Sudden Cardiac Death in Brazil: A Community-Based Autopsy Series (2006-2010)

Background: Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause, that occurs in less than one hour after the symptoms onset, in a person without any previous condition that would seem fatal or who was seen without any symptoms 24 hours before found dead. Although it is a relatively frequent event, there are only few reliable data in underdeveloped countries. Objective: We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000 residents) according to Coroners’ Office autopsy reports. Methods: We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to identify cases of SCD. Specific cause of death as well as demographic information, date, location and time of the event, comorbidities and whether cardiopulmonary resuscitation (CPR) was attempted were collected. Results: We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year. The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%) and occurred in men (67%), between the 6th and the 7th decades of life. Most events occurred during the morning in the home setting (53.3%) and CPR was attempted in almost half of victims (49.7%). The most prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was present in 49 cases (5.5%). Conclusion: The majority of victims of SCD were men, in their sixties and seventies and the main cause of death was CAD. Chagas’ disease, an important public health problem in Latin America, was found in about 5.5% of the cases.

Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE)

Background: Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. Objective: To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. Methods: 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%). Results: There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. Conclusion: Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.

Balanço hídrico de Guarea trichilioides L., na estação seca, em São José do Rio Preto

Guarea trichilioides L.4, (= Guarea guara (N.J. Jacquin) P. Wilson) é uma meliácea arbórea silvestre, fornecedora de madeira vermelha e conhecida, na região de São José do Rio Preto, pelo nome de "Marinheiro". Foi estudado o balanço hídrico desta planta na estação seca, pelo método das pesagens rápidas de folíolos destacados, verificando-se que, nas condições consideradas, não houve, praticamente, restrição acentuada da transpiração nas horas mais desfavoráveis do dia. A transpiração relativa foi bastante elevada, comparável aquela de outras árvores da mesma formação e bem superior à das árvores da floresta pluvial tropical. A transpiração cuticular foi baixa, comparável à da maioria das árvores da citada floresta pluvial e bem inferior àquela de muitas plantas permanentes do cerrado. O movimento hidroativo dos estômatos foi relativamente rápido na fase inicial, tornando-se, porem, bastante vagaroso antes de atingir o valor da transpiração cuticular. O deficit de saturação foi pequeno, comparável ao das árvores da floresta pluvial. O estudo do balanço hídrico e da estrutura foliar levam a considerar Guarea trichilioides como uma árvore da floresta tropical não adaptada a suportar condições de seca intensa.

Dispersão larval pós-alimentar de Lucilia sericata (Diptera, Calliphoridae) em condições de laboratório

Os dípteros califorídeos são os primeiros indivíduos a compor a sucessão faunística de cadáveres em decomposição, auxiliando assim na estimativa do intervalo pós-morte. Estudos de dispersão pós-alimentar de suas larvas possuem relevância para investigações médico-criminais. Diante disto, uma arena circular, simulando o ambiente natural, foi montada em laboratório a fim de verificar-se a dispersão larval radial pós-alimentar de Lucilia sericata (Meigen, 1826), tentando assim estabelecer relações entre as variáveis peso, distância e profundidade de enterramento na arena. Os resultados demonstraram que 45% das pupas foram recuperadas a uma profundidade compreendida entre 6 cm e 8 cm e a uma distância entre 33 cm e 45 cm do centro da arena. Não houve diferenças significativas quanto à propagação e profundidade de enterramento de machos, fêmeas e indivíduos inviáveis. Com relação ao peso, verificou-se que a média das fêmeas (x = 32,35 mg) foi superior a dos machos (x = 30,28 mg). A análise de correlação e de regressão entre peso e distância percorrida e entre peso e profundidade foram positivas, ou seja, pupas oriundas de larvas mais pesadas propagaram e se aprofundaram mais. O experimento permitiu ainda concluir que uma arena circular possibilita o deslocamento das larvas em todas as direções.

