Prevalence of excessive daytime sleepiness in Brazilian community-dwelling older adults with very low levels of schooling, and its association with sociodemographic characteristics and lifestyle: the Bambuí Health and Ageing Study (BHAS)

OBJECTIVE: Population-based studies on excessive daytime sleepiness (EDS) in older adults living in less developed countries are scarce. The purpose of this paper was to estimate the prevalence of EDS and its association with sociodemographic characteristics and lifestyle factors in Brazilian community-dwelling older adults. METHODS: The study was carried out in Bambuí, a city in the state of Minas Gerais, Brazil. EDS was defined as the presence of sleepiness in the last month occurring three or more times per week, with any interference in usual activities. The exploratory variables were: gender, age, skin color, marital status, schooling level, current employment status, religion, recent migration, smoking, binge drinking and physical activities during leisure time. RESULTS: Of 1,742 residents aged > 60 years, 1,514 (86.9%) participated. The prevalence of EDS was 13%. After adjustment for confounders, female gender and low schooling level remained positively and independently associated with EDS. CONCLUSIONS: The prevalence of EDS in the study population was within the range observed in studies carried out in developed countries. The most impressive finding was the association of EDS with schooling, indicating that even in a population with low levels of schooling, this was an important factor to explain the distribution of EDS.

Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT) underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF) current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

Epidemiological characteristics of congenital heart diseases in Londrina, Paraná South Brazil

OBJECTIVE: To determine the prevalence and other epidemiological characteristics of congenital heart diseases. METHODS: A retrospective population based study of children who were born in Londrina, from January '89 to December '98 (80,262 live births). Diagnoses were confirmed through autopsy, surgery, catheterization, or echocardiography. RESULTS: A total of 441 patients was as certained what corresponds to a prevalence of 5.494:1,000 live births. Ventricular septal defect was the commonest lesion. A small number of transpositions of the great vessels and of left ventricular hypoplasia was observed. A high propation of ventricular septal defect (28.3%) and atrioventricular septal defects (8.1%) occurred. Fifty-one (11.35%) affected children had syndromic diseases and 52 (12.01%) children had nonsyndromic anomalies. CONCLUSION: The prevalence of congenital heart diseases in Londrina is in accordance with that of other regions of the globe. This prevalence also may reflect the reality in the southern region of Brazil, because population characteristics are very similar in the 3 southernmost Brazilian states.

Structural and functional characteristics of rat hearts with and without myocardial infarct. Initial experience with doppler echocardiography

OBJECTIVE: To assess by Doppler echocardiography the structural and functional alterations of rat heart with surgical induced extensive myocardial infarction. METHODS: Five weeks after surgical ligature of the left coronary artery, 38 Wistar-EPM rats of both sexes, 10 of them with extensive infarction, undergone anatomical and functional evaluation by Doppler echocardiography and then euthanized for anatomopathological analysis. RESULTS: Echocardiography was 100% sensible and specific to anatomopathological confirmed extensive miocardial infarction. Extensive infarction lead to dilatation of left ventricle (diastolic diameter: 0.89cm vs.0.64cm; systolic: 0.72cm vs. 0.33cm) and left atrium (0.55cm vs. 0.33cm); thinning of left ventricular anterior wall (systolic: 0.14cm vs. 0.23cm, diastolic: 0.11cm vs. 0.14cm); increased mitral E/ A wave relation (6.45 vs. 1.95). Signals of increased end diastolic ventricle pressure, B point in mitral valve tracing in 62.5% and signs of pulmonary hypertension straightening of pulmonary valve (90%) and notching of pulmonary systolic flow (60%) were observed in animals with extensive infarction. CONCLUSION: Doppler echocardiography has a high sensitivity and specificity for detection of chronic extensive infarction. Extensive infarction caused dilatation of left cardiac chambers and showed in Doppler signals of increased end diastolic left ventricular pressure and pulmonary artery pressure.

Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3±12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

Intra-His bundle block: clinical, electrocardiographic, and electrophysiologic characteristics

OBJECTIVE: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. RESULTS: Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; 4 (25%) pt had intra-His Wenckebach phenomenon, which correlated with Mobitz I (MI) atrioventricular block on the electrocardiogram. Seven (44%) pt had 2:1 atrioventricular block, 2 of whom were asymptomatic (12.5%). One (6%) pt had intra- and infra-His bundle block. Clinically, 11 (68%) pt had syncope or presyncope, 3 (18%) had dyspnea on exertion, and 2 (12.5%) were asymptomatic. Eight (50%) pt had bundle-branch block as follows: 4 (25%) pt had left bundle-branch block, and 4 (25%) had right bundle-branch block. Left anterosuperior divisional block was observed in 3 pt (19%), 2 of whom with associated right bundle-branch block. CONCLUSION: Intra-His bundle block was observed in 11% of the pt with second-degree atrioventricular block, syncope or presyncope, or both, it being the most frequent clinical presentation. Intra-His bundle block was more common in the elderly (> 60 years) and among females. The most frequent electrocardiographic presentations were second-degree Mobitz I or type 2:1 atrioventricular block.

White-coat hypertension and normotension in the League of Hypertension of the Hospital das Clínicas, FMUSP: prevalence, clinical and demographic characteristics

OBJECTIVE: To assess the prevalence of white-coat normortension, white-coat hypertension, and white-coat effect. METHODS: We assessed 670 medical records of patients from the League of Hypertension of the Hospital das Clínicas of the Medical School of the University of São Paulo. White-coat hypertension (blood pressure at the medical office: mean of 3 measurements with the oscillometric device ³140 or ³90 mmHg, or both, and ambulatory blood pressure monitoring mean during wakefulness < 135/85) and white-coat normotension (office blood pressure < 140/90 and blood pressure during wakefulness on ambulatory blood pressure monitoring ³ 135/85) were analyzed in 183 patients taking no medication. The white-coat effect (difference between office and ambulatory blood pressure > 20 mmHg for systolic and 10 mmHg for diastolic) was analyzed in 487 patients on treatment, 374 of whom underwent multivariate analysis to identify the variables that better explain the white-coat effect. RESULTS: Prevalence of white-coat normotension was 12%, prevalence of white-coat hypertension was 20%, and prevalence of the white-coat effect was 27%. A significant correlation (p<0.05) was observed between white-coat hypertension and familial history of hypertension, and between the white-coat effect and sex, severity of the office diastolic blood pressure, and thickness of left ventricular posterior wall. CONCLUSION: White-coat hypertension, white-coat normotension, and white-coat effect should be considered in the diagnosis of hypertension.

Impact of nutritional counseling in reducing serum cholesterol in public health service patients

OBJECTIVE: To assess the impact of nutritional attention on the lipid profile and nutritional status of hypercholesterolemic patients attended in health centers of Belo Horizonte. METHODS: Using nutritional attendance patient record cards from two health units, the evolution of the lipid profile and the nutritional state (BMI) was monitored of 96 hypercholesterolemic patients who received diet. The patients were appraised at the following moments: initial (1st consultation), after 3 months (2nd consultation) and last consultation (variable for each patient). RESULTS: On the first attendance, 44,4% of the patients presented not only high total cholesterol and LDL-c, but also hypertriglyceridemia and 70.3% were overweight or obese, but most patients (75.6%) presented adequate HDL-c levels. There was significant reduction in the BMI, total cholesterol, LDL-c values (p < 0.01) and also in the triglyceride levels (p < 0.05) in the first three months, without alteration in the HDL-c levels. A significant reduction (p < 0.01) was observed in the frequency of individuals with high cholesterol (from 89.6% down to 47.9%), high and very high LDL-c (from 82.6% down to 45.7%), as well as high and very high triglyceride (from 43.6% down to 16.7%). The observed reduction in frequency of the low HDL-c was statistically meaningless. CONCLUSION: This study evidences the effect of the nutritional attention on lipid profile in hypercholesterolemic patients, reinforcing the need for a multiprofessional team to attend them at the public health services.

