Urbanization and kidney dysfunction in Brazilian indigenous people: a burden for the youth.

OBJECTIVE: The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS: This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS: A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION: Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.

Urbanization and cardiovascular health among Indigenous groups in Brazil.

BACKGROUND: We described the prevalence of cardiovascular risk factors in groups of Brazilian Indigenous people at different degrees of urbanization. METHODS: The Project of Atherosclerosis among Indigenous populations (Projeto de Aterosclerose em Indígenas; PAI) is a cross-sectional study conducted in Northeast Brazil between August 2016-June 2017. It included three populations: Fulni-ô Indigenous people (lowest degree of urbanization), Truká Indigenous people (greater urbanization), and a highly urbanized non-Indigenous local cohort (control group). Participants were assessed to register sociodemographic, anthropometric, as well as clinical and laboratory-derived cardiovascular (CV) risk parameters. Age-adjusted prevalence of hypertension was also computed. Nonparametric tests were used for group comparisons. RESULTS: Here we included 999 participants, with a predominance of females in all three groups (68.3% Control group, 65.0% Fulni-ô indigenous group, and 60.1% Truká indigenous group). Obesity was present in 45.6% of the urban non-Indigenous population, 37.7% Truká and in 27.6% Fulni-ô participants. The prevalence of hypertension was 29.1% (n = 297) with lower prevalence in the less urbanized Fulni-ô people (Fulni-ô - 18.2%; Truká - 33.9%; and Control - 33.8%; p < 0.001). In the elderly male population, the prevalence of hypertension was 18.7% in the Fulni-ô, 45.8% in the Truká, and 54.5% in the control group. Of the 342 participants that self-reported hypertension, 37.5% (n = 68) showed uncontrolled blood pressure (BP). Uncontrolled BP was more prevalent among Truká people when compared to Fulni-ô people and non-Indigenous participants (45.4%, 22.9%, and 40.7%, respectively; p < 0.001). CONCLUSIONS: We found a higher cardiovascular risk in communities with a higher degree of urbanization, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health.

The lifestyles and environments of traditional indigenous and city-living communities differ. We compared rates of obesity and hypertension in members of two under-studied Indigenous groups in Northeast Brazil and a nearby urbanized group. We found higher rates of obesity and hypertension amongst members of the more urbanized community, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health. These results suggest those living in the city should modify their lifestyle and monitor their cardiovascular health more carefully if possible.

Anti-chikungunya virus seroprevalence in Indigenous groups in the São Francisco Valley, Brazil.

BACKGROUND: Chikungunya fever (CHIKF) is a serious public health problem with a high rate of infection and chronic disabling manifestations that has affected more than 2 million people worldwide since 2005. In spite of this, epidemiological data on vulnerable groups such as Indigenous people are scarce, making it difficult to implement public policies in order to prevent this disease and assist these populations. OBJECTIVE: To describe the serological and epidemiological profile of chikungunya virus (CHIKV) in two Indigenous populations in Northeast Brazil, as well as in an urbanized control community, and to explore associations between CHIKV and anthropometric variables in these populations. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional ancillary study of the Project of Atherosclerosis among Indigenous Populations (PAI) that included people 30 to 70 years old, recruited from two Indigenous tribes (the less urbanized Fulni-ô and the more urbanized Truká people) and an urbanized non-Indigenous control group from the same area. Subjects underwent clinical evaluation and were tested for anti-CHIKV IgG by enzyme-linked immunosorbent assay. Serological profile was described according to ethnicity, sex, and age. The study population included 433 individuals distributed as follows: 109 (25·2%) Truká, 272 (62·8%) Fulni-ô, and 52 (12%) from the non-Indigenous urbanized control group. Overall prevalence of CHIKV IgG in the study sample was 49.9% (216; 95% CI: 45·1-54·7). When the sample was stratified, positive CHIKV IgG was distributed as follows: no individuals in the Truká group, 78·3% (213/272; 95% CI: 72·9-83·1) in the Fulni-ô group, and 5.8% (3/52; 95% CI: 1.21-16) in the control group. CONCLUSIONS/SIGNIFICANCE: Positive tests for CHIKV showed a very high prevalence in a traditional Indigenous population, in contrast to the absence of anti-CHIKV serology in the Truká people, who are more urbanized with respect to physical landscape, socio-cultural, and historical aspects, as well as a low prevalence in the non-Indigenous control group, although all groups are located in the same area.

