Rafael Dall'Alba

Austerity threatens universal health coverage in Brazil

www.thelancet.com Vol 388 August 27, 2016 867 suggest the government’s attempts to deregulate and diminish the role of public health care. Furthermore, Barros announced on July 21, 2016, a reduction of participation by foreign professionals in the country’s More Physicians (Mais Médicos) programme, 3 which was introduced in 2013 by Dilma Rousseff’s Government in response to protests across the country by people demanding better access to physicians. Participation of foreign physicians in Brazil, mainly Cubans, has benefi ted the 63 million Brazilians living in remote and vulnerable areas, which previously had shortages of health professionals. In a country where about 80% of the population relies exclusively on SUS, such policies might cause widespread negative consequences. In the midst of severe economic crisis, with the unemployment rate at over 11% and gross domestic product having fallen by 5·4% from the preceding year, more people will be unable to pay for private health care and more will be dependent on the increasingly stressed public system. As a result, the great achievements of the past 10 years (increased coverage of universal health care, decreased infant mortality, and reduced mortality from chronic illnesses) are likely to be reversed. Most members of congress supported the impeachment of the president, so the “neoliberal” policies of the interim government are likely to be approved. The intended resurrection of the economy through austerity will bring public health disasters in some or all of the aspects mentioned above. The eff ects of recessions depend mostly on the response of politicians to the early indicators. However, the protests in June and July, 2016, in defence of universal health care have a capacity to infl uence the government’s policies.

Early use of cardiac troponin-I and echocardiography imaging for prediction of myocardial infarction size in Wistar rats

AIMS Evaluating myocardial infarct (MI) size prior to intervention is fundamental to ensure accurate results in experimental studies. However, this assessment is performed at late time points. We aimed to evaluate whether measuring plasma cardiac troponin I (cTnI) and performing echocardiographic assessment at earlier time points can predict the occurrence of MI and infarct size. MAIN METHODS Male Wistar rats were subjected to MI (n=40) or sham surgery (n=11). cTnI levels were measured 2 and 8h after MI. Echocardiographic evaluations were performed at 48h and 14days post-MI. After 14days, the animals were euthanized, and the hearts were removed and paraffin-embedded for Sirius red staining. KEY FINDINGS cTnI plasma levels increased in the MI group relative to the sham group at 2h after MI (7.2±9.4ng/mL vs. 2.3±1.0ng/mL; p<0.01) with a further increase at 8h after MI (22.2±13.5ng/mL vs. 1.5±1.7ng/mL; p<0.001). cTnI levels (8h) and echocardiographic outcomes correlated with histological infarct size 14days after MI (r=0.74, p<0.001 and r=0.84, p<0.001, respectively), but only echocardiography could confidently identify small, medium, and large infarcts. Additionally, using a cutoff value of 4.8ng/mL we achieved 100% specificity and 91% sensitivity in detecting MI. SIGNIFICANCE A cutoff value of 4.8ng/mL for cTnI could be used as early as 8h after MI to accurately identify infarct in this model, whereas echocardiographic images taken 48h after MI predicted the infarcted area 14days after MI.