Demographic characteristics of the population undergoing cine coronary angiography at the Instituto do Coração of the Medical School of USP from 1986 to 1995

OBJECTIVE: To obtain information about the profile and behavior of a population with ischemic heart disease undergoing cine coronary angiography and to determine disease severity. METHODS: Retrospective study assessing patients hospitalized at InCor from 1986 to 1995, in which the variables age, sex, and number of major coronary arteries with obstruction degree > 40% were analyzed. RESULTS: We studied 18,221 patients and observed a significant increase in the number of females (22.8% to 25.2%, P=0.001) and an increase in age (57.1±29.3 to 60.4±10.7 years, P=0.0001). A significant increase in the incidence of multivessel disease was observed, which was more frequent among males (69.2% and 64.5%) and among the older patients (59.8±9.8 and 56.8±10.7 years, P=0.0001). A reduction in the incidence of single-vessel disease was also observed (66.2% vs 69.2% and 33.8% vs 30.5%, respectively, P<0.0001). CONCLUSION: A change in the profile of the population studied was observed as follows: patients undergoing cine coronary angiography at InCor were older, had a greater number of impaired major coronary arteries, and the number of females affected increased, leading to indices suggestive of a poorer prognosis.

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods: We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results: Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions: We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

Sex ratio and morphological characteristics of rufous gnateaters, Conopophaga lineata (Aves, Passeriformes) in Atlantic forest fragments

Unequal sex ratios lead to the loss of genetic variability, decreasing the viability of populations in the long term. Anthropogenic activities often disturb the natural habitats and can cause alterations in sex ratio and morphological characteristics of several species. Forest fragmentation is a major conservation concern, so that understanding its effects in natural populations is essential. In this study, we evaluated the sex ratio and the morphological characteristics of Rufous Gnateaters (Conopophaga lineata (Wied, 1831)) in small and large forest fragments in Minas Gerais, Brazil. Birds (n = 89) were sexed by plumage characteristics and molecular markers. The molecular analysis showed that plumage is not a totally reliable method for sexing Rufous Gnateaters. We observed that sex ratio did not differ between large and small forest fragments, but birds in small fragments had larger wings and tarsus. Wing and tarsus changes may affect the movement ability of individuals within and among forest fragments. In conclusion, Rufous Gnateaters have been able to survive in both small and large Atlantic rain forest fragments without altering their sex ratio, but morphological changes can be prejudicial to their long term survival.

Reproductive characteristics of characid fish species (Teleostei, Characiformes) and their relationship with body size and phylogeny

In this study, I investigated the reproductive biology of fish species from the family Characidae of the order Characiformes. I also investigated the relationship between reproductive biology and body weight and interpreted this relationship in a phylogenetic context. The results of the present study contribute to the understanding of the evolution of the reproductive strategies present in the species of this family. Most larger characid species and other characiforms exhibit a reproductive pattern that is generally characterized by a short seasonal reproductive period that lasts one to three months, between September and April. This is accompanied by total spawning, an extremely high fecundity, and, in many species, a reproductive migration. Many species with lower fecundity exhibit some form of parental care. Although reduction in body size may represent an adaptive advantage, it may also require evolutionary responses to new biological problems that arise. In terms of reproduction, smaller species have a tendency to reduce the number of oocytes that they produce. Many small characids have a reproductive pattern similar to that of larger characiforms. On the other hand they may also exhibit a range of modifications that possibly relate to the decrease in body size and the consequent reduction in fecundity. Examples of changes in the general reproductive pattern include the following: reduction in the size of mature oocytes; increase in fecundity; production of several batches of oocytes; an extended reproductive period or even continuous reproduction that allows individuals to reproduce more than once a year; high growth rates; rapid recruitment of juveniles; presence of more than one reproductive cohort that increases the sexually active population; and multiple independent development of insemination as a reproductive strategy. These changes are possibly associated with adaptive pressures that are related to the reduction in body size. In addition, such reproductive characteristics or novelties may reflect the phylogenetic history of a given species.

