Illustrated identification key to females of the genus Sabethes Robineau-Desvoidy recorded from Brazil (Diptera: Culicidae), in dichotomous and interactive formats, including an updated list of species and new records for the states.

Female mosquitoes of the genus Sabethes Robineau-Desvoidy, 1827 are implicated in the transmission of several arboviruses, including yellow fever virus. Here, we present an illustrated species identification key for females of the genus Sabethes recorded in Brazil, except Sa. nitidus Theobald, 1901 and Sa. harbachi Nascimento-Pereira, Guimares, Loureno-de-Oliveira & Motta, 2021 as only the males of these species are known. The key is available in dichotomous and interactive formats. An updated list of the Sabethes species of Brazil and new occurrence records for the states of the country are provided. The type localities of four speciesSa. glaucodaemon (Dyar & Shannon, 1925), Sa. amazonicus Gordon & Evans, 1922, Sa. belisarioi Neiva, 1908 and Sa. soperi Lane & Cerqueira, 1942are corrected or restricted.

Biological and behavioral features and colonization of the sylvatic mosquito Sabethes identicus (Diptera: Culicidae).

Mosquitoes of the genus Sabethes are exclusively sylvatic species occurring in Central and South Americas, where they play a role in the transmission of arbovirus. Sabethes identicus, a common bamboo-breeder species, has been found naturally infected with yellow fever virus. Our study aimed to describe biological and behavioral features of Sa. identicus in the laboratory, as well as establish and standardize an isolated colony for experimental assays. We tested different larval densities and evaluated larval and pupal development time, oviposition behavior, egg production, and longevity. We also shot and video-documented bionomics and behavioral aspects of the mosquitoes in the field and laboratory. A colony with more than 30 generations was achieved. Embryogenesis of Sa. identicus is completed in about three days with a 79% hatch rate, while larval and pupal development takes approximately 15-17 and nine days, respectively. The mosquito's entire life cycle lasts approximately 30 days. Adult females could survive 71 days, and each individual laid an average of 88 eggs over their lifetime; 50% of females and males survived 37 and 24 days, respectively. Hematophagy peaks as early as the first week of emergence. The net content of a bamboo internode influenced the choice for oviposition, with the average number of eggs laid in those containing rearing water with larval and pupal exuviae being significantly higher than when they had only dechlorinated water or water with yeast. We documented for the first time an ecological association of weevils and Sa. identicus, where the oviposition of the latter depends on the weevil creating a hole in the bamboo wall for egg-laying purposes. Video recordings revealed for the first time the peculiar movements of gravid females during egg-throwing into tiny bamboo holes, as well as the laborious escape of newly emerged adults from the bamboo cavity, and mating behavior.

Ecological, Genetic, and Phylogenetic Aspects of YFV 2017-2019 Spread in Rio de Janeiro State.

In Brazil, a yellow fever (YF) outbreak was reported in areas considered YF-free for decades. The low vaccination coverage and the increasing forest fragmentation, with the wide distribution of vector mosquitoes, have been related to yellow fever virus (YFV) transmission beyond endemic areas since 2016. Aiming to elucidate the molecular and phylogenetic aspects of YFV spread on a local scale, we generated 43 new YFV genomes sampled from humans, non-human primates (NHP), and primarily, mosquitoes from highly heterogenic areas in 15 localities from Rio de Janeiro (RJ) state during the YFV 2016-2019 outbreak in southeast Brazil. Our analysis revealed that the genetic diversity and spatial distribution of the sylvatic transmission of YFV in RJ originated from at least two introductions and followed two chains of dissemination, here named the YFV RJ-I and YFV RJ-II clades. They moved with similar dispersal speeds from the north to the south of the RJ state in parallel directions, separated by the Serra do Mar Mountain chain, with YFV RJ-I invading the north coast of São Paulo state. The YFV RJ-I clade showed a more significant heterogeneity across the entire polyprotein. The YFV RJ-II clade, with only two amino acid polymorphisms, mapped at NS1 (I1086V), present only in mosquitoes at the same locality and NS4A (I2176V), shared by all YFV clade RJ-II, suggests a recent clustering of YFV isolates collected from different hosts. Our analyses strengthen the role of surveillance, genomic analyses of YVF isolated from other hosts, and environmental studies into the strategies to forecast, control, and prevent yellow fever outbreaks.

