Fecal peritonitis in aging rat model. Therapeutic response to different antibiotic strategies

Abstract Purpose: To evaluate the response of aging rats with sepsis to two different antibiotic regimens. Methods: The study was conducted with 30 aging rats (18 month-old) with autologous feces peritonitis. The animals were divided into three groups: Group 0 received no therapeutic intervention (control), while Group 1 received a single dose of 40 mg/kg meropenem and Group 2 received a single dose of 20 mg/kg moxifloxacin. The intervention in both Groups was made 6 hours after induction of peritonitis. The animals were followed up to 15 days for evaluating morbidity and mortality. The weights at baseline were similar in all groups. Results: At the end of follow-up, weight loss was significantly greater (p=0.0045) in Group 0 (non-intervention controls). Culture from a blood sample at the end of follow-up was positive in all the animals in Group 0, in two animals in Group 1 and in four animals in Group 2. Morbidity/mortality was significantly higher in Group 0 compared to both Groups 1 and 2 (p=0.003) but the scores were not significantly different between Groups 1 and 2 (p=0.6967). Conclusion: Both antibiotic regimens rendered promising results for the treatment of fecal peritonitis.

Gestão e uso dos recursos hídricos e a expansão do agronegócio: água para quê e para quem? / Management and use of water resources and the expansion of agribusiness: water for what and for whom?

Resumo O artigo objetiva realizar uma análise da correlação entre a gestão e o uso dos recursos hídricos com a expansão do agronegócio e seus reflexos na contaminação ambiental e humana, apontando desafios para o SUS no âmbito do monitoramento de agrotóxicos na água para consumo humano. Pesquisa de natureza qualitativa, cuja abordagem metodológica adotada foi o estudo de caso aplicado em área de expansão do agronegócio no semiárido cearense. Os resultados demonstram que existe uma relação desigual na gestão e uso da água, em que há priorização do seu acesso para o agronegócio no Ceará, em detrimento de grande parte da população camponesa. Em consequência, a contaminação por agrotóxicos de águas superficiais e profundas traz desafios para a vigilância do controle destes na água para consumo humano. Nesse sentido, apresentam-se alternativas para subsidiar os serviços de saúde a uma atuação mais efetiva das vigilâncias em saúde de modo geral, e do Vigiagua em específico, tais como: a superação da fragmentação do olhar e das intervenções sobre os problemas de saúde; a exposição humana a múltiplos agrotóxicos; a insuficiência de laboratórios e de profissionais capacitados; ampliação de divulgação de informações aos usuários da água.

Abstract This article aims to conduct an analysis of the correlation between the management and use of water resources with the expansion of agribusiness and its reflections in environmental and human contamination, pointing toward challenges for SUS in the area of monitoring pesticides in water for human consumption. It is qualitative study with an adopted methodological framework of the case study, applied in an area of agribusiness expansion in the semi-arid region of the state of Ceará. The results demonstrate that there exists an unequal relationship in the management and use of water, in which agribusiness in Ceará is prioritized for access to water at the expense of the great majority of the rural population. As a result, pesticide contamination of surface and ground water brings challenges to surveillance of the control of pesticides in water for human consumption. In this sense, we present alternatives to develop health services with more effective actions in surveillance of health in general, and of Vigiagua in particular, such as: overcoming the fragmentation of vision and intervention regarding health problems; human exposure to multiple pesticides; the lack of laboratories and trained professionals; and enlarging the dissemination of information to the users of water.

Retinal nerve fiber layer in hepatosplenic schistosomiasis mansoni patients: analysis using optical coherence tomography / Camada de fibras nervosas da retina em portadores de esquistossomose mansônica na forma hepatoesplênica: análise por tomografia de coerência óptica

Purpose: To evaluate the retinal nerve fiber layer thickness in patients with the hepatosplenic schistosomiasis mansoni using optical coherence tomography. Methods: It was performed a observational, analytic, cross-sectional study. The group of patients enrolled 24 individuals (13 females and 11 males), aged from 27 to 73 years (55.7±11.6 years). In the control group were included 22 subjects (12 females and 10 males) aged from 31 to 77 years (55.4±16.5 years). Of the 92 eyes evaluated, three were excluded because they have opaque media, which made impossible to perform the test. All participants underwent a complete ophthalmologic examination and measurement of the retinal nerve fiber layer using optical coherence tomography. Results: The mean thickness of retinal nerve fiber layer was 98.1±15.2µm in the studied group and 114.2±10.0 µm in the control group (p<0.001). Conclusions: There was a significant decrease in the retinal nerve fiber layer thickness in all quadrants in patients with hepatosplenic schistosomiasis.

