Cause Of Death In Brazil Research Articles

2018 recommendations for the management of community acquired pneumonia.

ABSTRACTCommunity-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.

Medical perception of stroke care conditions in Brazil.

Stroke is currently the second leading cause of death in Brazil. Neurologists' reports on the absence of adequate resources for stroke care are frequent; however, there are no objective data on this perception.To assess the perception of neurologists of stroke care conditions in Brazil. Neurologists from all over Brazil were surveyed by means of an anonymous questionnaire about the main shortcomings in stroke care, focusing particularly on physical structure and infrastructure (diagnostic methods, patient transport, availability of beds, multi-professional team). The main shortcomings are indicated: the worst conditions, among all items surveyed, were found in the public sector. In the private sector, conditions were better. Care conditions are worse in the public sector with regard to both infrastructure and human resources. Future public health policies for the prevention and treatment of stroke should be formulated, taking into consideration neurologists' perceptions.

Correlation Between the Complexity of Coronary Lesions and High-Sensitivity Troponin Levels in Patients with Acute Coronary Syndrome

Abstract Background: Cardiovascular diseases are the leading cause of death in Brazil. Biochemical markers have diagnostic and prognostic importance in acute coronary syndromes (ACSs), with troponin as the preferred biomarker. Studies have already demonstrated a positive relationship between increased levels of high-sensitivity troponin (hsTn) and prognosis. However, few studies have correlated hsTn levels with the complexity of coronary lesions. Objectives: To compare hsTn levels with the complexity of coronary lesions according to the SYNTAX score, and to correlate the levels of this biomarker with the TIMI and GRACE scores in patients with ACS. Methods: Retrospective, cross-sectional study with 174 patients with ACS. The correlation between variables was assessed by the nonparametric Spearman's rank correlation, and statistical analysis was performed by the SPSS program, with a significance level of 5%. Results: Mean age was 63 years, and most patients were women (52.9%), hypertensive, non-diabetic and non-smokers. Nineteen percent of the patients had STEMI, 43.1% NSTEMI, and 36.8% unstable angina. Most were in Killip 1 (82.8%). Median hsTn was 67 pg/mL. Median risk scores were 3, 121 and 3 in the TIMI, GRACE and SYNTAX scores, respectively. There was a correlation of hsTn with SYNTAX (p <0.001, r = 0.440), TIMI (p < 0.001, r = 0.267) and GRACE (p = 0.001, r = 0.261) scores. Conclusion: A positive linear correlation was found of hsTn levels with the complexity of coronary lesions, and with the TIMI and GRACE clinical scores.

Cause-specific mortality for 249 causes in Brazil and states during 1990\u20132015: a systematic analysis for the global burden of disease study 2015

BackgroundReliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015.MethodsWe describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states.ResultsThere was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI.ConclusionsA widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.

Evolução da mortalidade por causas externas em Diamantina (MG), 2001 a 2012

Resumo Introdução As causas externas estão entre as principais causas de morte no Brasil, afetando, principalmente, jovens e adultos. Métodos Estudo retrospectivo dos óbitos por causas externas em Diamantina, em Minas Gerais, de 2001 a 2012. Foram utilizados dados de óbitos do Sistema de Informações sobre Mortalidade (SIM) e dados populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram calculados coeficientes trienais de mortalidade padronizados por idade, específicos por sexo, para todos os grupos de causas externas. As tendências foram analisadas por meio de modelos de regressão linear com o programa Stata 13. Resultados As causas externas constituíram a quinta causa de mortes no município, com coeficiente médio de 44,3/100 mil habitantes. Verificou-se maior risco de morte para homens (coeficiente médio=71,5/100 mil). Os acidentes de transporte constituíram a maior causa de óbitos (29,6%), seguidos por outras causas externas (21,5%), pelos homicídios (20,6%) e pelos suicídios (14,6%). A faixa etária de 20 a 29 anos foi a mais afetada, enquanto a faixa de 60 anos ou mais apresentou o maior risco. Verificou-se uma tendência de aumento (p&lt;0,05) na mortalidade geral por causa externas, na mortalidade masculina por acidentes de transporte e na mortalidade feminina por agressões. Conclusão As causas externas constituem um problema crescente de saúde pública em Diamantina, sendo necessária a implementação de medidas que visem ao seu controle e redução.

