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Background: Left atrial (LA) volume indexing for body surface area (BSA) may underestimate LA size in obese and overweight people. Since LA volume is a risk marker for some cardiovascular events, it is suggested that indexing for height would be an alternative more appropriate method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for height in our population. Methods: Echocardiograms from 2018 to 2021 were reviewed and patients without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAvol) measured by biplane Simpson's method were included. LAvol was indexed by BSA (ml/m2), by height (LAvol/m), by height raised to exponent 2.7 (ml/ m2.7) and by height squared (ml/h2). Results: A total of 545 patients, 50.5 ± 13.4 y., 335 females (61,5%) were analyzed. There were 145 normal weight (26.6%), 215 overweight (39.4%), 154 obese (28.3%) and 31 low weight (5.7%) patients. To establish normal values we included only the normal weight group and considered normal values from 2SD below to 2SD above the mean. Mean and normal values were: LAvol/h 26.0 ±4.5, 17 - 35 ml/m, LAvol/ht2 16 ± 2.8, 10.4 - 21.6 ml/ ht2 and LAvol/ht2.7 11.4 ± 2.2, 7.0 - 15.8 ml/m2.7. The normal LAvol/ht2.7 differed between male and female (11.4 ± 2.4 and 12.8 ± 2.6, p < 0.001). LA diameter, LAvol, LAvol/h, LAvol/h2 and LAvol/ht2.7 increased progressively from low-weight, normal weight, overweight and obese patients (p< 0.0001), but not LAvol/BSA. When indexing LAvol for height, for height2 and for height2.7 20.8%, 22.7% and 21.4% of the obese patients, respectively, were reclassified as enlarged LA, and 7.4%, 8.8% and 8.4% of the overweight patients as well. Using ROC curve analysis, LAvol/h2 had the highest AUC ant the best predictive value to identify LA enlargement and LAvol/BSA the worst one. Conclusions: Normal values for LAvol indexed for height by three different methods are described in normal individuals. We reinforce that LAvol indexation for BSA underestimates LA size in obese and overweight patients and in these groups, specially, indexing for height2 is probably the best method to evaluate LAvol.

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Aims: Atrial fibrillation (AF) is a public health problem and its prevalence is increasing worldwide. Electronic cohorts, with large electrocardiogram (ECG) databases linked to mortality data, can be useful in determining prognostic value of ECG abnormalities. Our aim is to evaluate the risk of mortality in patients with AF from Brazil. Methods: This observational retrospective study of primary care patients was developed with the digital ECG database from the Telehealth Network of Minas Gerais, Brazil. ECGs performed from 2010 to 2017 were interpreted by cardiologists and the University of Glasgow automated analysis software. An electronic cohort was obtained linking data from ECG exams and those from a national mortality information system, using standard probabilistic linkage methods. We considered only the first ECG of each patient. Patients under 16 years were excluded. Hazard ratios (HR) for mortality were adjusted for demographic and self-reported clinical factors and estimated with Cox regression. Results: From a dataset of 1,773,689 patients, 1,558,421 were included, mean age 51.6 years; 40.2% male. There were 3.34% deaths from all causes in 3.68 years of median follow up. The prevalence of AF was 1.33%. AF was an independent risk factor for all-cause mortality (HR 2.10, 95%CI 2.03-2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86-2.29). Females with AF had a higher risk of overall and cardiovascular mortality compared with males (p < 0.001). Conclusions: AF was a strong predictor of cardiovascular and all-cause mortality in a primary care population, with increased risk in women. Condensed abstract: To assess risk of mortality in AF patients, an electronic cohort was obtained linking data from ECG exams of Brazilian primary care patients and a national mortality information system. From 1,558,421 patients, AF (prevalence 1.33%) carried a higher risk of overall and cardiovascular mortality, with increased risk in women. What's New: This is the first study with a large Brazilian electronic cohort to evaluate the risk of mortality linked to AF in primary care patients.AF patients from a Brazilian primary care population had a higher risk of death for all causes (HR 2.10, 95%CI 2.03-2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86-2.29).Female patients with AF had an increased risk of overall and cardiovascular mortality compared with male patients (p < 0.001).