Back to Where It Was First Described: Vectors of Sylvatic Yellow Fever Transmission in the 2017 Outbreak in Espírito Santo, Brazil.

Evidence of sylvatic yellow fever was first reported in Atlantic Forest areas in Espírito Santo, Brazil, during a yellow fever virus (YFV) outbreak in 1931. An entomological survey was conducted in six forest sites during and after an outbreak reported ~80 years after the last case in the area. Among 10,658 mosquitoes of 78 species, Haemagogus leucocelaenus, and Hg. janthinomys/capricornii were considered the main vectors as they had a relatively high abundance, co-occurred in essentially all areas, and showed high YFV infection rates. Sabethes chloropterus, Sa. soperi, Sa. identicus, Aedes aureolineatus, and Shannoniana fluviatilis may have a secondary role in transmission. This is the first report of Sa. identicus, Ae. aureolineatus, and Sh. fluviatilis infected with YFV. Our study emphasizes the importance of entomological monitoring and maintenance of high vaccination coverage in receptive areas to YFV transmission.

Redescription of Wyeomyia (Decamyia) felicia (Dyar amp; Nez Tovar, 1927) and description of a new species of the subgenus from Trinidad (Diptera: Culicidae).

Mosquito species of the subgenus Decamyia Dyar, 1919 of genus Wyeomyia Theobald, 1901 are known to have immature stages mostly associated with Heliconia plants. Currently, the subgenus includes five species, some of which are poorly characterized. Here, we redescribe and illustrate the larval, pupal and adult life stages of Wy. felicia (Dyar Nez Tovar, 1927). In addition, Wyeomyia monticola, a new species of Decamyia from Trinidad, close to Wy. felicia, is described. The new species can be distinguished by morphological characters of the male genitalia, larva and pupa.

Ecological and environmental factors affecting transmission of sylvatic yellow fever in the 2017-2019 outbreak in the Atlantic Forest, Brazil.

BACKGROUND: Yellow fever virus (YFV) is an arbovirus that, despite the existence of a safe and effective vaccine, continues to cause outbreaks of varying dimensions in the Americas and Africa. Between 2017 and 2019, Brazil registered un unprecedented sylvatic YFV outbreak whose severity was the result of its spread into zones of the Atlantic Forest with no signals of viral circulation for nearly 80 years. METHODS: To investigate the influence of climatic, environmental, and ecological factors governing the dispersion and force of infection of YFV in a naïve area such as the landscape mosaic of Rio de Janeiro (RJ), we combined the analyses of a large set of data including entomological sampling performed before and during the 2017-2019 outbreak, with the geolocation of human and nonhuman primates (NHP) and mosquito infections. RESULTS: A greater abundance of Haemagogus mosquitoes combined with lower richness and diversity of mosquito fauna increased the probability of finding a YFV-infected mosquito. Furthermore, the analysis of functional traits showed that certain functional groups, composed mainly of Aedini mosquitoes which includes Aedes and Haemagogus mosquitoes, are also more representative in areas where infected mosquitoes were found. Human and NHP infections were more common in two types of landscapes: large and continuous forest, capable of harboring many YFV hosts, and patches of small forest fragments, where environmental imbalance can lead to a greater density of the primary vectors and high human exposure. In both, we show that most human infections (~ 62%) occurred within an 11-km radius of the finding of an infected NHP, which is in line with the flight range of the primary vectors. CONCLUSIONS: Together, our data suggest that entomological data and landscape composition analyses may help to predict areas permissive to yellow fever outbreaks, allowing protective measures to be taken to avoid human cases.

A new species of Wyeomyia (Diptera: Culicidae) from Heliconia flower bracts in northern South America.