Clinical outcome and characteristics of patients with cervical cancer submitted to renal replacement therapy.

e21627 Background: Cervical cancer is the 2nd most prevalent and 4th cause of cancer-related death in Brazil among women. It may cause renal failure due to tumoral growth, the treatments, among other causes. Purpose: To evaluate the clinical outcome and the risk of death in patients with cervical cancer hospitalized submitted to hemodialysis, to describe the clinical characteristics of these patients. Methods: Retrospective observational study. Patients diagnosed with cervical cancer, hospitalized, submitted to renal replacement therapy were identified in a single institution (n = 92). Risk of death was estimated using Kaplan-Meier analysis. The Cox proportional hazards regression model was used to determine the risk of death on the basis of: cancer staging, disease activity, Performance status at admission, oncological surgery before hemodialysis subgroup. Results: 92 patients with cervical cancer hospitalized were submitted to intermittent hemodialysis between January 2007 and December 2008. Data was available for all the 92 patients. Median age at diagnosis 47.8 years (25.4-95.1), 73.9% was diagnosed stage III/IV, 95% had disease progression/ active disease before hemodialysis. 84 patients (91%) were dead at the moment of analysis (Cut-off date 30/03/2010), median interval between first hemodialysis and death 1.1 months (0-24.8). The main cause of death was postrenal kidney failure (82.6%). In multivariate analysis, stage II/III/IV (compared with stage I) and disease progression/active disease were the only independent prognostic factors associated with increased risk of death (HR = 3.149; 95% CI, 1.765 to 5.610; P = .001 and HR = 4.205; 95% CI, 1.002 to 17.65; P = .05). Conclusions: Women with advanced disease and active disease/ disease progression have a significant increased risk of death compared with those with stage I, stable disease/ disease in remission. Prospective studies are warranted to investigate the benefit hemodialysis in patients with cervical cancer.

Mortalidade por doença cardíaca hipertensiva nas macrorregiões brasileiras

Introdução: As doenças cardiovasculares estão em primeiro lugar entre as causas de morte no Brasil. A doença cardíaca hipertensiva (DCH) descreve um espectro de resposta de órgãos-alvo, que inclui doença arterial coronariana, hipertrofia ventricular esquerda, insuficiência cardíaca e arritmias.Objetivo: Realizar uma análise epidemiológica da mortalidade por DCH nas macrorregiões brasileiras.Materiais e Métodos: Estudo descritivo das taxas de mortalidade de base populacional com dados secundários e uma análise comparativa entre as macrorregiões brasileiras, utilizando as variáveis: sexo, faixa-etária, ano do óbito, cor/raça e escolaridade.Resultados: Observou-se grande acréscimo nos coeficientes de mortalidade brutos a partir de 40 a 59 anos. A DCH acometeu principalmente pessoas pardas nas regiões norte, nordeste e centro-oeste e indivíduos brancos nas regiões sul e sudeste, provavelmente por maior predomínio desses fenótipos nas respectivas áreas. Quanto ao sexo, a mortalidade é elevada em ambos. O número de óbitos é inversamente proporcional à quantidade de anos de escolaridade em todas as regiões, sendo os maiores valores no grupo de analfabetos.Conclusão: Observamos que com o aumento da idade há elevação do coeficiente de mortalidade, especialmente onde há maior precariedade na assistência à saúde, nas medidas de prevenção, controle e acompanhamento, além de repasse de recursos, a exemplo da região nordeste.

Burden of disease by lower respiratory tract infections in Brazil, 1990 to 2015: estimates of the Global Burden of Disease 2015 study.

