 1,6%-1999 para 1,5%-2008, com valores extremos de 0,9%-2,3%. Os hospitais diminuíram a realização de RVM e duplicaram a de AC. Idade, tempo de internação e gastos em UTI correlacionaram-se significativamente com a letalidade nas RVM e AC pagas no ERJ. Em média, os gastos com os serviços hospitalares representaram 41% do total das RVM e 18% das AC, e os com as órteses e próteses, 55% das AC e 28% nas RVM. CONCLUSÃO: Evidencia-se necessidade de melhorar a qualidade do atendimento das instituições que realizam RVM e AC pagas pelo SUS.

Cardiovascular Research Publications from Latin America between 1999 and 2008. A Bibliometric Study

Background:Cardiovascular research publications seem to be increasing in Latin America overall.Objective:To analyze trends in cardiovascular publications and their citations from countries in Latin America between 1999 and 2008, and to compare them with those from the rest of the countries.Methods:We retrieved references of cardiovascular publications between 1999 and 2008 and their five-year post-publication citations from the Web of Knowledge database. For countries in Latin America, we calculated the total number of publications and their citation indices (total citations divided by number of publications) by year. We analyzed trends on publications and citation indices over time using Poisson regression models. The analysis was repeated for Latin America as a region, and compared with that for the rest of the countries grouped according to economic development.Results:Brazil (n = 6,132) had the highest number of publications in1999-2008, followed by Argentina (n = 1,686), Mexico (n = 1,368) and Chile (n = 874). Most countries showed an increase in publications over time, leaded by Guatemala (36.5% annually [95%CI: 16.7%-59.7%]), Colombia (22.1% [16.3%-28.2%]), Costa Rica (18.1% [8.1%-28.9%]) and Brazil (17.9% [16.9%-19.1%]). However, trends on citation indices varied widely (from -33.8% to 28.4%). From 1999 to 2008, cardiovascular publications of Latin America increased by 12.9% (12.1%-13.5%) annually. However, the citation indices of Latin America increased 1.5% (1.3%-1.7%) annually, a lower increase than those of all other country groups analyzed.Conclusions:Although the number of cardiovascular publications of Latin America increased from 1999 to 2008, trends on citation indices suggest they may have had a relatively low impact on the research field, stressing the importance of considering quality and dissemination on local research policies.

Determinacion de las relaciones polimorficas entre Teladorsagia circumcincta (Stadelmann, 1894) y Teladorsagia trifurcata (Ransom, 1907) en condiciones experimentales

En el presente estudio se demostró que Teladorsagia circumcincta (Stadelmann, 1894) y T. trifurcata (Ransom, 1907), nemátodes Trichostrongylidae de la sub-família Ostertagiinae, parasitan un espectro de hospedadores similares. La ausencia de barreras reproductivas entre T. trifurcata y T. circumcincta, así como la estabilización rápida de las proporciones de las dos entidades en el seno de la población, evidencia que T. trifurcata es un morfo de T. circumcincta.

Sobre o isolamento de uma cepa humana de Schistosoma mansoni, Sambon, 1907

In this paper the authors briefly describe a human Schistosoma mansoni strain from Pará State, Brazil. The CIRENE'S strain was capable of infecting 71.4% of the snail vector Biomphalaria glabrata (Telegrafo's strain) provided by the "Evando Chagas" Institute, Belém. The cycle was completed by the infection of six mice. The thoracic and abdominal organs were examined microscopically which demonstrated the passage of the worm into the liver and lungs. The authors discuss the importance of these results in the epidemiology of schistosomiasis in Pará.

Planorbis meridaensis Preston, 1907 (Gastropoda: Planorbidae), a synonym of Biomphalaria prona (Martens, 1873)

Biomphalaria prona from Lake Valencia, Venezuela (type locality) has a polymorphic shell wich in the great majority of specimens is wider, with fewer rapidly expanding whorls, the outer one subcarinate on the left side and more or less strongly deflected leftward. Besides those modal forms there are little frequent variants characterized by narrower shell with less rapidly expanding, regularly curved whorls directed forward. Recent studies have shown that such variants constitute the predominant shell phenotype in extralacustrine populations, but are anatomically and biochemically indistinguishable from the modal class of the Lake. In the present paper it is demonstrated that the nominal species Planorbis meridaensis Preston, 1907, from Mérida, Venezuela, is identical with B. prona (Martens, 1873) of wich it must be considered a junior synonym.