Profilaxia da anemia ancilostomótica: sindrome de carencia

É apresentada uma revisão das recentes aquisições na anemia ancilostomótica, assinalando a importância de alimentação qualitativamente deficiente junto á infestação helmíntica na gênese desta doença. Acentuou-se que a anemia ancilostomótica é uma doença de carência. Profilaxia clássica da Ancilostomose resume-se em evitar a infestação do homem pelos ancilostomídeos. Critica-se a aplicabilidade destas medidas e eficiência das mesmas no que diz respeito á incidência da anemia. O presente trabalho mostra aquisições preliminares sôbre fundamentos de uma profilaxia de carência (tipo profilaxia do bócio endêmico) da anemia ancilostomótica, baseada na administração de alimentos contaminados por um sal de ferro. As misturas sulfato ferroso-farinha de mandióca e citrato férrico amoniacal-caldo de feijão, mostraram-se eficientes em prevenir a queda das cifras hemáticas durante largos períodos de tempo em indivíduos maciçamente infestados (6-8 meses). Não foi verificada a dose diária mínima eficiente dêstes sais, obtendo-se resultados satisfatorios mesmo com 0.1 g diária de sulfato ferroso (correspondendo a 0.037 g de ferro metálico). Numerosos alimentos e sais de ferro foram experimentados com resultados infrutíferos por diferentes razões. A influência dos helmintos, pela hemorragias intestinais que acarretam poude ser mais uma vez estudada, nos casos de sais de ferro administrados em doses ineficientes ou em períodos de prova sem medicação marcial. É proposta nova classificação de intensidade de infestação, levando em consideração o conhecido fato de ser a atividade dos helmintos, exclusivamente expoliadora. Em conclusão, nos parece exequível a profilaxia da anemia ancilostomótica mediante ingestão de alimentos contaminados por quantidades eficientes de sais de ferro. Êste método profilático extremamente econômico será na prática, provàvelmente, muito superior aos métodos de profilaxia anti-helmíntica, que além de onerosos são pouco práticos, pois interferem em hábitos enraizados nas populações rurais.

Adição de ferro aos alimentos como método corretivo de anemias ferro-sensíveis

Em operarios pertencentes à Emprêsa Nacional de Contruções Civis e Hidraulicas, os autores administram sais de ferro misturados á alimentos. A um primeiro grupo (88 homens) fornecem sulfato na dose de 0.5g diária por homem, de mistura com farinha de mandióca durante 30 dias. A um segundo grupo (35 homens), depois de um período semelhante, administraram citrato ferrico amoniacal pardo, no dóse de 0.7g por homem, diariamente, de mistura com caldo de feijão, por mais trinta dias. Na tabela abaixo podemos apreciar os resultados: Com a diminuição do número de indivíduos com baixo teor de hemoglobina, no final da prova, as curvas hemogloninicas do segundo grupo tornaram-se visivelmente leptokurticas em relação á cuva normal. Concluindo verifica-se portanto, á administração marcial, nas dóses indicadas uma maior sensibilidade dos indivíduos de teor baixo de hemoglobina do que os indivíduos que possuem uma taxa de hemoglobina próxima da normal.