Lower respiratory tract infections (LRTIs) present significant incidence and mortality in the world. This article presents the impact of LRTIs in the burden of disease, according to the metrics used in the Global Burden of Disease study (GBD 2015) for Brazil in 1990 and 2015. Analysis of estimates from the GBD 2015: years of life lost due to premature death (YLLs), years lived with disability (YLDs), years of life lost due to death or disability (DALYs = YLLs + YLDs). LRTIs were the third cause of mortality in Brazil in 1990 and 2015, with 63.5 and 47.0 deaths/100,000 people, respectively. Although the number of deaths increased 26.8%, there was a reduction of 25.5% in mortality rates standardized by age, with emphasis on children under 5 years of age. The disability indicators, as measured by the DALYs, demonstrate a progressive reduction of the disease burden by LRTIs. Despite the reduction in mortality rates in the period, LRTIs were an important cause of disability and still the third cause of death in Brazil in 2015. The increase in the number of deaths occurred due to the increase in population and its aging. The reduction in mortality rates accompanied the improvement of socioeconomic conditions, broader access to health care, national availability of antibiotics, and vaccination policies adopted in the country. Despite the current socioeconomic difficulties, there has been a progressive reduction of the LRTIs load effect in Brazil, mostly in mortality and disability, and among children under 5 years of age.

Assessment of the investigation of ill-defined causes of death in Brazil in 2010.

to assess the results of the investigation of ill-defined causes of death (IDCD) to improve the quality of cause-of-death data in Brazil. this is a descriptive study using data from the Mortality Information System; all IDCD which occurred in 2010 were selected; deaths were analyzed according to macroregions, states, state capitals and characteristics of how the investigations were carried out. the proportion of IDCD was 8.6% in Brazil in 2010 and decreased to 7.0% after investigation and fell from 4.7% to 3.4% in state capitals after investigation; approximately 65% of the investigated cases were reclassified to a defined cause in states and state capitals. there was an improvement in data quality on cause of death resulting from these investigations which have led to an important decrease in the proportion of IDCD in the states and state capitals, although there are still some regional inequalities.

Comparing the Comprehensive Stroke Ward Versus Mixed Rehabilitation Ward-The Importance of the Team in the Acute Stroke Care in a Case-Control Study.

Ischemic stroke is one of the most frequent causes of death in Brazil. Many measures have been taken to reduce this tragic outcome, and one of those is the implementation of stroke units in hospitals. The aim of the present study is to analyze the in-hospital complications for patients with ischemic stroke admitted in a comprehensive stroke ward (CSW) as compared to patients admitted in a mixed rehabilitation ward (MRW). A retrospective interventional study with historic controls of patients admitted to the Neurology Division between January 2010 and October 2013. Patients admitted between January 2010 and September 2012 were included in the MRW group, and patients admitted from October 2012 until October 2013 were included in the CSW group. Throughout the whole study period, the same team assisted all the patients. Both groups were paired in relation to age and gender. The rate of in-hospital complications, mortality, and independency on discharge were evaluated in both groups. Each group was comprised of 91 patients. There were no statistically significant differences for any of the risk factors analyzed between the 2 groups nor for outcome measures-in-hospital complications, mortality, and independence on discharge. The present study demonstrated that in-hospital complications, independence on discharge, and mortality have similar rates in patients admitted to an MRW compared to patients admitted to a CSW, when the same staff provided them with specialized in-hospital care. Case-control study-Evidence Level 3.