Host-induced morphological changes of Schistosoma mansoni Sambon, 1907 male worms

In order to evaluate the permissiveness of Nectomys squamipes to Schistosoma mansoni and the influence of the albino mice on the morphological aspects of adult worms derived from a population isolated from N. squamipes, the morphology of adult S. mansoni Sambon, 1907 male worms was studied using a digital image analyser (MOP VIDEOPLAN) and light microscopy. Their sources were as follows: (1) recovered from the wild rodent N. squamipes Brants naturally infected from Sumidouro, RJ, Brazil; (2) recovered from albino mice experimentally infected with the strain derived from N. squamipes; (3) recovered after the isolation of a strain derived from aboriginal human infections in Sumidouro. Worms recovered from N. squamipes (group 1) showed body lenght and distance between suckers significantly bigger than those of the specimens maintained in mice (groups 2 and 3). The number of tests in group 1 was statistically less than of groups 2 and 3. Group 2 strains which were maintained in mice, presented the lenght of the worms as the only significant different character. Data show that: (1) N. squamipes is a more suitable host for the development of S. mansoni when compared to the albino mice; (2) a strain of S. mansoni isolated from a natural host undergoes morphological changes after its passage in the white mouse.

Morphological Study of Adult Male Worms of Schistosoma mansoni Sambon, 1907 by Scanning Electron Microscopy

Tubercles, spines and sensory receptors are the most studied structures of adult male worms of Schistosoma mansoni isolated in other countries. The purpose of this investigation was to properly define these structures in Brazilian worms. Specimens 7-8 weeks after infection were recovered from albino SW mice and from a wild rodent (Nectomys squamipes) and processed for scanning electron microscopy studies. Photomicrographs of the anterior region with the aspects related to the outer and inner regions of both suckers were considered. The ventral portion of the middle region was represented by the anterior of gynaecophoric canal while the dorsal surface was studied in its ventral and dorsal regions mainly focusing the aspect of the tubercles, spines and sensorial papillae. The outer surface of the oral sucker is spiny and spines are bigger, sharp with sensory receptors in their posterior edge. Tubercles with spines or receptors are more concentrated in the middle region and in one of the margins of the gynaecophoric canal. An excretory pore-like structure in the posterior portion was observed. The gynaecophoric canal has few sensory structures, spines broadned in their mid-region and are sharp pointed at the distal end. It was concluded that the presently studied characters are similar to those previously reported

Biodistribution Study of the Anaesthetic Sodium Phenobarbital Labelled with Technetium-99m in Swiss Mice Infected with Schistosoma mansoni Sambon, 1907

Technetium-99m (99mTc) is a radionuclide that has negligible enviromnental impact, is easily available, inexpensive and can be used as a radioactive tracer in biological experiences. In order to know the mode of action of sodium phenobarbital in moving adult Schistosoma mansoni worms from mesenteric veins to the liver, we labelled sodium phenobarbital (PBBT) with 99mTc and a biodistribution study in infected and non-infected Swiss mice was performed. The PBBT was incubated with stannous chloride used as reducing agent and with 99mTc, as sodium pertechnetate. The radioactivity labelling (%) was determined by paper ascending chromatography perfomed with acetone (solvent). The 99mTc-PBBT was administered by intraperitoneal route to Swiss mice infected eight weeks before. The animals were perfused after diferent periods of time (0,1,2,3,4 hr) when blood, spleen, liver, portal vein, mesenteric veins, stomach, kidneys and adult worms were isolated. The radioactivity present in these samples was counted in a well counter and the percentage was determined. The radioactivity was mainly taken up by the blood, kidney, liver and spleen. No radioactivity was found on the adult worms. We concluded that the worm shift was due to an action on the host of the sodium phenobarbital

Susceptibility of Nectomys rattus (Pelzen, 1883) to experimental infection with Schistosoma mansoni (Sambon, 1907): a potential reservoir in Brazil

