Pacientes de alta que permanecem dentro do hospital: quem são e por que permanecem?

A existência de hospitais específicos para pacientes de longa permanência se justifica pela necessidade de profissionais e cuidados especializados na sua assistência. O processo que leva à alta hospitalar nessas instituições tem se mostrado mais complexo do que apenas a estabilização do quadro clínico, incluindo fatores que adiam a saída do paciente. O objetivo desta dissertação é identificar os motivos pelos quais pacientes de alta hospitalar permanecem internados dentro de um hospital público de longa permanência situado na Grande São Paulo, na região do Alto Tiete. Um estudo exploratório descritivo transversal identificou 1.211 internações entre janeiro de 2011 e dezembro de 2014, sendo a média de idade de 53,9 anos e com predomínio do sexo masculino (62,7%). Das 822 internações analisadas, ocorreram “atrasos” na saída em 466 casos (56,7%). A média de atraso foi de 19,1 dias (variação de 1 a 606 dias), gerando um total de 8.895 pacientes-dia que poderiam ter sido evitados. Os principais motivos de atraso foram: transporte familiar (39,7%), aguardo de ambulância (14,8%), suporte da rede (12,7%), resistência familiar para saída (12,4%) e adequação de casa/equipamentos (9,4%). Foram propostas formas que poderiam acarretar em diminuição do período de internação hospitalar, uma vez que essa atuação é resultado de combinações de diversos fatores em diferentes áreas. Entretanto, as medidas que devem ser tomadas fundamentam-se num adequado entendimento do sistema de saúde local, do contexto cultural e da legislação vigente.

Immune Response Against Sporothrix schenckii in TLR-4-Deficient Mice

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Genetic, epidemiological and biological analysis of interleukin-10 promoter single-nucleotide polymorphisms suggests a definitive role for-819C/T in leprosy susceptibility

Leprosy is a complex infectious disease influenced by genetic and environmental factors. The genetic contributing factors are considered heterogeneous and several genes have been consistently associated with susceptibility like PARK2, tumor necrosis factor (TNF), lymphotoxin-alpha (LTA) and vitamin-D receptor (VDR). Here, we combined a case-control study (374 patients and 380 controls), with meta-analysis (5 studies; 2702 individuals) and biological study to test the epidemiological and physiological relevance of the interleukin-10 (IL-10) genetic markers in leprosy. We observed that the -819T allele is associated with leprosy susceptibility either in the case-control or in the meta-analysis studies. Haplotypes combining promoter single-nucleotide polymorphisms also implicated a haplotype carrying the -819T allele in leprosy susceptibility (odds ratio (OR) = 1.40; P = 0.01). Finally, we tested IL-10 production in peripheral blood mononuclear cells stimulated with Mycobacterium leprae antigens and found that -819T carriers produced lower levels of IL-10 when compared with noncarriers. Taken together, these data suggest that low levels of IL-10 during the disease outcome can drive patients to a chronic and unprotective response that culminates with leprosy.

Cancer risk assessment of ethyl carbamate in alcoholic beverages from Brazil with special consideration to the spirits cachaca and tiquira

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

THE ASSESSMENT OF ZINC STATUS BY THE ZINC TOLERANCE-TEST IN THYROID-DISEASE

Zinc status was evaluated in 12 hyperthyroid and in 7 hypothyroid patients in comparison with 8 euthyroid individuals by the oral zinc tolerance test and by the determination of urinary zinc excretion. Hyperthyroid patients presented a basal serum concentration similar to that of euthyroid individuals but greater urinary zinc excretion, indicating the occurrence of zinc depletion from tissues to the blood stream caused by the catabolism inherent in the hyperthyroid state. Hyperthyroidism also caused lower zinc assimilation by tissues after zinc ingestion. Hypothyroid individuals present lower basal zinc levels in serum than euthyroid and hyperthyroid individuals and urinary zinc excretion similar to that of euthyroid individuals. No changes in the parameters measured were observed after zinc load, suggesting reduced or delayed intestinal absorption and zinc assimilation by tissues. The present data are indicative of zinc deficiency, the lower intestinal zinc absorption probably being one of the contributing factors.