Objetivo: Avaliar a espessura da camada de fibras nervosas da retina em portadores de esquistossomose mansônica na forma hepatoesplênica utilizando a tomografia de coerência óptica. Métodos: Realizou-se estudo observacional, analítico, de corte transversal. O grupo de doentes foi composto por 24 indivíduos (13 femininos e 11 masculinos), com idades variando entre 27 e 73 anos (55,7±11,6 anos). No grupo controle foram incluídos 22 indivíduos (12 femininos e 10 masculinos) com idades entre 31 e 77 anos (55,4±16,5 anos). Dos 92 olhos avaliados, três foram excluídos por apresentarem opacidade de meios que impossibilitaram o exame. Todos os participantes foram submetidos ao exame oftalmológico completo e medida da camada de fibras nervosas da retina pela tomografia de coerência óptica. Resultados: A média das espessuras da camada de fibras nervosas da retina foi de 98,1±15,2μm no grupo de estudo e 114,2±10,0 μm no grupo controle (p<0,001). Conclusão: Observou-se diminuição significante da espessura da camada de fibras nervosas da retina, em todos os quadrantes, nos pacientes com esquistossomose mansônica na forma hepatoesplênica.

Brain damage and congenital cataract due to autogenously fecal peritonitis in pregnant Wistar rats

PURPOSE: To investigate the morphological aspects of brain and eyes in newborn rats whose mother underwent autogenously fecal peritonitis. METHODS: Four pregnant rats that underwent fecal peritonitis, with a 10% fecal suspension in dose of 4 ml per kilogram received two antimicrobial treatments: 1. intraperitoneal moxifloxacin and dexamethazone; and 2. Intravenous meropenem. After head inspection, the brain consistencies and the eyes belonging to all offspring were analyzed. RESULTS: The brains of newborn from rats that received 4 ml/kg of 10% suspension of feces showed, significantly smaller and less than the firm consistency of those in the control group. Congenital cataract was observed in 9 (34.6%). No cataract was observed in the 20 newborn rats from the mothers that received the combination of moxifloxacin and dexamethasone. Cataract could be observed in three (13.6%) offspring from mothers that received meropenem. CONCLUSIONS: Peritonitis can produce brain damage and congenital cataract in rats. The translation to humans is that intra abdominal infection in pregnant women may be associated with damage in brain and eye structures of their concepts. This can be averting using the adequate early therapeutically approach. .

Severe autogenously fecal peritonitis in ageing Wistar rats. Response to intravenous meropenem

PURPOSE: To evaluate the treatment outcome of severe peritonitis in rats with increasing age. METHODS: Thirty Wistar rats stratified in three groups: group I - six month-old; group II - 12 month-old; and group III - 18 month-old, underwent autogenously fecal peritonitis (6 ml/kg rat), and were treated with intravenous meropenem. The survival animals were followed-up for 45 days. The variables were expressed by their mean and standard error of the mean (SEM). p<0.05 was used for rejecting the null hypothesis. The study was approved by the Ethics Committee. RESULTS: There was a significant increase in the mortality and morbidity in elderly rats. Of interest, even among young survival rats presenting with severe residual abscesses both in the abdomen and thorax cavities, they present an almost normal life. CONCLUSIONS: The treatment of severe autogenously fecal peritonitis with intravenous meropenem reached reasonable results in rats with six and twelve months of age, even considering residual abscesses on abdomen and thorax cavities. However, the great majority (80%) of elderly rats could not overcome the initial severe infectious challenge, proving that ageing is a very important risk factor for impairing immune response. Thus, sepsis remains a challenging situation, especially in elderly. .

