Reductions in the prevalence and incidence of geohelminth infections following a city-wide sanitation program in a Brazilian Urban Centre.

OBJECTIVE: In the city of Salvador, a large urban centre in Northeast Brazil, a city-wide sanitation intervention started in 1997, aimed at improving the sewerage coverage of households from 26% to 80%. Our aim was to study the impact of the intervention on the prevalence and incidence of geohelminths in the school-aged population. METHODS: THE STUDY COMPRISED TWO COMPARABLE COHORTS: the first assembled in 1997, before the intervention, and the second assembled in 2003, after the intervention. Both were sampled from 24 sentinel areas chosen to represent the different environmental conditions throughout the city. Copro-parasitological examinations were carried out on every individual from both cohorts, at baseline and nine months later. Demographic, socio-economic, and environmental data were collected using semi-structured questionnaires and environmental surveys. A hierarchical modelling approach fitting a sequence of Poisson multivariate linear models was undertaken to test the effect of the intervention variables on the prevalence and incidence rate ratios. FINDINGS: 729 and 890 children aged 7-14 years (mean = 10.4 y, SD = 0.05 y) were analysed over the first and the second cohorts, respectively. The adjusted reductions of the prevalence and incidence rates at the second in relation to the first cohort were 27% and 34%, 25% and 32%, 33% and 26%, and 82% and 42% for geohelminths overall, Ascaris lumbricoides, Trichuris trichiura, and hookworm, respectively. Hierarchical modelling showed that a major part of each of these reductions was explained by the intervention. CONCLUSION: Our results show that a city-wide sanitation program may reduce significantly the prevalence and incidence of geohelminths.

Revascularizaçäo miocárdica sem circulaçäo extracorpórea: resultados cirúrgicos em 1090 pacientes / Coronary Artery Bypass Surgery Without Cardiopulmonary Bypass. Surgical Outcome in 1090 Patients

PURPOSE--To report our experience of 12 years of myocardial revascularization without cardiopulmonary bypass (CPB) and to discuss its expanding surgical indications. METHODS--This technique was employed in 1090 patients, between September/81 and April/93, corresponding to 17.4 per cent of all revascularized patients. Regarding gender, male patients were the majority (73.7 per cent) and ages ranged from 28 to 86 year-old (mean 57). Chronic coronary insufficiency was the main indication (69.4 per cent) and 18.9 per cent of our global experience were operated on during acute ischemia. The average number of grafts per patient was 1.6 and internal mammary artery was utilized in 60.1 per cent of patients. Left anterior descending coronary artery and right coronary artery were the coronary arteries most often treated. RESULTS--Our hospital mortality rate was 2.5 per cent (28/1090) although it was 7 per cent for patients over 70 years. The most common cause of death was cardiogenic shock after failed angioplasty. Postoperative complications included AMI in 4.8 per cent, arrhythmias in 5.5 per cent and pulmonary in 3.2 per cent. Mean of any type of blood derivate utilization was 0.28 units/patients. CONCLUSION--Myocardial revascularization without CPB is a valid alternative in a selected cohort of patients and it is performed with low morbidity and mortality. Nowadays it represents an excellent tactical option for high-risk patients and in failed angioplasties