Nausea e vomito em laparoscopia ginecologica: Efeitos do oxido nitroso e da metoclopramida

Background and Objectives - Gynecological laparoscopy causes high postoperative morbidity, mainly due to occurrences such as nausea and vomiting. They result from a great multiplicity of etiologies and drugs used in anesthesia may function as contributing factors. Both the emetic properties of nitrous oxide and the efficacy of metoclopramide as antiemetic agent are controversial. This study was undertaken to determine the effects of both drugs, when used alone or in combination. Methods - Eighty three physical status ASA I and II women were studied. They were premedicated with midazolam before induction of anesthesia with alfentanil and propofol. Anesthesia was maintained with isoflurane with or without nitrous oxide in oxygen. Muscle relaxation was achieved with atracurium. There were 4 groups of patients: GI: midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GII: midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen; GIII: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/oxygen; GIV: metoclopramide, midazolam, alfentanil, propofol, atracurium, isoflurane/nitrous oxide/oxygen. The incidence of nausea and vomiting was assessed both in the recovery room (RR) and in the ward. Results - There were no significant differences as regards age, weight and height of the patients and duration of anesthesia and surgery. Nausea and vomiting were more frequent in patients who received N2O (GII, 50%; GIV, 33%), as compared to those who didn't receive this agent (GI and GII, 9.5% and 14.35%, respectively). Metoclopramide decreased the incidence of nausea and vomiting in the recovery room, in patients who didn't receive N2O (GII). These patients remained in the recovery room for 90 minutes. Conclusions - N2O increases the incidence of nausea and vomiting and metoclopramide is effective in reducing these complications only in the recovery room.

The income distribution problem in Latin America and the Caribbean

Includes bibliography

A reforma psiquiátrica no interior do estado de São Paulo: psiquiatria reformada ou mudança paradigmática?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estresse oxidativo e sinalização pelas vias MAPK e NF-кB no músculo sóleo de ratos com insuficiência cardíaca crônica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Modelo de avaliação de maturidade em gerenciamento de projetos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

2 '-Deoxyguanosine, 2 '-deoxycytidine, and 2 '-deoxyadenosine adducts resulting from the reaction of tetrahydrofuran with DNA bases

A recent study showed that tetrahydrofuran (THF), a widely used solvent, is carcinogenic in experimental animals. Despite its carcinogenic activity, there is a paucity of information regarding cellular toxicity, biomolecular damage, and genotoxicity induced by THF. We describe here the structural characterization of adducts produced by the reaction of oxidized THF with 2'-deoxyguanosine (dGuo-THF 1 and dGuo-THF 2), 2'-deoxyadenosine (dAdo-THF), and 2'-deoxycytidine (dCyd-THF). Adducts were isolated from in vitro reactions by reverse-phase HPLC and fully characterized on the basis of spectroscopic measurements. The stable derivatives obtained by the reduction of adducts with NaBH4 ( the case of dGuo-THF 1, dCyd-THF, and dAdo-THF) and the stable adduct dGuo-THF 2 were used as standards for optimization of chromatographic separations for adduct detection in DNA through HPLC/ESI/MSMS. Using this methodology, we successfully detected the four adducts in calf thymus DNA reacted with oxidized THF. The present study also provides evidence that rat liver microsomal monooxigenases oxidize THF to the reactive electrophilic compounds that are able to damage the DNA molecule, as indicated by a significant increase in adduct dGuo-THF 1 level when NADPH was added to the THF/ microsomes/dGuo incubation mixtures. Our data point to DNA-THF adducts as possible contributing factors to the toxicological effects of THF exposure.

