Sistematização do atendimento de urgência aos pacientes em tratamento hemodialítico do município de Belo Horizonte: uma proposta de atendimento construída em conjunto entre gestores, prestadores e usuários.

Este trabalho relata a experiência de integração do nível primário com o secundário na rede municipal de saúde do Sistema Único de Saúde em Belo Horizonte. Trata-se da construção coletiva, pelos usuários do Sistema Único de Saúde (SUS) e equipe de saúde de um protocolo de atendimento em urgências clinicas aos portadores de Insuficiência Renal crônica. Descreve-se o processo de criação do protocolo partindo da procura da Comissão Municipal de Nefrologia e Transplante por representantes de entidades de pacientes portadores de Insuficiência Renal Crônica (IRC) para solicitar que o atendimento em situações de urgência clinica que fosse regulamentado com base nas diretrizes ministeriais vigentes, para possibilitar agilidade no atendimento e evitar sofrimento desnecessário. A metodologia utilizada foi o relato de experiência e utilizou-se como roteiro os passos previstos em estudos de caso. Foi realizada revisão bibliográfica e fundamentação teórica e legal dos diversos aspectos dos problemas clínicos que mais acometem os portadores de IRC. O resultado foi a construção de um fluxo de atendimento construído em conjunto com prestadores e usuários mediado pela secretaria municipal de saúde. Foram discutidos e buscadas soluções para vários temas polêmicos relacionados. A rara experiência relatada neste trabalho, que antes de tudo significa um marco para a trajetória do SUS na cidade de Belo Horizonte mostrou que é possível a intersetorialidade, com a participação bilateral dos prestadores e usuários, mediada pelos gestores municipais, avançando-se na organização e melhoria nos serviços assistenciais. Conclui-se que houve contribuição para a construção da qualidade da atenção e da efetividade no atendimento às situações de urgências vividas pelos cerca de 2.115 pessoas que possuem insuficiência renal crônica e são dependentes de diálise na rede assistencial do SUS da região metropolitana de Belo Horizonte.

Interacting model for the cosmological dark sector

We discuss a new interacting model for the cosmological dark sector in which the attenuated dilution of cold dark matter scales as a(-3)f(a), where f(a) is an arbitrary function of the cosmic scale factor a. From thermodynamic arguments, we show that f(a) is proportional to the entropy source of the particle creation process. In order to investigate the cosmological consequences of this kind of interacting models, we expand f(a) in a power series, and viable cosmological solutions are obtained. Finally, we use current observational data to place constraints on the interacting function f(a).

Evaluation of residential bioaerosol concentrations and their related health effects

Limited research has been conducted on the collection of bioaerosols and their health effects on individuals in the El Paso area. A year long study was conducted in the region to evaluate indoor bioaerosol concentrations (Mota et al., unpublished data). As part of the study, air samples were collected during each season for a year from 38 homes from the El Paso area. The main objective of the study was to assess seasonality differences in bioaerosol concentrations. The air samples were then cultured and analyzed for bacterial and fungal concentrations. As a supplement to that study, a health questionnaire was given during each seasonal air sampling to the participating resident to complete regarding their health status. The aim of this study was to evaluate the health questionnaire and assess any associations between the collected bioaerosol concentrations and the self-reported respiratory symptoms of the participating home residents. Symptom frequencies were tabulated and basic descriptive statistics, along with logistic regressions, were conducted on the relationship between “High” reporters of symptoms and bioaerosol concentrations and environmental factors. The most commonly reported symptoms by homeowners were nasal symptoms and allergies. In addition, there was evidence to support an association between indoor respirable bacteria concentrations and homeowners that report greater than or equal to 8 respiratory symptoms (OR=1.10, p=0.045). Smoking status, indoor humidity and season also displayed associations with homeowners that report greater than or equal to 8 respiratory symptoms (OR=3.3, p=0.045; OR=71.0, p=0.030; OR=7.2, 3.2, p=0.001, 0.008). With such a strong association, future assessment of symptoms, bioaerosol concentrations and environmental factors is needed to further establish their relationship. ^