60 Access to magnesium sulfate for eclampsia and severe pre-eclampsia in the public health system in Brazil: Situational analysis

Background Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive syndrome, including timely access to magnesium sulfate. Objective To identify the potential causes of improper magnesium sulfate use. Method A situational analysis was conducted with a survey on information available at the official websites on the policy, regulation and availability of the medication, field analysis and interviews with local managers of public obstetric health services in Campinas, a city in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations. Results There was no access to magnesium sulfate in primary care facilities, urgent obstetric care was excluded from urgency care services and clinical protocols for professional guidance on the proper use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals (Table). Conclusion The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care favors the improper use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates. Download : Download high-res image (873KB) Download : Download full-size image

Analysis of impacts from environmental factors evaluated by icf in individuals post-cva

Abstract Introduction: The CVA is the second cause of death in Brazil, presenting with serious clinical repercussions and as a public health issue. Live with the disabilities caused by it requires facing daily situations, which can increase the disability, such as the ones imposed by the environment inside or outside home. Objective: Analyze the environmental factors of ICF with a facilitator or barrier for victims of Stroke. Materials and methods: A cross-sectional study, 152 individuals; span of less than 60 months involvement and enrolled in the Family Health Units in João Pessoa, Brazil. A questionnaire was used to characterize the socio-economic and clinical form and the Core Set for stroke to identify environmental factors. The data were stored in EpiInfo 7. Associations between environmental factors and the variables age, gender, and marital status verified by chi-square test. Results: Assistive technologies and products or substances for personal consumption were the main factors recognized as facilitators, followed by interpersonal relationships. The most prevalent factors as barriers were the physical structures of public and private spaces, highlighting the physical geography of their residence. It was found that the immediate family was associated with variable marital status, use of products and technology for personal use in daily life was associated with age and, friends partnered with variable gender. Conclusions: The Core Set is shown as a sensitive instrument to capture the barriers and facilitators in population surveys. Their findings point to the need to think about public policy more appropriate for this population.{#}

Endothelial Changes in Individuals with Prehypertension.

Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension. The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events. The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.

Notification of Huntington's disease as primary cause of death in Brazil from 1984 to 2008.

The aim of this article was to conduct a retrospective observational study on reported deaths due to Huntington's disease (HD) in Brazil in the past 25 years (from 1984 to 2008). Data were obtained from the Brazilian Mortality Information System (SIM/DATASUS), the official system of Brazilian Mortality Database. The data obtained included information regarding the gender of the deceased and the number of death notifications, which we stratified by demographic regions and states. HD mortality per 100,000 was calculated and plotted in a graph. Linear regression was calculated using ordinary least square technique. We observed that the mortality due to HD recorded by SIM/DATASUS from 1984 to 2008 had increased at much higher rates than the population in the same period. Also, some Brazilian regions still show very low rates of HD mortality compared to the national average of deaths due to HD. These findings suggest that HD mortality has been underestimated. Ignorance about the disease as well as the fact that death from HD can occur as a consequence of heart disease, pneumonia, or suicide can strongly contribute to the misguided notification of HD as the cause of death in the official reports.

Progression of Mortality due to Diseases of the Circulatory System and Human Development Index in Rio de Janeiro Municipalities.

BackgroundDiseases of the circulatory system (DCS) are the major cause of death in Brazil and worldwide.ObjectiveTo correlate the compensated and adjusted mortality rates due to DCS in the Rio de Janeiro State municipalities between 1979 and 2010 with the Human Development Index (HDI) from 1970 onwards.MethodsPopulation and death data were obtained in DATASUS/MS database. Mortality rates due to ischemic heart diseases (IHD), cerebrovascular diseases (CBVD) and DCS adjusted by using the direct method and compensated for ill-defined causes. The HDI data were obtained at the Brazilian Institute of Applied Research in Economics. The mortality rates and HDI values were correlated by estimating Pearson linear coefficients. The correlation coefficients between the mortality rates of census years 1991, 2000 and 2010 and HDI data of census years 1970, 1980 and 1991 were calculated with discrepancy of two demographic censuses. The linear regression coefficients were estimated with disease as the dependent variable and HDI as the independent variable.ResultsIn recent decades, there was a reduction in mortality due to DCS in all Rio de Janeiro State municipalities, mainly because of the decline in mortality due to CBVD, which was preceded by an elevation in HDI. There was a strong correlation between the socioeconomic indicator and mortality rates.ConclusionThe HDI progression showed a strong correlation with the decline in mortality due to DCS, signaling to the relevance of improvements in life conditions.