Diversity and population characteristics of terrestrial isopods (Crustacea, Oniscidea) across three forest environments in southern Brazil

Terrestrial isopods are important and dominant component of meso and macrodecomposer soil communities. The present study investigates the diversity and species composition of terrestrial isopods on three forests on the Serra Geral of the state of Rio Grande do Sul, Brazil. The area has two natural formations (Primary Woodland and Secondary Woodland) and one plantation of introduced Pinus. The pitfall traps operated from March 2001 to May 2002, with two summer periods and one winter. There were 14 sampling dates overall. Of the five species found: Alboscia silveirensis Araujo, 1999, Atlantoscia floridana (van Name, 1940), Benthana araucariana Araujo & Lopes, 2003 (Philoscidae), Balloniscus glaber Araujo & Zardo, 1995 (Balloniscidae) and Styloniscus otakensis (Chilton, 1901) (Styloniscidae); only A. floridana is abundant on all environments and B. glaber is nearly exclusive for the native forests. The obtained data made it possible to infer about population characteristics of this species. The Similarity Analysis showed a quantitative difference among the Secondary forest and Pinus plantation, but not a qualitative one. The operational sex ratio (OSR) analysis for A. floridana does not reveal significant differences in male and female proportions among environments. The reproductive period identified in the present study for A. floridana was from spring to autumn in the primary forest and Pinus plantation and during all year for the secondary forest. The OSR analysis for B. glaber reveals no significant differences in abundance between males and females for secondary forest, but the primary forest was a significant difference. The reproductive period for B. glaber extended from summer to autumn (for primary and secondary forest). This is the first record for Brazil of an established terrestrial isopod population in a Pinus sp. plantation area, evidenced by the presence of young, adults and ovigerous females, balanced sex ratio, expected fecundity and reproduction pattern, as compared to populations from native vegetation areas.

Estudos dos agrupamentos vegetativos relacionados com as áreas onde foram efetuadas as pesquisas sôbre a febre amarela silvestre no Município de Passos, Estado de Minas Gerais