Contribuição ao estudo do problema alimentar da Amazônia

Salientando os diversos aspectos a atender, para a solução racional do problema da alimentação na Amazônia, aliás já fixados em 1941 pela Comissão que traçou as linhas gerais de um plano de saneamento dessa vasta região, aludem os A.A. às realizações já empreendidas dentro do programa traçado, e que versaram apenas sôbre os hábitos alimentares de um grande núcleo de população e sôbre o valor nutritivo de alguns elementos pouco conhecidos da fauna e da flora locais. Abordam, à guisa de ensaio, neste trabalho, o ponto concernente ao planejamento de regimes adequados, que se adaptem tanto às exigências, como as possibilidades regionais. Frisam, então, de início, as bases racionais a que devem eles obedecer respeito não só à redução do total de calorias, fornecidas, nos seus 2/3, por hidratos de carbono e ao qual se subordinam as cotas das três principais vitaminas do complexo B,* como também a restrição, igualmente indicada, da taxa de proteínas; respeito, ainda, as cotas recomendáveis das vitaminas A e C e de cálcio, dando aí especial atenção ao detalhe da sua aproveitabilidade. Referem, de passagem, à conveniência de não se descurar do problema do ferro alimentar, em face das endemias reinantes na região e das dificuldades para fazer, artificialmente, o enriquecimento marcial dos regimes, já que, para instituí-los, partem do principio de ser vantajoso lançar mão de recursos de produção local, sem ficar em marcada dependência de grandes centres distribuidores regionais. Mostrando as dificuldades para a utilização, na escala desejada, da carne e leite de vaca, como artigos básicos de regime — e apontam, entre os percalços, os inerentes ao transporte e conservação desses alimentos — apresentam uma tabela básica, para o adulto em trabalho moderado, a qual lhe fornece 2.600 calorias diárias e obedece aos pontos fundamentais já aludidos. Nela figuram: os peixes, cujas variedades de pequeno porte poderão, com vantagem, ser consumidas fritas ou torradas, com espinhas; o amendoim; as verduras de produção econômica na Amazônia, incluídas na lista as ramas de batata doce, da mandioca e do inhame; essas raízes e tubérculos feculentos, de parceria com o cara; a farinha de mandioca, de grande uso na região; frutas, em que e, alias, rica a flora local; melado ou rapadura, como boa fonte de açucarados, cálcio e ferro; gorduras de origem animal e vegetal. Detêm-se, a propósito de cada um desses alimentos, sôbre o seu valor nutritivo e as possibilidades reais de produção local ou regional. Enumeram, por fim, vários outros, a que, similarmente, será possível recorrer, em maior ou menor escala — criação de animais domésticos, caças, carne e ovos de tartaruga, arroz, raízes, brotos de palmeiras, feijão de vara, castanhas de sapucaia, do caju e do Para — numa demonstração de ser possível a Amazônia valer-se, de muito, a si própria, no tocante à alimentação das suas populações.

Compositae: Mutisia Lutzii G. M. Barroso n. sp

Planta muitíssimo interessante, que se distingue das demais espécies do gênero pela forma pectinada da folha. Dedicamos a linda espécie ao Dr. Adolpho Lutz, eminente sábio, que tanto trabalhou em prol da ciência, no Brasil.

Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.

BACKGROUND: Data from prospective cohort studies regarding the association between subclinical hyperthyroidism and cardiovascular outcomes are conflicting.We aimed to assess the risks of total and coronary heart disease (CHD) mortality, CHD events, and atrial fibrillation (AF) associated with endogenous subclinical hyperthyroidism among all available large prospective cohorts. METHODS: Individual data on 52 674 participants were pooled from 10 cohorts. Coronary heart disease events were analyzed in 22 437 participants from 6 cohorts with available data, and incident AF was analyzed in 8711 participants from 5 cohorts. Euthyroidism was defined as thyrotropin level between 0.45 and 4.49 mIU/L and endogenous subclinical hyperthyroidism as thyrotropin level lower than 0.45 mIU/L with normal free thyroxine levels, after excluding those receiving thyroid-altering medications. RESULTS: Of 52 674 participants, 2188 (4.2%) had subclinical hyperthyroidism. During follow-up, 8527 participants died (including 1896 from CHD), 3653 of 22 437 had CHD events, and 785 of 8711 developed AF. In age- and sex-adjusted analyses, subclinical hyperthyroidism was associated with increased total mortality (hazard ratio[HR], 1.24, 95% CI, 1.06-1.46), CHD mortality (HR,1.29; 95% CI, 1.02-1.62), CHD events (HR, 1.21; 95%CI, 0.99-1.46), and AF (HR, 1.68; 95% CI, 1.16-2.43).Risks did not differ significantly by age, sex, or preexisting cardiovascular disease and were similar after further adjustment for cardiovascular risk factors, with attributable risk of 14.5% for total mortality to 41.5% forAF in those with subclinical hyperthyroidism. Risks for CHD mortality and AF (but not other outcomes) were higher for thyrotropin level lower than 0.10 mIU/L compared with thyrotropin level between 0.10 and 0.44 mIU/L(for both, P value for trend, .03). CONCLUSION: Endogenous subclinical hyperthyroidism is associated with increased risks of total, CHD mortality, and incident AF, with highest risks of CHD mortality and AF when thyrotropin level is lower than 0.10 mIU/L.