Severe autogenously fecal peritonitis in Wistar rats with permanent bilateral carotid occlusion. Response to intra peritoneal moxifloxacin combined with dexamethasone

To evaluate the treatment outcome of severe peritonitis in rats submitted to permanent bilateral carotid occlusion (PBCO). METHODS: Sixteen Wistar rats (mean age of 8.5 months) with PBCO underwent autogenously fecal peritonitis, and were treated with moxifloxacin combined with dexamethasone, and followed-up for 45 days. Ten rats (mean age five months) without PBCO were used as a control group. The variables were expressed by their mean and standard error of the mean (SEM). p<0.05 was used for rejecting the null hypothesis. The study was approved by the Ethics Committee. RESULTS: There was a significant increase (p=0.0002) in the mortality and morbidity in older rats that underwent PBCO (study group). However, even among the survival rats presenting with severe residual abscesses both in the abdomen and thorax cavities, they present an almost normal life. CONCLUSIONS: The treatment of severe autogenously fecal peritonitis with intraperitoneal moxifloxacin combined with dexamethasone was very effective in young rats without permanent bilateral carotid occlusion. The treatment reached reasonable results in older rats with PBCO, even considering residual abscesses on abdomen and thorax. Older age was the greater risk factor for the outcome of the treatment of severe peritonitis. Sepsis remains a challenging situation, especially in elderly.

Translational realistic expectations of chronic cerebral hypoxemia in rat model after bilateral commom carotid artery ligation. Neurocognitive aspects

To evaluate the effects of chronic cerebral hypoxia on memory of rats submitted to bilateral common carotid artery ligation (BCCL). METHODS: Every each week, for 16 weeks, 31 rats were tested for memory using a water and land mazes and compared with 30 normal rats (control group A). The variables were expressed by their mean and standard error of the mean (SEM). p<0.05 was used for rejecting the null hypothesis. The study was approved by the Ethics Committee for animal investigation. RESULTS: There was a significant increase in the latency time, in the survival water and land mazes, after four weeks (study group B) follow-up. However, without any medication or therapeutically induced measures, after 16 weeks (study group C) follow-up the latency mean times tend to be similar to control group (A) in the neurocognitive tests. CONCLUSIONS: Neurocognitive deficits after 16 weeks post-operative follow-up of rats that underwent bilateral common carotid artery ligation is a natural adaptive phenomenon. Thus, is not realistic to allow translational information from this animal model for therapeutically approaches aiming at to prevent, or to improve brain damage in human beings suffering from chronic deprivation of adequate blood supply.

Alcohol extract of Schinu sterebinthifolius raddi (anacardiaceae) as a local antimicrobial agent in severe autogenously fecal peritonitis in rats

PURPOSE: To develop an alcoholic extract of the inner bark of the Schinus terebinthifolius raddi and to test its impact on autogenously fecal peritonitis in Wistar rats. METHODS: The inner bark of the Schinus terebinthifolius raddi was kept for seven days in 70% ethanol alcohol. The total elimination of the solvent was performed in a rotary evaporator under reduced pressure at 55-60°C. Four milliliter of this extract was injected, after 24 h, into the abdominal cavity of six out of eight survival rats that underwent autogenously fecal peritonitis with five milliliter of 10% filtered fecal suspension. They were clinically followed up for 45 days when they were euthanized. The necropsy findings (inventory) of the abdominal and thorax cavities were inspected and the main findings were recorded and photographed. The investigation was approved by the Ethics Committee. RESULTS: Two out of six survival rats that were critically ill after 24 h died within the 12 h after the extract injection into the abdominal cavity. Four rats that were also critically ill recovered and gradually became healthy, eating well, regaining weight and moving normally in the cage. At 45 days post severe peritonitis the necropsy findings revealed few signs of residual infection on the abdominal and thorax cavities. There were no bowel adhesions. CONCLUSION: The impact of alcoholic extract of the inner bark of the Schinus terebinthifolius raddi was considered very positive and promising as natural local antiseptic against very severe peritonitis in Wistar rats. .

Os perímetros irrigados como estratégia geopolítica para o desenvolvimento do semiárido e suas implicações à saúde, ao trabalho e ao ambiente / Irrigated perimeters as a geopolitical strategy for the development of the semi-arid region and its implications for health, labor and the environment

Objetiva-se analisar os perímetros irrigados enquanto estratégia geopolítica para a expansão da fronteira agrícola brasileira e o "desenvolvimento" do semiárido nordestino, em sua relação com os determinantes sociais da saúde em comunidades camponesas. Trata-se de pesquisa realizada na Chapada do Apodi, nos estados do Ceará e Rio Grande do Norte, entre 2007 e 2011. Adotaram-se variados desenhos, técnicas e instrumentos de pesquisa, como pesquisa-ação, estudo etnográfico, questionário e exames laboratoriais, análise de contaminação de águas, cartografia social e grupo focal. Identificou-se que, na conjuntura da expansão do agronegócio, as políticas públicas de irrigação trouxeram consequências para a saúde, o trabalho e o ambiente, com a implantação do Perímetro Irrigado Jaguaribe-Apodi, no Ceará. São expressivos o contexto de conflito socioambiental e a resistência na fase prévia à instalação do Perímetro Irrigado Santa Cruz do Apodi no Rio Grande do Norte, o que traz consequências para o processo saúde-doença em comunidades camponesas. É importante a avaliação da política pública de irrigação considerar os impactos dos perímetros sobre o modo de vida, o trabalho, a saúde e o ambiente nesses territórios atingidos.