A new species of the genus Wyeomyia, Wyeomyia (Decamyia) anthica sp. n., is described based on morphological and molecular analyses and is illustrated in larval, pupal and adult life stages. Among the four valid species of the subgenus Decamyia, the new species is closest to Wy. ulocoma (Theobald, 1903), from which it can be distinguished by morphological characters of the male genitalia, larval and pupal stages, and mitochondrial cytochrome c oxidase 1 gene sequence. Wyeomyia ulocoma is recorded from Brazil for the first time.

Wyeomyia shannoni Lane amp; Cerqueira, 1942, a taxonomic puzzle (Diptera: Culicidae): synonymy, genus transfer, homonymy, and description of a new species of Sabethes Robineau-Desvoidy, 1827.

We discovered the immature stages of Wyeomyia shannoni Lane Cerqueira, 1942, unknown for almost 80 years, and found that they, as well as the adult male, are identical with those previously described for Sabethes (Peytonulus) paradoxus Harbach, 2002. Consequently, the species described by Lane and Cerqueira is here considered a senior synonym of Sa. paradoxus and is transferred to the genus Sabethes, hereafter named Sabethes (Peytonulus) shannoni (Lane Cerqueira, 1942), comb. n. As the name shannoni is preoccupied in the genus Sabethes, the species known as Sabethes (Sabethes) shannoni Cerqueira, 1961 is here renamed Sabethes (Sabethes) cerqueirai Nascimento-Pereira, Neves, Loureno-de-Oliveira Motta, nom. n. We improved the morphological characterization of Sa. (Pey.) shannoni (Lane Cerqueira) by including an illustration of the female genitalia, larval mouthparts and the female genital lobe of the pupa. Finally, we describe and illustrate a new species of Sabethes closely related to Sa. (Pey.) shannoni, named Sabethes (Peytonulus) harbachi Nascimento-Pereira, Guimares, Loureno-de-Oliveira Motta, sp. n.

Redescription and placement of Wyeomyia rorotai Senevet, Chabelard amp; Abonnenc (Diptera: Culicidae) in the subgenus Decamyia based on morphological and molecular analyses.

Decamyia Dyar is a subgenus of Wyeomyia Theobald with three valid species. Wyeomyia rorotai Senevet, Chabelard Abonnenc, a species originally described rather briefly in the subgenus Dendromyia, is without subgeneric position in the genus. In the present work, we redescribe Wy. rorotai in all life stages and formally define its taxonomic placement in the subgenus Decamyia by combining morphological and molecular analyses based on the mitochondrial cytochrome c oxidase subunit I gene. We also show that Decamyia is a rather homogeneous group of four species, i.e. Wy. ulocoma (Theobald), Wy. pseudopecten Dyar Knab, Wy. felicia Dyar Núñez Tovar and Wy. rorotai, the immature stages of which almost exclusively inhabit the flower bracts of Heliconiaceae.

High Speed Video Documentation of the Mosquito Sabethes albiprivus Egg-Catapulting Oviposition Behavior (Diptera: Culicidae).

The oviposition behavior of mosquitoes varies between species. We documented the unusual mechanism of egg laying in the mosquito Sabethes albiprivus Theobald with the aid of high speed video recordings in the laboratory. A sapucaia (Lecythis pisonis Camb.) nut oviposition trap, described herein, was used to simulate a tree hole with a small opening, which is the natural larval habitat of Sa. albiprivus. We showed that females approach the opening and perform a sequence of rapid, short up-and-down flights before egg laying. At this time, the egg is already visible externally, being held at the very tip of the abdomen. Females catapult one egg at a time by rapidly curling their abdomen downward, sending the egg through the opening while their legs are positioned in different configurations throughout the event. The estimated velocity of the catapulted eggs was almost 1 m/s.

Survey on Non-Human Primates and Mosquitoes Does not Provide Evidences of Spillover/Spillback between the Urban and Sylvatic Cycles of Yellow Fever and Zika Viruses Following Severe Outbreaks in Southeast Brazil.