Urbanization and kidney dysfunction in Brazilian indigenous people: a burden for the youth

SUMMARY OBJECTIVE: The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS: This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS: A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION: Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years.

UNLABELLED: Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. OBJECTIVE: To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism. METHOD: Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to TEE. RESULTS: Ten percent were aged 45 years; or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thrombus in left heart. CONCLUSION: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.

Speckle-tracking pela ecocardiografia bidimensional: aplicações clíonicas / Speckle-tracking echocardiography: clinical applications

Strain (ε) e strain rate (SR ou s-1) são índices clínicos de deformação miocárdica regional e global, que podem ser aferidos pela técnica do rastreamento de pontos (speckle tracking) através da ecocardiografia bidimensional (2D-STE). Ambos foram introduzidos e validados utilizando-se a ressonância magnética e a sonomicrometria como padrões de referência. O strain obtido com o 2D-STE apresenta várias vantagens em relação ao strain obtido com o Doppler Tecidual, principalmente uma menor variabilidade intra e inter-observador. Três padrões principais de deformação formam um eixo perpendicular no sistema de coordenadas internas do coração durante a sístole: encurtamento longitudinal, encurtamento circunferencial e espessamento radial. Aplicando-se o 2D-STE é possível aferir o strain no sentido longitudinal, circunferencial e radial da estrutura analisada, sem sofrer influência do ângulo. O 2D-STE, como ferramenta diagnóstica acurada e de fácil uso, está se desenvolvendo muito rapidamente, não só pelo seu poder diagnóstico, mas também pelo valor prognóstico das informações em várias patologias cardíacas. A possibilidade de detecção de lesão sub-clínica cardíaca tem sido uma das grandes vantagens na utilização do 2D-STE. Como todo método diagnóstico, este também tem as suas limitações, que devem ser conhecidas e respeitadas. As perspectivas futuras para o método são bastante promissoras. Embora alguns autores acreditem que o strain irá substituir a FEVE, outros acham que as informações obtidas com o 2D-STE devem ser introduzidas como um complemento e não como um substituto para os índices clínicos estabelecidos.

Strain (ε) and strain rate (SR or s-1) are clinical indices of regional myocardial deformation which can be measured by speckle tracking echocardiography and have been introduced and validated using tagged MRI and sonomicrometry. The strain measured by 2D-STE has several advantages over the strain obtained with Tissue Doppler, mainly a lower intra and inter-observer variability. Three main systolic deformation patterns form perpendicular axis in the heart’s internal coordinate system: longitudinal shortening, circumferential shortening and radial thickening. Applying the 2D-STE is possible to measure the strain in the longitudinal, circumferential, and radial axis without angle influence. The 2D-STE as a relatively user-friendly and accurate diagnostic tool is developing at a rapid pace, not only for its diagnostic power, but also because of the prognostic value of the information in various heart diseases. The possibility of detection of cardiac subclinical damage has been one of the major advantages in using the 2D-STE. Like any diagnostic method, this also has its limitations, which must be known and respected. Future prospects for the method are very promising. Although some authors believe that the strain will replace LVEF, others feel that the information obtained with the 2D-STE should be introduced as a supplement and not as a substitute for established clinical indices.

Fatores associados à menor dose de radiação em pacientes submetidos à angiotomografia de artérias coronárias de 64 canais / Factors associated with lower radiation doses in patients undergoing 64-slice computed tomography

Fundamentos: Nota-se crescente utilização da angiotomografia de arterias coronárias, encontrando-se na literatura grande variabilidade na dose de radiação empregada. Há preocupação mundial em relação à exposição à radiação ionizante em procedimentos médicos, sendo que estratégias para minimização da dose são fortemente encorajadas. Objetivos: Determinar a dose de radiação utilizada em clínica privada no Rio de Janeiro e fatores associados à redução da dose. Métodos: Estudos retrospectivo e observacional, envolvendo 232 pacientes consecutivos submetidos à angiotomografia de artérias coronárias de 64 detectores por indicação clínica, utilizando-se técnicas visando à redução da dose de radiação. Resultados: A dose média geral de radiação empregada foi 7,6mSv, sem diferença na dose aplicada em homens e mulheres (7,9mSv vs. 7,0mSv, respectivamente, p=0,15). A utilização de modulação de dose pelo eletrocardiograma (ECG) e tensão do tubo de 100kV estão ambas associadas à queda de aproximadamente 50 por cento cada na dose. Fatores como idade avançada e presença de stents estão associados à maior exposição. Conclusões: A dose de radiação utilizada rotineiramente...