An analysis was made of irrigated perimeters as a geopolitical strategy for expanding Brazilian agricultural frontiers and the "development" of the northeastern semi-arid region with respect to social determinants in health in rural communities. Research was conducted in the Chapada do Apodi in the states of Ceará and Rio Grande do Norte between 2007 and 2011. Various research techniques and tools were adopted, such as research-action, ethnographic studies, questionnaires and laboratory exams, water contamination analyses, social cartography and focal groups. In the context of agribusiness expansion, it was revealed that public policies of irrigation have had consequences for health, labor and the environment with the implementation of the Jaguaribe-Apodi Irrigated Perimeter in Ceará. The social and environmental conflict and resistance in the phase prior to the installation of the Santa Cruz do Apodi Irrigated Perimeter in Rio Grande do Norte was significant as it had consequences for the health-disease process on rural communities. It is important for the evaluation of public irrigation policies to consider the impacts of the perimeters on the lifestyle, labor, health and the environment of the affected territories.

Autogenous fecal peritonitis in Wistar rats with permanent bilateral carotid occlusion: morbidity, mortality and microbiological response

PURPOSE: To investigate morbidity, mortality and microbiological response to fecal peritonitis induced in Wistar rats with permanent bilateral carotid ligation (PBCL). METHODS: Fecal peritonitis was induced in 30 rats, with 10 animals in each group: Group1 - normal young animals; Group2 - normal mature animals; and Group3 - rats with PBCL after four months postoperative follow-up. Peritonitis was induced with 10% stool suspension. Morbidity and mortality were evaluated. The survival animals after seven days were euthanized for tests. For microbiological studies blood were collected from the carotids and right ventricle; and fragments of lung and peritoneum. RESULTS: The morbidity and mortality of young animals were significantly lower than in mature animals with and without PBCL. There was no difference in morbidity and mortality among mature rats with and without PBCL. The diversity of microorganisms producing septicemia was similar to native micro biota of the large bowel. CONCLUSIONS: The immune response was more efficient in young animals, represented by significant less morbidity and no natural mortality. PBLC did not affect morbidity and mortality in mature rats. The immune response to fecal peritonitis has age as an independent predictor.

Learning and survival memory undergoing a permanent bilateral carotid ligation in rats

PURPOSE: To evaluate the effect of cerebral hypoxia-ischemia on memory and learning survival of rats submitted to permanent bilateral carotid ligation (PBCL). METHODS: Twenty-four survivors of PBCL were evaluated after 30 days with regard to memory and learning using a water survival maze. Twenty-three healthy rats were used as control group. The results were expressed by their means and standard error of the mean (SEM). p<0.05 was used for rejecting the null hypothesis. The study was approved by the Ethics Committee for animal investigation. RESULTS: The mortality rate for the surgery was 44.4%. The latency time to find the survival platform was higher in rats that underwent PBCL (Normal: 10.24 ± 1.85s - Study: 25.30 ± 4.69s - Mann - Whitney p=0.0388). Additionally, the type of swimming and the spatial stability of the studied rats on the survival platform were compromised in these animals. CONCLUSION: The permanent bilateral carotid ligation induces change in the learning and survival memory.

Efeito terapêutico do "cross-linking" corneano na ceratopatia bolhosa sintomática / Therapeutic effect of corneal cross-linking on symptomatic bullous keratophaty

