Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011

Background:Circulatory system diseases are the first cause of death in Brazil.Objective:To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast), from 1996 to 2011.Methods:Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011.Results:Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005.Conclusions:Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes.

Fatty Acid and Cholesterol Concentrations in Usually Consumed Fish in Brazil

Background: Several studies have demonstrated clinical benefits of fish consumption for the cardiovascular system. These effects are attributed to the increased amounts of polyunsaturated fatty acids in these foods. However, the concentrations of fatty acids may vary according to region. Objective: The goal of this study was to determine the amount of,cholesterol and fatty acids in 10 Brazilian fishes and in a non-native farmed salmon usually consumed in Brazil. Methods: The concentrations of cholesterol and fatty acids, especially omega-3, were determined in grilled fishes. Each fish sample was divided in 3 sub-samples (chops) and each one was extracted from the fish to minimize possible differences in muscle and fat contents. Results: The largest cholesterol amount was found in white grouper (107.6 mg/100 g of fish) and the smallest in badejo (70 mg/100 g). Omega-3 amount varied from 0.01 g/100 g in badejo to 0.900 g/100 g in weakfish. Saturated fat varied from 0.687 g/100 g in seabass to 4.530 g/100 g in filhote. The salmon had the greatest concentration of polyunsaturated fats (3.29 g/100 g) and the highest content of monounsaturated was found in pescadinha (5.98 g/100 g). Whiting and boyfriend had the best omega-6/omega 3 ratios respectively 2.22 and 1.19, however these species showed very little amounts of omega-3. Conclusion: All studied Brazilian fishes and imported salmon have low amounts of saturated fat and most of them also have low amounts of omega-3.

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.

Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE

AbstractBackground:Risk scores for cardiac surgery cannot continue to be neglected.Objective:To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.Methods:A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.Results:Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).Conclusion:Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0)

Pulmonary Embolism Mortality in Brazil from 1989 to 2010: Gender and Regional Disparities

Abstract Background: A significant variation in pulmonary embolism (PE) mortality trends have been documented around the world. We investigated the trends in mortality rate from PE in Brazil over a period of 21 years and its regional and gender differences. Methods: Using a nationwide database of death certificate information we searched for all cases with PE as the underlying cause of death between 1989 and 2010. Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). We calculated age-, gender- and region-specific mortality rates for each year, using the 2000 Brazilian population for direct standardization. Results: Over 21 years the age-standardized mortality rate (ASMR) fell 31% from 3.04/100,000 to 2.09/100,000. In every year between 1989 and 2010, the ASMR was higher in women than in men, but both showed a significant declining trend, from 3.10/100,000 to 2.36/100,000 and from 2.94/100,000 to 1.80/100,000, respectively. Although all country regions showed a decline in their ASMR, the largest fall in death rates was concentrated in the highest income regions of the South and Southeast Brazil. The North and Northeast regions, the lowest income areas, showed a less marked fall in death rates and no distinct change in the PE mortality rate in women. Conclusions: Our study showed a reduction in the PE mortality rate over two decades in Brazil. However, significant variation in this trend was observed amongst the five country regions and between genders, pointing to possible disparities in health care access and quality in these groups.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012

Abstract Background: Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. Objective: to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. Results: there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). Conclusion: Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.

Regent advances in the study of the mineral nutrition of cotton in Brazil

Due to the great economic importance of the cotton crop to Brazil, a systematic series of research work has been carried out in recent years dealing with its mineral nutrition an fertilization. A summary of recent finding is given in the following sections.