The aim of the present research was to evaluate the potential of Nectomys rattus, the "water rat", to develop Schistosoma mansoni infection. Comparison with N. squamipes was carried out. Both species of rodents were submitted to transcutaneous infection using different infective cercariae loads: 50, 100 or 500. N. rattus showed high susceptibility to S. mansoni, with an infection rate of 71%. Rodents were able to excrete viable eggs of S. mansoni in the feaces during all infection period. For both species, the small intestine, followed by the liver and the large intestine, presented the highest concentration of eggs among the surveyed organs. Infection caused no animal death. Moreover, N. rattus accomplished the parasite's life cycle, by infecting the snails Biomphalaria glabrata and later Mus musculus. These evidences indicate that both N. rattus, as for N. squamipes are potential reservoirs for schistosomiasis in Brazil. Considering the fact that N. rattus and N. squamipes exist in the same natural ecosystems of S. mansoni, we suggest that these rodents must be regarded as influential factors in epidemiology surveys.

Morphological study of adult male worms of Schistosoma mansoni Sambon, 1907 by confocal laser scanning microscopy

Aiming to detail data obtained through brightfield microscopy (BM) on reproductive, excretory and digestive system, specimens of Schistosoma mansoni eight weeks old, were recovered from SW mice, stained with Langeron's carmine and analyzed under a confocal laser scanning microscope CLSM 410 (Carl Zeiss). The reproductive system presented a single and lobate testis, with intercommunications between the lobes without efferent duct. Supernumerary testicular lobe was amorphous and isolated from the normal ones. Collecting tubules (excretory ducts), followed by the excretory bladder, opening to the external media through the excretory pore, were observed at the posterior extremity of the body. In the digestive tract, a cecal swelling was noted at the junction that originates the single cecum. It was concluded that through confocal laser scanning microscopy, new interpretations of morphological structures of S. mansoni worms could be achieved, modifying adopted and current descriptions. The gonad consists of a single lobed testis, similar to that observed in some trematode species. Moreover, the same specimens can be observed either by BM or CLSM, considering that the latter causes only focal and limited damage in tissue structures.

Schistosoma mansoni Sambon, 1907: morphometric differences between adult worms from sympatric rodent and human isolates

A computer software for image analysis (IMAGE PRO PLUS, MEDIA CYBERNETICS) was utilized in male and females adult worms, aiming the morphological characterization of Schistosoma mansoni samples isolated from a slyvatic rodent, Nectomys squamipes, and humans in Sumidouro, Rio de Janeiro, Brazil and recovered from Mus musculus C3H/He. The following characters for males's testicular lobes were analyzed: number, area, density, larger and smaller diameter, longer and shorter axis and perimeter and extension; for females: area, longer and shorter axis, larger and smaller diameter and perimeter of the eggs and spine; oral and ventral suckers area and distance between them in both sex were determined. By the analysis of variance (one way ANOVA) significant differences (p<0.05) were observed in all studied characters, except for the density of testicular lobes. Significant differences (p<0.05) were detected for all characters in the female worms. Data ratify that sympatric isolates present phenotypic differences and the adult female characters are useful for the proper identification of S. mansoni isolates.

A short review on the morphology of Trypanosoma cruzi: from 1909 to 1999

The morphology of Trypanosoma cruzi is reviewed since the initial description of Giemsa-stained preparations by Carlos Chagas until the most recent micrographs obtained with freeze-fracture techniques. Special emphasis is given to structures such as the cell surface, the flagellum, the kinetoplast, the reservosomes and the endocytic pathway, and the acidocalcisomes.

Differences of susceptibility of five triatomine species to pyrethroid insecticides - implications for Chagas disease vector control

As pyrethroids are presently the favored group of insecticides to control triatomines, we performed a series of bioassays to determine the intrinsic activity of some of the main compounds used in the control campaigns, against five of the main species of triatomines to be controlled. Comparing the insecticides it can be seen that lambdacyhalothrin is more effective than the other three pyrethroids, both considering the LD50 and 99 for all the three species with comparable results. On Triatoma infestans the LD50 of lambdacyhalothrin was followed by that of alfacypermethrin, cyfluthrin and deltamethrin. On Rhodnius prolixus the sequence, in decreasing order of activity, was lambdacyhalothrin, alfacypermethrin, deltamethrin and cyfluthrin. Some modifications can be seen when we compare the LD99, that has more to see to what happens in the field. T. brasiliensis showed to be as sensible to lambdacyhalothrin as T. infestans, the most susceptible for this product. By the other side T. sordida is the least susceptible considering the LD99 of this insecticide.