Background:Coronary artery disease is the main cause of death in Brazil. In the
Brazilian public health system, the in-hospital mortality associated with
acute myocardial infarction is high. The Minas Telecardio 2 Project (Projeto
Minas Telecardio 2) aims at implementing a myocardial infarction system of
care in the Northern Region of Minas Gerais (MG) to decrease hospital
morbidity and mortality. The aim of this study was to describe the profile
of the patients with acute coronary syndrome (ACS) cared for in the period
that preceded the implementation of the system of care.Methods:Observational, prospective study of patients with ACS admitted between June
2013 and March 2014 to six emergency departments in Montes Claros, MG, and
followed up until hospital discharge.Results:During the study period, 593 patients were admitted with a diagnosis of ACS
(mean age 63 ± 12 years, 67.6% men), including 306 (51.6%) cases of
unstable angina, 214 (36.0%) of ST-elevation myocardial infarction (STEMI),
and 73 (12.3%) of non-ST-elevation myocardial infarction (NSTEMI). The total
STEMI mortality was 21%, and the in-hospital mortality was 17.2%. In the
STEMI patients, 46,0% underwent reperfusion therapy, including primary
angioplasty in 88 and thrombolysis in six. Overall, aspirin was administered
to 95.1% of the patients within 24 hours and to 93.5% at discharge, a
P2Y12 inhibitor was administered to 88.7% participants within
24 hours and to 75.1% at discharge. A total of 73.1% patients received
heparin within 24 hours.Conclusion:We observed a low reperfusion rate in patients with STEMI and limited
adherence to the recommended ACS treatment in the Northern Region of MG.
These observations enable opportunities to improve health care.
Spontaneous intracranial hypotension (SIH) is an infrequent cause of daily persistent orthostatic headache with an incidence of 5 to 100,000 persons/year. In very rare cases, no cause can be found and these conditions may be called spontaneous cerebrospinal fluid leak (CSFL). Radionuclide cisternography (RNC) has played useful role in detecting CSFL. Although RNC has been used in many cases, few have been reported in which CSFL out of the subarachnoid space was detected. A case of CSFL confirmed by RNC direct findings is reported. SIH is difficult to diagnose and 95% of patients may initially receive an incorrect diagnosis. RNC has been shown to be fairly characteristic in SIH patients.
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