The status (quo) of VET in Brazil : an empirical study about its function, meaning and impingements from the perspective of former dual system apprentices

Magdeburg, Univ., Fak. für Humanwiss., Diss., 2015

First nesting record of the Bay-Capped Wren-Spinetail Spartonoica maluroides (Aves, Furnariidae) in Brazil, with nest and nestling descriptions and notes on breeding behavior

The only breeding record of Spartonoica maluroides (d'Orbigny & Lafresnaye, 1837) for Brazil is based on the observation of a fledgling in southern Rio Grande do Sul in January 1976. On 7 December 2005 we discovered a nest containing three nestlings at the southeastern end of Lagoa Pequena, municipality of Pelotas, Rio Grande do Sul. The nest was concealed at the base of a cavity in a Spartina densiflora (Poaceae) tussock located at the edge of a saltmarsh. The nest was built of fine pieces of dead Scirpus olneyi (Cyperaceae) and S. densiflora leaves firmly interlaced to the internal leaves of the tussock. Live leaves of S. densiflora lining the cavity comprised a substantial part of the nest's architecture, forming most of its upper lateral walls and roof. The lower section was more elaborate, resembling a deep cup and forming a distinct incubation chamber. Adults reached the nest's interior through an irregular apical opening amidst the leaves. The nest was 244 mm high and 140 mm wide. The incubation chamber had an external diameter of 138.5 mm, an internal diameter of 79.4 mm and was 86 mm deep. It was lined with fine leaves and white plant fibers. Nestlings were five to six days old. A total of 107 neossoptiles restricted to the capital, spinal and alar tracts were recorded in one nestling. The distribution of neossoptiles in the ocular region of S. maluroides forms a distinct pattern which can be typical of Furnariidae and related families. Two adults attended the nest, bringing small insects to the nestlings and removing fecal sacs. We recorded at least 74 visits to the nest during a ca. 6 h period during an afternoon. The average number of visits per hour was 12.8 ± 1.3. An adult bird spent on average 0.7 ± 0.56 minutes inside the nest attending nestlings. The nest remained unattended on average for 3.61 ± 3.13 minutes. The hour of the day had no influence on the amount of time spent by an adult in the nest or away from it. We returned to the area on 15 December 2005 and found the nest abandoned. Observations confirm that S. maluroides is a resident breeder in southern Brazil and that the saltmarshes of the Lagoa do Patos estuary are an important year-round habitat for the species. A nestling and the nest were collected to document the record.

Helminths of introduced house sparrows (Passer domesticus) in Brazil: does population age affect parasite richness?

Species introductions have altered host and parasite diversity throughout the world. In the case of introduced hosts, population age appears to be a good predictor of parasite richness. Habitat alteration is another variable that may impact host-parasite interactions by affecting the availability of intermediate hosts. The house sparrow (Passer domesticus (Linnaeus, 1758)) is a good model to test these predictions. It was introduced in several parts of the world and can be found across rural-urban gradients. A total of 160 house sparrows from Porto Alegre, state of Rio Grande do Sul, Brazil, were necropsied. Thirty house sparrows (19 %) were parasitized with at least one out of five helminth species (Digenea: Tamerlania inopina Freitas, 1951 and Eumegacetes sp.; Eucestoda: Choanotaenia passerina (Fuhrmann, 1907) Fuhrmann, 1932; Nematoda: Dispharynx nasuta (Rudolphi, 1819) Stiles & Hassall, 1920 and Cardiofilaria pavlovskyi Strom, 1937). Overall, there was no difference in prevalence and intensity of infection of any parasite species, parasite richness and community diversity between adult males and females and adults and juveniles. The number of infected sparrows among seasons, the richness of helminths and the abundance of species were also similar between rural and urban landscapes. Only the prevalence of C. passerina varied seasonally (p=0.0007). A decrease in the number of parasite species from the original range of P. domesticus (13) to its port of entrance in Brazil, the city of Rio de Janeiro (nine), to Porto Alegre (five) is compatible with the hypothesis that host population age is a good predictor of parasite richness.

Mammals in the Royal Natural History Museum, Stockholm, collected in Brazil and Bolivia by A.M. Olalla during 1934-1938 / Bruce D. Patterson.

n.s. no.66(1992)