The work reported here was carried-out on the invitation of Dr. Henry Kumm, Director of the Rockefeller Foundation, and by appointment from Dr. Henrique Aragão, Director of the Instituto Oswaldo Cruz. It was done during the investigation of sylvan yellow fever, in June 1947, with a view to establishing the phyto-ecological conditions of the county of Passos. The pe¬riod was, however, too short for definite conclusions to be reached. Thanks are due to Dr. O. R. Causey, Chief of Research on Yellow Fever for transpor¬tation and other help. THE REGIONAL VEGETATION. Aerial photographs of the county of Passos shoto that it is covered by three great types of vegetation: Rain Forest, Secondary Pasture Land and Scrub.1 Detailed investigation, however, brings out the fact that these correspond to different seres; furthermore, each type presents not only the specific, characteristics of the biological form dominant for the climate, but also are at various stages, which express HABITATS differing from those of the normal sere. The phytogeographic survey of the region shows that most of it is now covered by secondary pasture land (disclimax) in which Melinis minutiflora, v. "fat grass" (fig. 1), predominates. The mosaic of Rain Forest and of small patches of Scrub reveals the effects of human intervention (BARRETO, H. L. de Mello 1); consequently, all the formations have to be regarded as secon¬dary, though some of them probably include relicts of the primitive climax (WARMING, E. 2). On close examination, the Scrub cannot be considered as the climax, because of the following facts: 1. In the zone of Rain-Forest stretches of forest are present in very varied topographic conditions and the reconstitution of the associations show that man has destroyed an ecological unit (fig. 2). 2. In the zone of Scrub the characteristic patches are small. The banks of rivers and brooks, the valleys and ravine and whatever the soil has retained some humidity, is being invaded fry Rain Forest, which seems to be growing under optimum conditions. The Scrub is thus limited to small belts on the calcareous mountains and on sandy soils with alcaline depths (pH abo¬ve 7) which do not retain enough moisture for the Rain Forest that is progres¬sively restricting the area occupied by Scrub. In view of the topographic and present climatic conditions the Rain Forest must consequently be regarded as the regional climax. The presence of ecologically contradictory elements and associations shows that the real problem is that of the fluctuations of the climate of Passos or even of Minas Geraes during the quaternary and recent periods (DAN-SEREAU, P. : 3), a subject on which little is known and which is tied to the evolution of the climate of Brazil (OLIVEIRA, E. : 4) . The transformation of Scrub into Rain Forest has been - observed by the author before, in other parts of Brazil (VELOSO, PL P.: 5) . It seems probable that the Rio Grande has also greatly influenced the change of the regional vegetation, by invading areas of Scrub and dislocating the limit of the Pluvial climate towards the Canastra Range, though there are remnants of Scrub (postclimax) transfor¬med into secondary open country (disclimax, fig. 5) by human devastation and the setting of fire to the land. VEGETATION GROUPS OF THE PLUVIAL TYPE. The map of the region also shows that at the present time the small patches of forest (whether devasted or intact) occupy the least accessible places, such as valleys, peaks and abrupt slopes (fig. 2). Even these are now being destroyed, so that in the near future this forested region will be en¬tirely reduced to poor pasture land unless energetic measures of conservation are undertaken in time. The Special Service for Prophylaxis against Yellow Fever installed two of their four Stations for the Capture of Mosquitos in this area, one of them at Batatal and the other at Cachoeira, which have separate formations each of them composed of several associations. Other vegetation formations were also analysed, from the synecological point of view, so as to ascertain of which degree of succession their associations belong. These phytosociological sur¬veys give an idea of the principal characteristics of each station. BATATAL FORMATION. The abrupt nature of the valley has rendered this location inappropriate for agricultural purposes since colonial times. The relict of the primitive forest climax saved by this circumstance has expanded gradually to zones whose paedologic conditions favour the eatablishment of mesophilous species. The aerial photograph shows two small stretches of forest, one apparently primi¬tive, the other composed of associations belonging to the subclimax of the subsere. CACHOEIRA FORMATION. Aerial photographs show that this station is crossed by a small river, which divides it into two separate parts. The first, which presents ecological conditions similar, though not identical to those of Batatal, is favoured by topography and apparently remains primitive forest. Though the topography of the other, on the whole, favours the establishment of groups belonging to the normal sere of the climax, is has been partly devastated recently and the aspect of the associations has been completely modified. It was is this part that the four posts for the capturing of mosquitos were set up. The first forest is favoured by deposition of organic matter, washed out from the nearby devasted areas by torrential rains, and thus provides, an appropriate HABITAT for the climax species with certain hygrophilous trends of the ecological quasiclimax type. This association seems to have reached a biological equilibrium, as the dominates. Gallesia gorarema and Cariniana legalis (fig. 10), present an optimum vitality with a vigorous habit and a normal evolutionary cycle. The Cariniantum legalis Gallesiosum equilibrium, corresponds however, to a provisory association, because if the moving of soil by torrential rains should cease it would become possible…

Some characteristics of hyperreactivity to bacterial lipopolysaccharide induced in mice by Trypanosoma cruzi infection

Mice infected with T. cruzi strain, acquire a high level of susceptibility to the effects of bacterial gram-negative LPS. The LD50 of adult female SW mice to LPS from S. typhosa, decreases from 450 to 2,5 mcg 10-12 days after T. cruzi infection. This hyperreactivity to LPS induced by T. cruzi presents all the characteristics of that found in infection caused by many other agents. During the acaute phase of experimental infection with T. cruzi Y strain, mice generally die with a hypovolemic shock very similar to that induced in uninfected animals injected with an adequate dose of bacterial endotoxin. There is evidence for and against the hypothesis that LPS absorbed from the instestinal tract may be involved in the mechanism of death of mice during the acute phase of T. cruzi infection.