In the last decade, Flaviviruses such as yellow fever (YFV) and Zika (ZIKV) have expanded their transmission areas. These viruses originated in Africa, where they exhibit both sylvatic and interhuman transmission cycles. In Brazil, the risk of YFV urbanization has grown, with the sylvatic transmission approaching the most densely populated metropolis, while concern about ZIKV spillback to a sylvatic cycle has risen. To investigate these health threats, we carried out extensive collections and arbovirus screening of 144 free-living, non-human primates (NHPs) and 5219 mosquitoes before, during, and after ZIKV and YFV outbreaks (2015-2018) in southeast Brazil. ZIKV infection was not detected in any NHP collected at any time. In contrast, current and previous YFV infections were detected in NHPs sampled between 2017 and 2018, but not before the onset of the YFV outbreak. Mosquito pools screened by high-throughput PCR were positive for YFV when captured in the wild and during the YFV outbreak, but were negative for 94 other arboviruses, including ZIKV, regardless of the time of collection. In conclusion, there was no evidence of YFV transmission in coastal southeast Brazil before the current outbreak, nor the spread or establishment of an independent sylvatic cycle of ZIKV or urban Aedes aegypti transmission of YFV in the region. In view of the region's receptivity and vulnerability to arbovirus transmission, surveillance of NHPs and mosquitoes should be strengthened and continuous.

Haemagogus leucocelaenus and Haemagogus janthinomys are the primary vectors in the major yellow fever outbreak in Brazil, 2016-2018.

The yellow fever virus (YFV) caused a severe outbreak in Brazil in 2016-2018 that rapidly spread across the Atlantic Forest in its most populated region without viral circulation for almost 80 years. A comprehensive entomological survey combining analysis of distribution, abundance and YFV natural infection in mosquitoes captured before and during the outbreak was conducted in 44 municipalities of five Brazilian states. In total, 17,662 mosquitoes of 89 species were collected. Before evidence of virus circulation, mosquitoes were tested negative but traditional vectors were alarmingly detected in 82% of municipalities, revealing high receptivity to sylvatic transmission. During the outbreak, five species were found positive in 42% of municipalities. Haemagogus janthinomys and Hg. leucocelaenus are considered the primary vectors due to their large distribution combined with high abundance and natural infection rates, concurring together for the rapid spread and severity of this outbreak. Aedes taeniorhynchus was found infected for the first time, but like Sabethes chloropterus and Aedes scapularis, it appears to have a potential local or secondary role because of their low abundance, distribution and infection rates. There was no evidence of YFV transmission by Aedes albopictus and Aedes aegypti, although the former was the most widespread species across affected municipalities, presenting an important overlap between the niches of the sylvatic vectors and the anthropic ones. The definition of receptive areas, expansion of vaccination in the most affected age group and exposed populations and the adoption of universal vaccination to the entire Brazilian population need to be urgently implemented.

Mosquitoes (Diptera: Culicidae) From the Northwestern Brazilian Amazon: Araçá River.

The mosquito fauna (Diptera: Culicidae) from two remote localities along the Araçá River, within the Municipality of Barcelos, towards the northern border of the Brazilian State of Amazonas, were sampled using CDC, Shannon, Malaise, and Suspended traps, along with net sweeping and immature collections. During June 2010, 111 collections yielded more than 23,500 mosquitoes distributed in 15 genera, representing 119 different species, together with eight morphospecies, which may represent undescribed new taxa. Among the species collected, there is one new distributional record for Brazil and nine new distributional records for the State of Amazonas. With the highest number of species, the genus Culex Linnaeus also had the largest number of individuals followed by Aedes Meigen with the second highest number of species. The most abundant species was Culex (Melanoconion) gnomatos Sallum, Hutchings & Ferreira followed by Culex (Melanoconion) portesi Senevet & Abonnenc, Culex (Culex) mollis Dyar & Knab, Aedes (Ochlerotatus) fulvus (Wiedemann), Culex (Melanoconion) pedroi Sirivanakarn & Belkin, Culex (Melanoconion) crybda Dyar, Aedes (Ochlerotatus) nubilus (Theobald), and Anopheles (Anopheles) peryassui Dyar & Knab. The epidemiological implications of mosquito species found are discussed and are compared with other mosquito inventories from the Amazon region. As the first standardized mosquito inventory of the Araçá River, with the identification of 127 species level taxa, the number of mosquito species which have been collected along the northern tributaries of the middle Rio Negro Basin (i.e., Padauari and Araçá Rivers) increased significantly.