OBJETIVO: Avaliar o efeito do "cross-linking" corneano na ceratopatia bolhosa sintomática e seu impacto na acuidade visual, espessura corneana e sintomatologia dolorosa. MÉTODOS: Doze pacientes com ceratopatia bolhosa sintomática foram incluídos. Exame clínico com questionário específico para a pesquisa com escala de dor (escala visual analógica numérica), acuidade visual e mensuração da espessura corneana foi realizada pré "cross-linking" corneano, 7, 30 e 60 dias após. Em todos os pacientes o tratamento com UVA-crosslinking foi realizado após abrasão do epitélio corneano na lâmpada de fenda e instilação de solução de riboflavina 0,1 por cento a cada 5 minutos por 30 minutos. Após esse período o paciente foi submetido à exposição à luz ultravioleta A (UVA), utilizando riboflavina e anestesia tópica a cada 5 minutos por 30 minutos. O paciente utilizou colírios de ofloxacina 0,3 por cento e lágrima artificial até completa reepitelização. O teste de Friedman foi usado para comparar as médias das frequências da acuidade visual, sintomatologia dolorosa e espessura central da córnea. Os valores de "p" menor que 0,05 foram considerados como estatisticamente significantes. RESULTADOS: Doze olhos de 12 pacientes com erosões epiteliais recorrentes foram tratados. O tempo de seguimento foi de dois meses. Foi observada redução significante da dor (p<0,001). As medidas da espessura corneana e da acuidade visual não sofreram alterações estatisticamente significantes. CONCLUSÃO: Foi constatado o potencial de aplicação do "cross-linking" corneano no tratamento de pacientes com dor causada por ceratopatia bolhosa. É necessário maior seguimento para confirmar se os resultados podem ser reproduzidos em longo prazo.

PURPOSE: To evaluate the corneal cross-linking (CXL) effect on symptomatic bullous keratopathy, and its impact on the visual acuity, corneal thickness and pain symptomatology. METHODS: Twelve patients with symptomatic bullous keratophaty were included. A clinical examination with a specific questionnaire (pain scale - visual numeric analog scale), visual acuity, and corneal thickness measures was performed before corneal cross-linking and 7, 30 and 60 days after the procedure. In all patients, the treatment with the UVA-crosslinking was done after corneal abrasion on the slit-lamp and instillation of 0.1 percent riboflavin in saline for every five minutes, lasting 30 minutes. Subsequently, the patient underwent the UVA light exposure, using riboflavin and topical anesthesia, every five minutes lasting 30 minutes. The patient received 0.3 percent ofloxacine drops, and artificial tears until complete reepithelization. The Friedman test was used to compare the means of frequencies of visual acuity, pain symptoms and corneal thickness. A "p" value <0.05 was considered for rejecting the null hypothesis. RESULTS: Twelve eyes from 12 patients with recurrent epithelium erosions were treated. The mean follow-up was two months. Significant pain reduction was observed (p<0.001). Corneal thickness and visual acuity measurements presented with no significant difference. CONCLUSION: The potential use of cross-linking in the treatment of bullous keratopathy pain was proved to be likely. A longer follow-up to confirm whether these results can be reproduced in the long term is necessary.

Resposta humoral ao vírus dengue em mães/filhos: relação com a sequência de Mõbius / Humoral immune response to dengue virus in mothers/children: relation with Mõbius sequence

OBJETIVO: Investigar a resposta humoral para o vírus dengue em pacientes com sequência de Mõbius e suas mães, analisando a relação entre a infecção na gestação e o nascimento de portadores da sequência de Mõbius. MÉTODOS: Foram revisados os prontuários dos pacientes atendidos em centro de referência. Aplicou-se um questionário estruturado a cada genitora. Sorologia por Elisa para IgG de dengue foi efetuada em 35 pacientes e suas mães. O teste de neutralização por redução em placas foi feito nas que referiram infecção viral na gestação e em seus filhos, para determinar o sorotipo viral causador da infecção. RESULTADOS: Febre, cefaléia e/ou dor retro-orbitária foi referida por 18 (51,4 por cento) mães. Três (8,6 por cento) referiram dengue no primeiro ou início do segundo trimestre de gestação. Cruzando-se as informações das sorologias das mães e crianças observou-se que em 57,1 por cento dos casos há positividade sorológica para o vírus do dengue na mãe e no filho. Das três mães com infecção na gestação, uma e seu filho, apresentou teste de neutralização por redução em placa positivo para o vírus dengue tipo três (DENV-3), entretanto o sorotipo apenas foi introduzido em Pernambuco em 2002, o que exclui a possibilidade de ter ocorrido transmissão vertical da doença. CONCLUSÃO: As sorologias dos casos que tiveram diagnóstico clínico de dengue na gravidez revelaram-se incompatíveis com a hipótese de ter ocorrido transmissão vertical da doença. Portanto, na amostra estudada, a infecção pelo vírus do dengue não pode ser considerada como fator implicado na gênese da sequência de Mõbius.