Proteins, Pathogens, and Failure at the Composite-Tooth Interface

In the United States, composites accounted for nearly 70% of the 173.2 million composite and amalgam restorations placed in 2006 (Kingman et al., 2012), and it is likely that the use of composite will continue to increase as dentists phase out dental amalgam. This trend is not, however, without consequences. The failure rate of composite restorations is double that of amalgam (Ferracane, 2013). Composite restorations accumulate more biofilm, experience more secondary decay, and require more frequent replacement. In vivo biodegradation of the adhesive bond at the composite-tooth interface is a major contributor to the cascade of events leading to restoration failure. Binding by proteins, particularly gp340, from the salivary pellicle leads to biofilm attachment, which accelerates degradation of the interfacial bond and demineralization of the tooth by recruiting the pioneer bacterium Streptococcus mutans to the surface. Bacterial production of lactic acid lowers the pH of the oral microenvironment, erodes hydroxyapatite in enamel and dentin, and promotes hydrolysis of the adhesive. Secreted esterases further hydrolyze the adhesive polymer, exposing the soft underlying collagenous dentinal matrix and allowing further infiltration by the pathogenic biofilm. Manifold approaches are being pursued to increase the longevity of composite dental restorations based on the major contributing factors responsible for degradation. The key material and biological components and the interactions involved in the destructive processes, including recent advances in understanding the structural and molecular basis of biofilm recruitment, are described in this review. Innovative strategies to mitigate these pathogenic effects and slow deterioration are discussed.

Influence of N-acetylcysteine on oxidative stress in slow-twitch soleus muscle of heart failure rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Investigation of a new acetogen isolated from an enrichment of the tammar wallaby forestomach

Background: Forestomach fermentation in Australian marsupials such as wallabies and kangaroos, though analogous to rumen fermentation, results in lower methane emissions. Insights into hydrogenotrophy in these systems could help in devising strategies to reduce ruminal methanogenesis. Reductive acetogenesis may be a significant hydrogen sink in these systems and previous molecular analyses have revealed a novel diversity of putative acetogens in the tammar wallaby forestomach.Results: Methanogen-inhibited enrichment cultures prepared from tammar wallaby forestomach contents consumed hydrogen and produced primarily acetate. Functional gene (formyltetrahydrofolate synthetase and acetyl-CoA synthase) analyses revealed a restricted diversity of Clostridiales species as the putative acetogens in the cultures. A new acetogen (growth on H-2/CO2 with acetate as primary end product) designated isolate TWA4, was obtained from the cultures. Isolate TWA4 classified within the Lachnospiraceae and demonstrated > 97% rrs identity to previously isolated kangaroo acetogens. Isolate TWA4 was a potent hydrogenotroph and demonstrated excellent mixotrophic growth (concomitant consumption of hydrogen during heterotrophic growth) with glycerol. Mixotrophic growth of isolate TWA4 on glycerol resulted in increased cell densities and acetate production compared to autotrophic growth. Co-cultures with an autotrophic methanogen Methanobrevibacter smithii revealed that isolate TWA4 performed reductive acetogenesis under high hydrogen concentration (> 5 mM), but not at low concentrations. Under heterotrophic growth conditions, isolate TWA4 did not significantly stimulate methanogenesis in a co-culture with M. smithii contrary to the expectation for organisms growing fermentatively.Conclusions: The unique properties of tammar wallaby acetogens might be contributing factors to reduced methanogen numbers and methane emissions from tammar wallaby forestomach fermentation, compared to ruminal fermentation. The macropod forestomach may be a useful source of acetogens for future strategies to reduce methane emissions from ruminants, particularly if these strategies also include some level of methane suppression and/or acetogen stimulation, for example by harnessing mixotrophic growth capabilities

Influências geogênicas/antropogênicas na composição química das águas pluviais de Dois Córregos, bacia do Rio Jaú (SP)

Thirty-seven rainwater samples were collected at Jaú River watershed, Dois Córregos city (SP), between August 2009 and July 2010, where were analyzed the following variables: pH, Na+ , K+ , Ca2+, Mg2+, NO3- , Cl- , SO4 2- , PO4 3- and SiO2. The results indicate that Ca2+ (6.65%) and NO3- (35%) are the most abundant ions that followed the trend: Ca2+ > Mg2+ > K+ > Na+ for cations and NO3 - > SO4 2- > Cland PO4 3- for anions. The phosphate fertilizers use, agricultural soils dust, lithology, biomass burning and fossil fuels can be the major contributing factors to explain the chemical composition of rainwater at Jaú River watershed, Dois Córregos city (SP).