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The protective effect of infectious agents against allergic reactions has been thoroughly investigated. Current studies have demonstrated the ability of some helminths to modulate the immune response of infected hosts. The objective of the present study was to investigate the relationship between Toxocara canis infection and the development of an allergic response in mice immunised with ovalbumin (OVA). We determined the total and differential blood and bronchoalveolar lavage fluid cells using BALB/c mice as a model. To this end, the levels of interleukin (IL)-4, IL-5 and IL-10 and anti-OVA-IgE were measured using an ELISA. The inflammatory process in the lungs was observed using histology slides stained with haematoxylin and eosin. The results showed an increase in the total number of leukocytes and eosinophils in the blood of infected and immunised animals at 18 days after infection. We observed a slight lymphocytic inflammatory infiltrate in the portal space in all infected mice. Anti-OVA-IgE levels were detected in smaller proportions in the plasma of immunised and infected mice compared with mice that were only infected. Therefore, we concluded that T. canis potentiates inflammation in the lungs in response to OVA, although anti-OVA-IgE levels suggest a potential reduction of the inflammatory process through this mechanism.

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The protective effect of infectious agents against allergic reactions has been thoroughly investigated. Current studies have demonstrated the ability of some helminths to modulate the immune response of infected hosts. The objective of the present study was to investigate the relationship between Toxocara canis infection and the development of an allergic response in mice immunised with ovalbumin (OVA). We determined the total and differential blood and bronchoalveolar lavage fluid cells using BALB/c mice as a model. To this end, the levels of interleukin (IL)-4, IL-5 and IL-10 and anti-OVA-IgE were measured using an ELISA. The inflammatory process in the lungs was observed using histology slides stained with haematoxylin and eosin. The results showed an increase in the total number of leukocytes and eosinophils in the blood of infected and immunised animals at 18 days after infection. We observed a slight lymphocytic inflammatory infiltrate in the portal space in all infected mice. Anti-OVA-IgE levels were detected in smaller proportions in the plasma of immunised and infected mice compared with mice that were only infected. Therefore, we concluded that T. canis potentiates inflammation in the lungs in response to OVA, although anti-OVA-IgE levels suggest a potential reduction of the inflammatory process through this mechanism.

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Twelve community health workers (CHWs) were trained to offer basic health care for children under five years of age through household visits in Itapirapuã Paulista, a municipality in Vale do Ribeira, São Paulo State, Brazil. Their tasks included diagnosis, initial treatment, and management of diarrhea and acute respiratory diseases at the household level, growth monitoring, incentives to complete basic immunization, and counseling on infant food supplementation. An average of 409 (396-417) children were visited weekly by CHWs in their homes over the course of three years. In this period, the hospitalization rate dropped drastically, and the use of oral rehydration therapy during bouts of diarrhea increased greatly. However, prevalence of stunting and incidence of low birth weight did not change. Child health indicators (CHI) in this municipality were better than those in a municipality chosen as a control. CHWs may have contributed to improved local CHI, but the results should be interpreted with caution for two reasons: (1) CHI is improving in Brazil countrywide and (2) it is a small program implemented in an area with high morbidity and mortality rates and low availability of health services.

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Doze agentes comunitários de saúde (ACS) foram treinados para diagnosticar e iniciar tratamento de diarréia e infeçäo respiratória no domicílio, monitorar crescimento, incentivar imunizaçäo básica e orientar a introduçäo de alimentos à dieta entre menores de cinco anos no Município de Itapirapuä Paulista, Vale do Ribeira, Säo Paulo, Brasil. Esses cuidados eram oferecidos através de visitas domiciliares a todas crianças nessa faixa etária, residentes na área de abrangência do ACS. Ao longo de três anos, foram visitadas semanalmente, em média, 409 (396-417) crianças. Nesse período, a taxa de hospitalizaçäo entre menores de cinco anos foi drasticamente reduzida, e a utilizaçäo de soro reidratante oral e a cobertura vacinal básica sensivelmente aumentadas. A prevalência de déficit altura/idade e incidência de baixo peso ao nascer praticamente näo se modificaram. Os indicadores de saúde infantil nesse município, foram sistematicamente melhores que os indicadores de um município tomado como controle. É bastante provável que os ACS tenham contribuído para essas melhorias. No entanto, há que considerar o fato de os indicadores de saúde infantil estarem melhorando no Brasil, e que este é um programa de pequena escala implementado em um área com elevados índices de morbimortalidade infantil e baixa oferta de cuidados em saúde

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Geralmente, o tratamento para tumores carcinóides típicos em brônquio é a ressecçäo pulmonar econômica, com ou sem broncoplastia. Este éum relato de caso de uma paciente com tumor carcinóide típico no brônquio lobar inferior esquerdo, junto à carina lobar. Foi realizada broncotomia longitudinal, ressecçäo do tumor e sutura do brónquio, preservando o parênquima pulmonar. A paciente evoluiu bem e apresenta três anos de pós-operatório sem evidência de recidiva da doença nas broncoscopias de controle

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