Potential risk of re-emergence of urban transmission of Yellow Fever virus in Brazil facilitated by competent Aedes populations.

Yellow fever virus (YFV) causing a deadly viral disease is transmitted by the bite of infected mosquitoes. In Brazil, YFV is restricted to a forest cycle maintained between non-human primates and forest-canopy mosquitoes, where humans can be tangentially infected. Since late 2016, a growing number of human cases have been reported in Southeastern Brazil at the gates of the most populated areas of South America, the Atlantic coast, with Rio de Janeiro state hosting nearly 16 million people. We showed that the anthropophilic mosquitoes Aedes aegypti and Aedes albopictus as well as the YFV-enzootic mosquitoes Haemagogus leucocelaenus and Sabethes albiprivus from the YFV-free region of the Atlantic coast were highly susceptible to American and African YFV strains. Therefore, the risk of reemergence of urban YFV epidemics in South America is major with a virus introduced either from a forest cycle or by a traveler returning from the YFV-endemic region of Africa.

A acupuntura vai além da agulha: trajetórias de formação e atuação de acupunturistas / Acupuncture goes beyond the needle: trajectories of formation and action of acupuncturists

O objetivo deste estudo foi analisar as trajetórias de formação e a atuação profissional de acupunturistas. Trata-se de estudo de natureza qualitativa, baseado no referencial metodológico das narrativas de histórias de vida. Participaram oito profissionais de saúde ­ cinco homens e três mulheres ­, graduados em enfermagem, fisioterapia e medicina, que utilizavam a acupuntura a partir da perspectiva da medicina chinesa (MC) e que responderam a entrevistas semiestruturadas. A análise das narrativas resultou em três categorias centrais: busca por novas racionalidades em saúde; adentrando no universo da acupuntura; a acupuntura vai além da agulha. Observou-se que a busca pela acupuntura foi motivada pela insatisfação com a formação inicial no paradigma biomédico. A trajetória de formação na acupuntura foi gradativa e envolveu profunda inserção na racionalidade da MC, devido à complexidade de sua proposta terapêutica, o que os levou a entender que a inserção da agulha representa a confluência de diversos aspectos da racionalidade, não podendo ser reduzida a mera aplicação técnica. Nesse sentido, aponta-se a necessidade de discutir a formação desses profissionais e sua atuação no Sistema Único de Saúde, bem como a aplicabilidade da perspectiva biomédica de pesquisa nos estudos sobre acupuntura.

Complicações da síndrome coronariana e de acidente vascular encefálico em estudo de coorte / Complications of coronary syndrome and stroke in cohort study

Fundamentos: Os componentes da síndrome coronariana aguda e do acidente vascular encefálico apresentamem sua etiologia o envolvimento de processo aterotrombótico. Ambas as doenças apresentam fatores de risco em comum e grande parte deles é modificável. O entendimento de que essas doenças são consequências do processo vascular subjacente possibilita o desenvolvimento de novas intervenções terapêuticas e pode ajudar a identificar pacientes de risco e, portanto, prevenir manifestações da aterotrombose.Objetivos: Verificar a incidência de complicações da síndrome coronariana aguda ou de acidente vascular encefálico e seus fatores de risco em uma coorte, durante um ano de acompanhamento. Métodos: Estudo de coorte, prospectivo, que incluiu pacientes de ≥30 anos, de ambos os sexos, com diagnóstico de síndrome coronariana aguda ou de acidente vascular encefálico, internados em hospital na cidade de Porto Alegre, RS. O desfecho foi a presença de complicações até um ano após a alta hospitalar. Foram consideradas complicações: a ocorrência de novo episódio de AVE, de reinfarto, de insuficiência cardíaca ou de óbito. Utilizou-se regressão de Poisson com variância robusta para a análise ajustada. Resultados: De 512 participantes, 130 apresentaram complicações (27,6%; IC95% 23,6-31,7). Os participantes com≥80 anos (p=0,01), cor da pele não branca (p=0,008), com hábito de fumar (p=0,01) e diabetes mellitus (p=0,02)apresentaram maior incidência de complicações. Conclusões: A incidência de complicações por SCA ou AVE foi elevada. As doenças confirmaram sua condição de gravidade, sendo a ocorrência de óbitos a complicação mais incidente no acompanhamento. Observou-se importante associação do diabetes mellitus e do tabagismo com a ocorrência de complicações mesmo com ocontrole para idade e cor da pele.