Geochemistry at DSDP Leg 70 Holes

The hydrothermal mounds on the southern flank of the Galapagos Spreading Center are characterized by the following main features: 1) They are located over a young basement (0.5 to 0.85 m.y. of age) in a region known for its high sedimentation rate (about 5 cm/10**3 y.) because it is part of the equatorial high biological productivity zone. 2) They are located in a region with generally high heat flow (8 to 10 HFU). The highest heat-flow measurements (up to 10**3 HFU) correspond to mound peaks (Williams et al., 1979), where temperatures up to 15°C were measured during a dive of the submersible Alvin (Corliss et al., 1978). 3) They are often located on small vertical faults which displace the basement by a few meters (Lonsdale, 1977) and affect the 25- to 50-meter-thick sediment cover. Most of these characteristics have also been observed in the other three known cases of hydrothermal deposits with mineral parageneses similar to that of the Galapagos mounds. However, the case of the hydrothermal mounds south of the Galapagos Spreading Center is unique because of the unusual thickness of the hydrothermal deposits present. The mounds are composed of several, up to 4.5-meter-thick, layers of green clays which, in one case (Hole 509B), are overlain by about 1.4 meters of Mn-oxide crust. We suspect that such a large accumulation of hydrothermal products results from the "funnelling" of the hydrothermal solutions exiting from a highly permeable basement along the faults. This chapter reports a preliminary study of those green clays collected by hydraulic piston coring of the Galapagos mounds during Deep Sea Drilling Project (DSDP) Leg 70 of the D/V Glomar Challenger. Green clays have also been reported from three presently or recently active hydrothermal areas in or close to spreading centers.

Intersexualidad y derecho: análisis del concepto género en las sentencias de asignación de sexo (Análisis de las sentencias: T-477 de 1.995, SU-337 de 1.999, T-551 de 1.999, T-692 de 1.999, T-1390 de 2.000, T-1025 de 2.002, T-1021 de 2.003 y T-912 de 2.008)

Esta monografía estudia 8 casos de menores de edad intersexuales que han sido fallados por la Corte Constitucional. A partir de las discertaciones jurídicas hechas por los magistrados se pueden encontrar interesantes elementos para el estudio del concepto género y la postura que frente al mismo ha tomado la Corte en su jurisprudencia.

Compliance program reference : inspections of licensed and unlicensed blood banks (compliance program #7342.001) and inspections of source plasma establishments (compliance program #7342.002).

Mode of access: Internet.

Micronutrient And Physiologic Parameters Before And 6 Months After Rygb.

Bariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB). Thirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed. The mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021). Despite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.

Prognostic Impact Of Perineural Invasion And Lymphovascular Invasion In Advanced Stage Oral Squamous Cell Carcinoma.

Perineural invasion (PNI) and lymphovascular invasion (LVI) have been associated with the risk of local recurrences and lymph node metastasis. The aim of this study was to evaluate the prognostic impact of PNI and LVI in patients with advanced stage squamous cell carcinoma of the tongue and floor of the mouth. One hundred and forty-two patients without previous treatment were selected. These patients underwent radical surgery with neck dissection and adjuvant treatment. Clinicopathological data were retrieved from the medical charts, including histopathology and surgery reports. Univariate analysis was performed to assess the impact of studied variables on survival. Overall survival was negatively influenced by six tumour-related factors: increasing T stage (P = 0.003), more than two clinically positive nodes (P = 0.002), extracapsular spread of lymph node metastasis (P < 0.001), tumour thickness (P = 0.04), PNI (P < 0.001), and LVI (P = 0.012). Disease-free survival was influenced by PNI (P = 0.04), extracapsular spread of lymph node metastasis (P = 0.008), and N stage (P = 0.006). Multivariate analysis showed PNI to be an independent predictor for overall survival (P = 0.01) and disease-free survival (P = 0.03). Thus the presence of PNI in oral carcinoma surgical specimens has a significant impact on survival outcomes in patients with advanced stage tumours submitted to radical surgery and adjuvant radiotherapy/radiochemotherapy.