Background: In parallel to an upsurge in the use of computed tomography coronary angiography (CTCA), the literature varies widely in terms of radiation doses, prompting worldwide concern about radiation exposure in medical procedures, with strong supportfor strategies aimed at reducing these doses. Objectives: To determine the radiation dose employed in CTCA studies in a private clinic at Rio de Janeiro, Brazil, and the factors associated with lower radiation doses. Methods: Retrospective observational study of 232consecutive patients clinically referred for 64-slice CTCA with radiation dose r eduction techniques. Results: The mean radiation dose was 7.6mSv, with no difference between men and women (7.9mSv vs. 7.0mSv, respectively, p=0,15). Electrocardiogram (ECG) dose modulation and reduced 100kV tubevoltage are associated with dose reductions of approximately 50% each. Factors such as increasing age and the presence of coronary stents are associated with higher exposure. Conclusions: The routine radiation dose used with exposure minimization techniques...

Hipertrofia lipídica do septo interatrial: relato de casos e revisão da literatura / Lipomatous hypertrophy of the interatrial septum: case reports and review of the literature

Relato de dois casos clínicos recentemente acompanhados no Johns Hopkins Hospital: ambos com diagnóstico de hipertrofia lipomatosa (HL) do septo interatrial (SIA), sem apresentarem sintomas associados a essa patologia. O primeiro caso relata um paciente que teve indicação de tomografia atrial direita ao ecocardiograma, enquanto no segundo paciente, o exame foi feito para diagnóstico diferencial de dor no braço esquerdo aos esforços. Normalmente a HL do SIA é um achado incidental implicação clínica, tendo importância no diagnóstico diferencial com outras massas cardíacas. Geralmente não tem indicação de tratamento e sua relação com patologias que promovem acúmulo de gordura corpórea ainda não e bem estabelecida.

Case study of two patients recently evaluated at our institution and diagnosed with asymptomatic lipomatoushypertrophy of the interatrial septum. The first case is a patient referred for cardiac CT for differential diagnosis ofa mass in the right atrium detected by echocardiography; the second patient was referred for differential diagnosisof left arm pain induced by exercise. Lipomatous hypertrophy of the interatrial septum is usually anincidental finding with no clinical implications which is important for differential diagnosis with other cardiacmasses. Surgical treatment is usually not warranted and its links to pathologies that build up body fat is still not fully understood.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years

Embolia cerebral de fonte cardíaca é frequentemente relacionada a acidente vascular cerebral (AVC) em jovem.OBJETIVO: Descrever achados ecocardiográficos em jovens e não jovens com AVC isquêmico, sem suspeita de fonte cardíaca.MÉTODO: Estudo transversal; 523 pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte cardíaca submeteram-se ao ecocardiograma transesofágico (ECOTE). RESULTADOS: 10% dos pacientes tinha 45 anos; ou menos. Hipertrofia do ventrículo esquerdo, aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de ateroma na aorta foram significantemente mais frequentes nos pacientes com mais que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas.CONCLUSÃO: ECOTE é amplamente sugerido na investigação de embolia em pacientes jovens, porém parece ser tão importante também no grupo de pacientes mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e tratadas para melhor prognóstico.

Ausência de fatores de risco de doença coronária em índios Yanomami e influência da aculturação na pressão arterial / Absence of coronary heart disease risk factors in Yanomami indians and influence of aculturation on blood pressure

Objetivo - Investigar a hipótese de que a hipertensão arterial e a doença coronária são "doenças da civilização", analisando a distribuição dos antecedentes dessas doenças em uma população indígena e observando a influência da aculturação na pressão arterial. Métodos - Foram examinados 725 índios Yanomami de ambos os sexos, habitantes de oito aldeias nos Estados de Roraima e Amazonas. Foram feitas medidas referentes a todos os clássicos fatores de risco de doença coronária e foram colhidas amostras de urina para a dosagem de eletrólitos. Resultados - Não foi encontrado nenhum dos conhecidos fatores de risco de doença coronária. Os níveis de pressão arterial foram baixos e não aumentaram com a idade. Houve influência da aculturação na pressão arterial e essa influência foi medida, pelo menos em parte, pelo aumento do peso corporal e ingestão de sódio. Conclusão - A ausência, em uma população indígena relativamente isolada, de hipertensão e de outros fatores de risco de doença coronária e o aumento de pressão arterial com a aculturação sugerem, fortemente, que essas doenças são "doenças da civilização".