Background: The components of acute coronary syndrome and stroke have the involvement of atherothrombotic process in their etiology. Both diseases have risk factors in common and most of them are modifiable. Understanding that these diseases are consequences of the underlying vascular process enables the development of new therapeutic interventions and can help identify patients at risk and thus prevent manifestations of atherothrombosis. Objectives: To check the incidence of complications of acute coronary syndrome or stroke and its risk factors in a cohort over on eyear of follow-up. Methods: Cohort prospective study that included patients aged ≥ 30 years, of both sexes, diagnosed with acute coronary syndrome or stroke admitted to the hospital in Porto Alegre, state of Rio Grande do Sul. The outcome was the presence of complications up toone year after hospital discharge. The following were considered complications: the occurrence of new episode of stroke, reinfarction, heart failure or death. We used Poisson regression with robust variance in the adjusted analysis. Results: Of 512 participants, 130 had complications (27.6%; 95% CI 23.6-31.7). Participants aged ≥ 80 (p=0.01), white color(p=0.008), smokers (p=0.01) and with diabetes mellitus (p=0.02) presented greater incidence of complications. Conclusions: The incidence of complications for ACS or stroke was high. Diseases confirmed the severity of condition. The occurrenceof deaths was the most frequent complication in the follow-up. There was an important association of diabetes mellitus and smoking with the occurrence of complications, even controlling for age and skin color.

Atividade física após hospitalização por doenças do aparelho circulatório / Physical activity after hospital for circulatory diseases

Os objetivos do estudo foram verificar a prática de atividade física em pacientes internados por síndrome coronariana aguda e/ou doença cerebrovascular no momento da hospitalização e um ano após a alta hospitalar e investigar a associação entre a prática de atividade física um ano após a alta hospitalar com as características demográficas, socioeconômicas e comportamentais. Foi realizado um estudo de coorte com pacientes de ambos os sexos, acima de 30 anos de idade hospitalizados por Síndrome Coronariana Aguda e/ou doenças Cerebrovasculares, entre maio de 2009 a maio de 2011, no Sul do Brasil. Entre os 187 participantes, constatou-se que 9,6% dos sujeitos praticavam atividade física no momento da hospitalização e um ano após a alta hospitalar, 68,4% da amostra não praticava atividade física nos dois momentos, e apenas 3,2% tiveram uma mudança de comportamento, começando a praticar atividade física após o evento. Desta forma, apenas 12,8% foram considerados como fisicamente ativos um ano após a alta hospitalar. Após ajuste pela regressão de Poisson, verificou-se que os sujeitos com menos de 80 anos praticavam menos atividade física. Assim, observou-se que a experiência da hospitalização, a gravidade das doenças de interesse deste estudo e os benefícios potenciais da atividade física como integrante da recuperação não foram suficientes para mudança de comportamento.

The objectives of the study were to assess the physical activity in patients hospitalized for acute coronary syndrome and / or cerebrovascular disease at the time of hospitalization and one year after hospital discharge and to investigate the association between physical activity one year after hospital discharge with demographic, socioeconomic and behavioral characteristics. We conducted a cohort study of patients of both sexes, over 30 years of age hospitalized for Acute Coronary Syndrome and / or cerebrovascular diseases, from May 2009 to May 2011, in southern Brazil. Among the 187 participants, it was found that 9.6% of the subjects practiced physical activity at the time of hospitalization and one year after discharge, 68,4% of the sample did not practice physical activity in the two periods, and only 3,2% had a behavior change, beginning to practice physical activity after the event. Thus, only 12,8% were considered physically active one year after hospital discharge. After adjusting the Poisson regression model, it was found that subjects less than 80 years practiced less physical activity. It was found that the experience of hospitalization, the gravity of the disease of interest in this study and the potential benefits of physical activity as part of the recovery were not enough to change behavior.

