Hospital costs related to streptococcal meningitis among children in Sao Jose dos Campos, Sao Paulo State, Brazil

Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of Sao Jose dos Campos, Sao Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.

Pierre-Auguste Renoir (1841-1919) and rheumatoid arthritis

Pierre-Auguste Renoir (1841-1919), one of the world's most celebrated impressionist painters, suffered from rheumatoid arthritis for most of his life. His symptoms developed when he was in his 50s and they became aggressive at about the age of 60 years that led to almost complete disability when he was 70 years old. Although the deformities he suffered because of the rheumatoid arthritis were disabling, Renoir never stopped painting nor decreased the quality of his work. The transition between styles adopted by the painter (Impressionist, Dry and Pearly periods) bear no relationship to the stages of flare-ups or the establishment of joint deformities due to rheumatoid arthritis. His work shows aspects of the body's ability to overcome pain and physical limitation.

A New Method to Predict the Epidemiology of Fungal Keratitis by Monitoring the Sales Distribution of Antifungal Eye Drops in Brazil

Purpose: Fungi are a major cause of keratitis, although few medications are licensed for their treatment. The aim of this study is to observe the variation in commercialisation of antifungal eye drops, and to predict the seasonal distribution of fungal keratitis in Brazil. Methods: Data from a retrospective study of antifungal eye drops sales from the only pharmaceutical ophthalmologic laboratory, authorized to dispense them in Brazil (Opthalmos) were gathered. These data were correlated with geographic and seasonal distribution of fungal keratitis in Brazil between July 2002 and June 2008. Results: A total of 26,087 antifungal eye drop units were sold, with a mean of 2.3 per patient. There was significant variation in antifungal sales during the year (p < 0.01). A linear regression model displayed a significant association between reduced relative humidity and antifungal drug sales (R-2 = 0.17, p < 0.01). Conclusions: Antifungal eye drops sales suggest that there is a seasonal distribution of fungal keratitis. A possible interpretation is that the third quarter of the year (a period when the climate is drier), when agricultural activity is more intense in Brazil, suggests a correlation with a higher incidence of fungal keratitis. A similar model could be applied to other diseases, that are managed with unique, or few, and monitorable medications to predict epidemiological aspects.

Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, São Paulo, Brasil

O conhecimento dos custos hospitalares é de grande importância para os processos de tomada de decisão em saúde pública. O objetivo deste estudo foi estimar os custos hospitalares diretos relacionados à meningite pneumocócica em crianças com até 13 anos (inclusive), na cidade de São José dos Campos, São Paulo, Brasil, de janeiro de 1999 a dezembro de 2008. Foram obtidos dados de prontuários médicos. O cálculo foi realizado pelo método misto de mensuração das quantidades dos itens de custos e atribuição de valor aos itens consumidos (micro-costing e gross-costing). Os valores monetários referem-se a novembro de 2009, sendo expressos em reais. A análise das frequências e médias foi realizada pelo programa Epi Info versão 3.5.1. Foram notificados 41 casos. Os custos hospitalares diretos variaram de R$ 1.277,90 a R$ 19.887,56 (média = R$ 5.666,43), ou seja, 10 a 20 vezes maiores que o custo médio de internações pago pelo SUS. Os custos dos honorários profissionais foram os mais relevantes, seguidos pelos custos dos medicamentos, procedimentos, materiais e exames laboratoriais.

História e memória do ensino de física no Brasil: a faculdade de medicina de São Paulo (1913-1943)

Este trabalho apresenta um recorte histórico do ensino de Física na Faculdade de Medicina de São Paulo no período de 1913 a 1943. Vimos que o curso superior de Física foi essencial no remodelamento curricular da Física secundária. Destacamos a seleção cultural escolar por meio dos livros didáticos, apontando para aqueles que influenciaram e guiaram as mudanças curriculares da instituição, cujo enfoque curricular, no ensino de Física, foi criado em virtude de uma necessidade social. Mergulhamos nas práticas escolares por meio das relações microscópicas entre o que se estudava e que encontramos materializado nas avaliações do conteúdo de Física. Dessa forma, expusemos tradições pedagógicas, procedimentos e condutas sobre o cotidiano escolar da instituição que visavam aprimorar o ensino de Física. Assim, as questões e exercícios das provas analisadas, foram necessidades pedagógicas criadas dentro e para a escola, que não são constantes e uniformes, uma vez que dependem da sociedade, do público escolar e das matérias.

Estrutura e aspectos da regeneração natural de Floresta Ombrófila Mista no Parque Estadual de Campos do Jordão, SP, Brasil

O estudo buscou avaliar diferenças florísticas e estruturais entre os componentes adulto e regenerante de trecho de Floresta Ombrófila Mista em Campos do Jordão, a fim de levantar hipóteses sobre sua trajetória sucessional. Para amostragem do componente adulto (CAP > 15 cm) foram instaladas 50 parcelas permanentes de 10 × 20 m e, em cada uma dessas, cinco subparcelas de 1 × 1 m para amostragem do componente regenerante (h > 30 cm e CAP < 15 cm). No componente adulto foram amostrados 1.770 indivíduos, distribuídos em 58 espécies, 38 gêneros e 26 famílias (H' = 3,08 e J = 0,73). Já entre os regenerantes foram observados 576 indivíduos, 55 espécies, 39 gêneros e 23 famílias (H' = 3,41 e J = 0,84). Constatou-se que são necessárias ações de manejo para a conservação in situ das coníferas locais.

Cem anos do direito internacional público (1913) de José mendes (1861-1918) – olhar reflexivo sobre o direito internacional nas arcadas (1911-1918)

Ensino do Direito internacional nas arcadas – José Mendes foi professor ordinário da disciplina (1911-1918) – sua obra Direito internacional público – preleções (1913) completa cem anos de publicação.

Mesenchymal stem cells (MSC) prevented the progression of renovascular hypertension, improved renal function and architecture

Renovascular hypertension induced by 2 Kidney-1 Clip (2K-1C) is a renin-angiotensin-system (RAS)-dependent model, leading to renal vascular rarefaction and renal failure. RAS inhibitors are not able to reduce arterial pressure (AP) and/or preserve the renal function, and thus, alternative therapies are needed. Three weeks after left renal artery occlusion, fluorescently tagged mesenchymal stem cells (MSC) (2×10(5) cells/animal) were injected weekly into the tail vein in 2K-1C hypertensive rats. Flow cytometry showed labeled MSC in the cortex and medulla of the clipped kidney. MSC prevented a further increase in the AP, significantly reduced proteinuria and decreased sympathetic hyperactivity in 2K-1C rats. Renal function parameters were unchanged, except for an increase in urinary volume observed in 2K-1C rats, which was not corrected by MSC. The treatment improved the morphology and decreased the fibrotic areas in the clipped kidney and also significantly reduced renal vascular rarefaction typical of 2K-1C model. Expression levels of IL-1β, TNF-α angiotensinogen, ACE, and Ang II receptor AT1 were elevated, whereas AT2 levels were decreased in the medulla of the clipped kidney. MSC normalized these expression levels. In conclusion, MSC therapy in the 2K-1C model (i) prevented the progressive increase of AP, (ii) improved renal morphology and microvascular rarefaction, (iii) reduced fibrosis, proteinuria and inflammatory cytokines, (iv) suppressed the intrarenal RAS, iv) decreased sympathetic hyperactivity in anesthetized animals and v) MSC were detected at the CNS suggesting that the cells crossed the blood-brain barrier. This therapy may be a promising strategy to treat renovascular hypertension and its renal consequences in the near future.