Statin use in Brazil: findings and implications.

INTRODUCTION AND OBJECTIVES: Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS: Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression. RESULTS: A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. CONCLUSIONS: This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.

Appendicular Lean Soft Tissue: Development and Cross-Validation of Predictive Models for Older Men and Women.

BACKGROUND: Sarcopenia may explain, in a large proportion, physical disability, falls and fractures, especially in aged elderly. However, a diagnosis in an operationally systematic, simple and low cost way is extremely important, particularly for home-based, epidemiological studies. OBJECTIVE: The purpose of this study was to develop and validate predictive equations of appendicular lean soft tissue (ALST) in elderly older than 80 years. DESIGN AND SETTINGS: A validation study was performed in 106 elderly (men and women) aged 80 years and older. MEASUREMENTS: Body weight, height, circumference (arm, midcalf, hip and waist) and triceps skinfold were measured in the elderly. ALST were measured using as the reference method dual-energy X-ray absorptiometry (DXA). RESULTS: Two models were predicted. The first model (ALST, in kg = 0.074*height + 0.277*weight - 0.144*triceps skinfold - 0.103*waist circumference + 1.831*gender -0.966), which considered all possible variables in stepwise multiple regression, presented better statistical performance (r2 = 0.82; SEE = 1.67 kg), compared to the second model (ALST, in kg = 0.138*height + 0.103*weight + 3.061*gender - 12.489), a more practical equation, due to a lesser quantity of predictive variables (r2 = 0.75; SEE = 1.94 kg). Both models were validated, however, it was verified trend (p<0.05) for overestimation of predicted ALST. CONCLUSION: In summary, two models for predicting ALST in men and women with age ≥ 80 years were developed and cross-validated. Model 1, with a greater number of predictive variables, presented a better accuracy than did the model with only three variables (height, weight, and gender). Validation studies are needed to test the usefulness of both models in other populations.

Subacute toxicity assessment of annatto in rat.

Increased human use of annatto (Bixa orellana L), a red yellow food colorant, demands generation of toxicity data. The toxic effects of annatto powder (bixin 27%) have been assessed following administration of a subacute regimen (4 weeks, 20 doses) in Wistar male and female rats. A full study with three dose levels was considered unnecessary since no sign of toxicity had been noted in a preliminary experiment with 1000 mg/kg body weight/day as was recommended by the OECD guideline. In this study, annatto administered by gavage at a dose level of 2000 mg/kg/day decreased male body weight gain, but had no effect on either food intake or food conversion efficiency. Haematological and plasma biochemical examination as well necropsy performed at the end of administration (29th day) and observation (43rd day) periods revealed no alterations related with annatto administration. Kidney apoptosis occurred in 20% treated female rats in restricted areas without proliferation or tubular segments modification. The precise nature of apoptosis was not investigated in the present study. These findings suggest that annatto was no toxic to the rat.

Stereology and ultrastructure of the seminal vesicle of C57/BL/6J mice following chronic alcohol ingestion.

Excessive alcohol consumption causes metabolic changes and pathologic alterations in testes and accessory sex organ in different animal species. The aim of the present study was to evaluate the macroscopic, histologic and ultrastructural alterations provoked by chronic ingestion of different ethanol concentrations over increasing periods of time on the secretory epithelium of the seminal vesicle of C57/BL/6J mice in using stereological methods. Sixty male adult mice were divided into three experimental groups: Control, Alcoholic 25% and Alcoholic 35%, respectively, receiving tap water and tap water containing ethanol diluted to 25 and 35 degrees Gay Lussac. All mice were fed with the same solid diet. After 150 and 250 days of treatment the animals were sacrificed and the seminal vesicles were collected and processed for light and transmission electron microscopy. The cellular, cytoplasmic and nuclear volumes and the area density of autophagic and secretory vacuoles were measured. The histologic alterations observed in the alcoholic mice consisted of a reduction in epithelial size and cell volume, with maintenance of the same nuclear and cytoplasmic ratio as verified in the control groups. The ultrastructural alterations were: increased density of dense body area, decreased density of secretory granule area, and dilated rough endoplasmic reticulum and Golgi cisternae. We conclude that chronic ethanol ingestion causes depleting morphologic alterations in the epithelial cells of the seminal vesicle and negatively affects the secretory process of this gland.

Diffusion of calcium through dentin.

The purpose of this research was to investigate whether calcium ions from a paste of calcium hydroxide [Ca(OH)2] and saline introduced into root canals diffuse through the dentin to reach the surface of the root. Six teeth were opened and submitted to a biomechanical process, after which all the smear layer was removed. The experiment was divided into three phases: dissolution, dissolution and diffusion I, and dissolution and diffusion II. Dissolution-each tooth, with no Ca(OH)2 paste in place, was sealed both cervically and apically and stored in 700 ml of deonized water until calcium losses from the tooth into the water were stabilized. Dissolution and diffusion I-each root canal was filled with a paste of Ca(OH)2 and saline, sealed again apically and cervically, and returned to its solution. Dissolution and diffusion II-samples were divided into three parts: the control group or group 1, containing the original paste; group 2, in which the existing paste was diluted and the teeth were resealed and replaced in their solutions; and group 3, in which the existing paste was removed and a fresh paste was introduced. The diffusion was greater in group 3, followed by group 2. In the control group, we found a diffusion of calcium, which is statistically null. The results showed that calcium diffusion was observed, in the first 16 days, in all situations in which there was Ca(OH)2 paste inside the root canals.