Use of medicines recommended for secondary prevention of acute coronary syndrome.

OBJECTIVE: To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS: In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS: More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS: The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

Use of medicines recommended for secondary prevention of acute coronary syndrome / Uso de medicamentos recomendados na prevenção secundária da síndrome coronariana aguda

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

RESUMO OBJETIVO : Analisar se variáveis demográficas e socioeconômicas e intervenção coronária percutânea estão associadas ao uso de medicamentos para prevenção secundária da síndrome coronariana aguda. MÉTODOS : Neste estudo de coorte, foram incluídos 138 pacientes com síndrome coronariana aguda, com idade igual ou superior a 30 anos e de ambos os sexos. Os dados foram coletados no momento da alta hospitalar e após seis e 12 meses da alta. O desfecho do estudo foi o uso simultâneo dos medicamentos recomendados para prevenção secundária da síndrome coronariana aguda: antiagregante plaquetário, betabloqueador, estatina e inibidor da enzima conversora de angiotensina ou bloqueador do receptor de angiotensina. As variáveis independentes foram: sexo, idade, escolaridade em anos de estudo, renda mensal em tercis e intervenção coronária percutânea. Descreveu-se a prevalência do uso de cada grupo de medicamento com respectivos intervalos de confiança de 95%, bem como o uso simultâneo dos quatro, em todos os períodos analisados. Na análise bruta verificou-se a associação do desfecho com as variáveis independentes para cada período por meio do teste Qui-quadrado. A análise ajustada foi realizada por Regressão de Poisson. RESULTADOS : Mais de um terço dos pacientes (36,2%; IC95% 28,2;44,3) recebeu prescrição dos quatro medicamentos, simultaneamente, no momento da alta. Não foram observadas diferenças nas prevalências de uso na comparação com os dois períodos de seguimento. A classe de medicamento mais prescrita na alta foi antiagregante plaquetário (91,3%). Na análise bruta, as variáveis demográficas e socioeconômicas não se associaram ao desfecho em nenhum dos três períodos. CONCLUSÕES : A prevalência de uso simultâneo dos medicamentos na alta e nos seguimentos apontou para a subutilização dessa terapêutica na prática clínica. São necessárias estratégias de intervenção para melhoria da qualidade da atenção dada aos pacientes que se estendam além da alta hospitalar, um ponto crítico de transição no cuidado.

Determination of diuretics and laxatives as adulterants in herbal formulations for weight loss.

A new method is described for the determination of the most common diuretic and laxative adulterants found in formulations of anorexics and antidepressants. The method is based on the separation of furosemide, hydrochlorothiazide, chlorthalidone and amiloride (diuretics), phenolphthalein (laxative), amfepramone (anorexic) and fluoxetine and paroxetine (antidepressants) by capillary zone electrophoresis with capacitively coupled contactless conductivity detection. The method showed a precision ranging from 1.9% to 6.9% for a concentration of 25 mg/L, 0.6% to 5.3% for a concentration of 50 mg/L and 1.6% to 6.0% for a concentration of 100 mg/L for all analytes. The accuracy was 99% for amiloride, 102% for chlorthalidone, 101% for hydrochlorothiazide, 101% for furosemide, 94% for phenolphthalein, 105% for fluoxetine, 114% for paroxetine and 117% for amfepramone. The method allowed the drugs to be determined in the formulations at concentrations higher than 5.1 mg/kg for amiloride, 7.7 mg/kg for chlorthalidone, 6.8 mg/kg for hydrochlorothiazide, 10.7 mg/kg for furosemide, 8.4 mg/kg for phenolphthalein, 11.0 mg/kg for fluoxetine, 9.4 mg/kg for paroxetine and 11.0 mg/kg for amfepramone. Three of the 26 analysed herbal formulations were found to be adulterated (not declared on the label) with the diuretic hydrochlorothiazide. Five other samples contained diuretics declared on the label on the formulation. Thus, a total of eight samples, which were marketed as natural products, contained diuretics (declared or not) on the formulation.