Characterization of self-extermination attempt cases in an emergency department in an university hospital

Violence becomes a matter to be discussed in the health-disease process, once it reaches the collective and individual health, requiring action and articulation of services. Suicide is the third leading cause of death in Brazil, however, these self-extermination attempts are not being successfully reported (undernotified) and, sometimes, not even reported at all. To characterize the cases of self-extermination attempt in the emergency department of a university hospital. This was a retrospective, cross-sectional study with a quantitative approach. 162 medical records were included in self-extermination attempt cases, for the period from January 2008 to September 2013. From the 162 analyzed records, 56.17% were women; 22.22% within the age group between 24 and 38 years old, average age of 34.5 years old; 53.09% single; 94.44% coming from Uberlândia. 39.51% occurred at night; frequency of 19.14% on Mondays; 24.68% of attempts in 2012. Abusive ingestion of medications in 34.07% of cases; 51.23% were brought to the hospital by the Fire Department; 35.83% had a mental disorder; 45.67% of the cases were the patient’s first attempt; 39.42% of cases occurred after relationship conflicts. 54.32% were discharged within 18 hours, on average, after care in the emergency room; 21.60% have returned because of a new attempt. The research was characterized attempts at self-extermination cases, with predominantly female, aged between 24 and 38, use of medication as an agent to act, with high recidivism among the female group. It is suggested research with longer periods and samples and analyzed by The National Policy for Reduction of Morbidity and Mortality by Accidents and Violence.

Epidemiological Profile and Quality Indicators in Patients with Acute Coronary Syndrome in Northern Minas Gerais - Minas Telecardio 2 Project

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.

Leprosy-related mortality in Brazil: a neglected condition of a neglected disease.

Leprosy is a public health problem and a neglected condition of morbidity and mortality in several countries of the world. We analysed time trends and spatiotemporal patterns of leprosy-related mortality in Brazil. We performed a nationwide population-based study using secondary mortality data. We included all deaths that occurred in Brazil between 2000 and 2011, in which leprosy was mentioned in any field of death certificates. Leprosy was identified in 7732/12 491 280 deaths (0.1%). Average annual age-adjusted mortality rate was 0.43 deaths/100 000 inhabitants (95% CI 0.40-0.46). The burden of leprosy deaths was higher among males, elderly, black race/colour and in leprosy-endemic regions. Lepromatous leprosy was the most common clinical form mentioned. Mortality rates showed a significant nationwide decrease over the period (annual percent change [APC]: -2.8%; 95% CI -4.2 to -2.4). We observed decreasing mortality rates in the South, Southeast and Central-West regions, while the rates remained stable in North and Northeast regions. Spatial and spatiotemporal high-risk clusters for leprosy-related deaths were distributed mainly in highly endemic and socio-economically deprived regions. Leprosy is a neglected cause of death in Brazil since the disease is preventable, and a cost-effective treatment is available. Sustainable control measures should include appropriate management and systematic monitoring of leprosy-related complications, such as severe leprosy reactions and adverse effects to multidrug therapy.

Profile of patients with acute coronary syndrome in public hospital of São Paulo, Brazil

Background: Cardiovascular diseases are the leading cause of death in Brazil. For the reduction of this important public health problem is essential an effective prevention in basic care of health and control of cardiovacular risk factors.

Aferição da glicemia capilar na clínica odontológica - rastreamento de casos de Diabete tipo II

Estimates show that in 2025, the Brazilian population is expected to reach 228 million. The type 2 Diabetes was the third leading cause of death in Brazil (Censo 2010). By 2025, should be about 11 million diabetics in the country, representing an increase of over 100 % compared to 5 million in 2000. This study aims to track possible cases through benchmarking test postprandial blood glucose. The evaluation of 69 women and 34 men showed a percentage of 8% possible cases which had mean postprandial blood glucose of more than two hours of 232.75 mg/dl and a maximum of 412mg/dl in agreement with Ministry of Health studies.