Pressão arterial em seis aldeias Yanomami

Objetivo - Estudar em Índios Yanomami, que não acrescentam sal aos alimentos, a intercalação da pressão arterial (PA) com variáveis constitucionais (idade, peso, altura e freqüência de pulso) e com os eletrólitos urinários. Casuística e Métodos - 125 Índios Yanomami do sexo masculino e 129 do feminino de seis aldeias na região da serra de Surucucu e dos rios Catrimani e Ajarani no estado de Roraima. Foram feitas 2 medidas de pressão em posição sentada e usou-se a média de ambas na análise dos dados. Resultados - Não foi encontrado nenhum hipertenso. A PA sistólica diminuiu com a idade e apresentou correlação positiva e significativa com o peso, com o pulso e com a concentração urinária de Na+ . A PA diastólica apenas se correlacionou com o peso. A altura e as concentrações urinárias d e K + , Ca + + e Mg ++ não apresentaram correlação com a PA. Conclusão - Ausência de hipertensão e de aumento da PA com a idade em Índios Yanomami isolados.

Ausência de fatores de risco de doença coronária em indios Yanomami e influência da aculturaçäo na pressäo arterial / Absence of coronary heart disease risk factors in yanomami indians and influence of aculturation on blood pressure

Objetivo - Investigar a hipótese de que a hipertensão arterial e a doença coronária são "doenças da civilização", analisando a distribuição dos antecedentes dessas doenças em uma população indígena e observando a influência da aculturação na pressão arterial. Métodos - Foram examinados 725 índios Yanomami de ambos os sexos, habitantes de oito aldeias nos Estados de Roraima e Amazonas. Foram feitas medidas referentes a todos os clássicos fatores de risco de doença coronária e foram colhidas amostras de urina para a dosagem de eletrólitos. Resultados - Não foi encontrado nenhum dos conhecidos fatores de risco de doença coronária. Os níveis de pressão arterial foram baixos e não aumentaram com a idade. Houve influência da aculturação na pressão arterial e essa influência foi medida, pelo menos em parte, pelo aumento do peso corporal e ingestão de sódio. Conclusão - A ausência, em uma população indígena relativamente isolada, de hipertensão e de outros fatores de risco de doença coronária e o aumento de pressão arterial com a aculturação sugerem, fortemente, que essas doenças são "doenças da civilização"

Purpose - To investigate the hypothesis that hypertension and coronary heart disease are "civilization diseases", analyzing the distribution of their antecedents in an Indian population and observing the influence of acculturation on blood pressure. Methods - Seven-hundred and twentyfive Yanomami indians of both sexes, ages above 14 years, inhabitants of eight villages in Roraima and Amazon states were examined. Measures related to all classical coronary risk factors were carried out and urine samples were collected to measure electrolytes. Results - None of the known coronary risk factors were found. The blood pressure levels were low and did not increase with increasing age. There was influence of acculturation on blood pressure and it was in part mediated by increase in body weight and sodium intake. Conclusion - The absence of hypertension and other coronary risk factors and the increase of blood pressure with acculturation, among an isolated population, strongly suggest that these diseases are "civilization diseases

Impacto clínico da ecocardiografia transesofágica em pacientes com acidente vascular cerebral sem evidência clínica de fonte emboligênica cardíaca / Clinical impact of transesophageal echocardiography in patients with stroke without clinical evidence of cardiovascular sources of emboli

OBJECTIVE: The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli. METHODS: We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. Transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid. RESULTS: Transeophageal echocardiography detected at least one abnormality in 40 cases (58 percent). Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9 percent); anticoagulation was added in 10 cases and surgical correction in one patient. CONCLUSION: Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism

Estratificação de risco cardiovascular no paciente assintomático por tomografia computadorizada cardíaca de múltiplos detectores / Cardiovascular risk stratification by multidetector computed tomography in the asymptomatic patient

Os atuais métodos de previsão de eventos cardiovasculares são muito imprecisos, somente explicando aproximadamente metade dos eventos. Isso é ainda mais acentuado no grupo de pacientes assintomáticos. A tomografia computadorizada por múltiplos detectores tem se mostrado um valioso aliado do cardiologista, fornecendo em um só exame, diversas informações sobre o sistema cardiovascular que, combinadas, têm o potencial de aumentar muito a acurácia na previsão de eventos cardiovasculares, diminuindo a morbimortalidade. No presente artigo será examinado o presente e potencial futuro desse novo método na avaliação de pacientes assintomáticos do ponto de vista cardiovascular.