PURPOSE: To investigate the humoral immune response to dengue virus in patients with Mõbius sequence and their mothers, assessing the relation between this infection during pregnancy and Mõbius sequence. METHODS: The medical records were reviewed, and a questionnaire was answered by each mother. IgG ELISA was performed in 35 patients and their mothers. A plaque reduction neutralization test was further done in the mothers who reported a viral infection during pregnancy and in their children for determining which dengue serotype virus had caused the infection. RESULTS: Fever, headache and/or retrobulbar pain during pregnancy was referred by eighteen (51.4 percent) mothers. Three (8.6 percent) reported dengue during the first or second quarteers of pregnancy. When cross analyzing the mothers and their respective children serological results, 57.1 percent of them matched. Of the three mothers with clinical diagnosis of viral infection during pregnancy, one and its respective children had a positive plaque reduction neutralization test for dengue serotype three (DENV-3), this serotype reached Pernambuco in 2002, which excludes the possibility of a vertical transmission to the children. CONCLUSION: The serology of the cases that had clinical diagnosis of dengue during pregnancy proved to be incompatible with the hypothesis of the disease vertical transmission. Therefore, in the present serie, the dengue virus infection can not be considered as a factor involved in the genesis of Mõbius sequence.

Evolução temporal do perfil de gravidade clínico e das intervenções invasivas e farmacológicas no infarto agudo do miocárdio em unidade coronariana no período de 1994-2003 / Trends in outcomes of severe clinical profile and management of invasive and pharmacological interventions of acute myocardial infarction in the coronary care unit from 1994 to 2003

Objetivo: analisar o comportamento do perfil de gravidade clínico, as intervenções invasivas e farmacológicas em pacientes acometidos de Infarto Agudo do Miocárdio (IAM), ao longo de 9 anos.Métodos: Estudo de coorte, em que foram avaliados 1055 pacientes, não selecionados e consecutivos, internados com diagnóstico de IAM, no período de 1994-2003, em unidade coronariana (UC). Foram analisadas variáveis relacionadas ao perfil clínico, procedimentos invasivos e farmacológicos. A análise estatística utilizou o qui-quadrado para tendência linear.Resultados: Entre os 1055 pacientes incluídos, 67,4 por cento eram homens e 32,4 por cento mulheres, com idade média de 60,93 anos e 64,84 anos, respectivamente. Não se observou variação significativa no conjunto do perfil de grvidade dos pacientes...

Tendência temporal de letalidade hospitalar por infarto agudo do miocárdio: 1994-2003 / Temporal tendency of in-hospital lethality due to acute myocardial infarction: 1994-2003

OBJETIVO: Analisar a tendência temporal de letalidade atribuída ao infarto agudo do miocárdio (IAM) e se a mudança de conduta interferiu diretamente nesta letalidade. MÉTODOS: Avaliaram-se 1055 pacientes não selecionados internados em unidade coronariana de 1994-2003. Foram analisadas variáveis relacionadas ao perfil clínico e terapêutico. A análise estatística utilizou o amortecimento exponencial de séries temporais e outras técnicas como a regressão linear logística. RESULTADOS: A letalidade média foi de 10,8 por cento, sendo 12 por cento em 1994 e 7 por cento em 2002 (p=0,000), uma redução relativa de 58 por cento. Não houve variação significativa do perfil de risco dos pacientes. Eram 67,4 por cento homens e 32,4 por cento mulheres, com idade média de 60,93 e 64,84 anos, respectivamente e observou-se aumento significativo no percentual de cateterismos cardíacos (de 14 por cento para 51 por cento), na angioplastia realizada após 24 horas do infarto (de 2 por cento para 33 por cento), na cirurgia de revascularização miocárdica (de 4 por cento para 7 por cento) e na angioplastia primária (de 4 por cento para 11 por cento) com p=0,000, p=0,021, p=0,000 e p=0,000, respectivamente, para tendência linear. Nas primeiras 24 horas houve aumento do uso de aspirina e betabloqueadores, de 78 por cento para 100 por cento e, de 33 por cento para 76 por cento (p=0,003 e p=0,004, respectivamente) ao longo dos anos. Após a análise, persistiram como determinantes de letalidade a terapia de reperfusão miocárdica, a utilização de aspirina e de betabloqueador nas primeiras 24 horas do IAM (p=0,010, p=0,024 e p=0,035, respectivamente). CONCLUSAO: Houve queda da letalidade e a mudança de conduta no tratamento do IAM ao longo dos anos foi responsável pela redução da letalidade nesta série temporal.