Epidemiological study of bancroftian filariasis in Recife, Northeastern Brazil

Wuchereria bancrofti in Pernambuco was first documented in 1952 (Azevedo & Dobbin 1952), and since then it has been reported in surveys carried out in selected areas of Recife. Several surveys were carried out from 1981 to 1991 by SUCAM. In the 1985 SUCAM's report the disease is considered under control. The CPqAM Filariasis Research Program was established in 1985 and a filarial survey was carried out in the town of Olinda, Greater Recife. In order to verify the real epidemiological situation, a study was conducted in the city of Recife. 21/36 of the Special Zones of Social Interest (ZEIS), were randomly selected for the present study. From 10,664 persons screened, 683 were positive and the prevalence rate for microfilaraemia (mf) varied from 0.6% to 14.9%. A mean mf prevalence of 6.5%, showed that the infection occurs in a wide geographic distribution in Greater Recife and that the intensity of transmission is a real and potential threat to public health in affected communities. Mf rate among males and females differed significantly. Due to the rapid increase in population, unplanned urban settlements, poor sanitary facilities and the favorable geographical conditions to the development of the vector, filariasis may actually be increasing in Recife.

Characteristics of the bological cycle of Lutzomyia evandroi Costa Lima & Antunes, 1936 (Diptera: Psychodidae) under experimental conditions

Lutzomyia evandroi Costa Lima and Antunes, 1936 is found in Rio Grande do Norte, northeastern Brazil, in areas of visceral and mucocutaneous leishmaniasis and follows the same geographic distribution of L. longipalpis. The biological cycle, oviposition, morphological and behavioral characteristics of the species were studied under experimental conditions. The average number of eggs per wild caught female varied from 21 to 50 eggs along the year, with a peak occurring between January and March and another in August, with oviposition lasting for 4 to 12 days. The mean larval phase was 24 days. Ovipositing rates were influenced by rainfall and temperature indexes, with an increase of eggs per oviposition at the beginning and at the end of the rainy season, and a decrease at the peak of the rainy season.

Autotransplant of spleen tissue in children with schistosomiasis: evaluation of splenic function after splenosis

Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneomococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 ± 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90% and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65% of the patients of this series.

Larvicidal activity of the essential oil from Lippia sidoides cham. against Aedes aegypti linn

The aim of this work was to study the larvicidal activity of Lippia sidoides essential oil against Aedes aegypti larvae. The essential oil and its hydrolate (saturated solution of essential oil in water) were obtained by vapor extraction and their chemical composition determined by GL-chromatography coupled to mass spectroscopy. Bioassays were run with the essential oil, pure and diluted hydrolate and with their main constituents thymol and carvacrol. The results obtained showed that L. sidoides essential oil and its hydrolate have larvicidal action against the mosquito A. aegypti, causing an almost instantaneous mortality. Thymol, an alkylated phenol derivative and one of the major components of L. sidoides essential oil, was identified as the active principle responsible for the larvicidal action, causing 100% larval mortality at the lowest tested concentration of 0.017% (w/v). These results suggest that the essential oil of L. sidoides is promising as larvicide against A. aegypti and could be useful in the search of newer, more selective, and biodegradable larvicidal natural compounds to be used in official combat programs and at home.

Efficiency of rubidium marking in Aedes albopictus (Diptera: Culicidae): preliminary evaluation on persistence of egg labeling, survival, and fecundity of marked female

Rubidium chloride (RbCl) has been used for the study of vector biology and behavior, although the efficacy of marking, egg production, and survivorship of marked females have been poorly studied. Four concentrations of RbCl were tested, among which 0.025 M was the best for marking Aedes albopictus: more than 80% of egg batches of females fed once with blood containing RbCl were marked; Rb-marked egg batches, interspersed with non marked ones were recovered until 61 days after a blood meal containing RbCl followed by non marked meals; RbCl was essentially detected in the abdomen of marked females, whose egg production and survivorship did not differ from non marked ones, at least in the three weeks following the Rb-marked blood meal.

Candida colonization in intensive care unit patients' urine

The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU) patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100%) and indwelling urinary catheter (92.6%). The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.