RESUMO
OBJETIVO Se abordará el análisis de las capacidades técnico-asistenciales y de gestión para el desarrollo de tres Programas sanitarios estratégicos en la red de servicios de salud de la Subregión Sudeste, Área programática del Hospital El Cruce, Región Sanitaria VI, Provincia de Buenos Aires. Se seleccionaron tres Programas, que por su relevancia sanitaria en términos de impacto en salud y por los procesos de interacción entre servicios que implican, ponen de manifiesto el grado de consolidación de la red, alcances y obstáculos a revertir. Estos Programas son; Programa de Cardiopatías Congénitas, Programa de Procuración y Trasplante y Programa Cirugías de Corta Estancia. Los dos primeros representan Programas de alta complejidad y el tercero corresponde a intervenciones de baja complejidad asistencial. METODOLOGÍA El diseño metodológico será cuantitativo y cualitativo, incluyendo variables de estructura, procesos y resultados de los Programas en el contexto de la red. Por su temporalidad y procesos aplicados para la recolección de datos se trata de un estudio transversal retroprospectivo, que triangula información secundaria con fuentes primaria aplicando entrevista a actores claves. RESULTADOS El estudio contribuirá a la identificación de barreras y oportunidades para la consolidación de redes, particularmente referidas a la accesibilidad y cobertura efectiva de los Programas estudiados; posibilitará sistematizar capacidades técnico asistenciales y de gestión que aporten base a la planificación de procesos de atención en red y de recursos asistenciales; y aportará evidencias para el desarrollo de herramientas de medición de brechas asistenciales y de cobertura en los Programas seleccionados y en la red en general
Assuntos
Planos e Programas de Saúde , Triagem , Continuidade da Assistência ao Paciente , Rede Social , Acessibilidade aos Serviços de SaúdeRESUMO
CD154, a member of the tumor necrosis factor receptor family, is involved in several biological responses. In the sera of systemic lupus erythematosus (SLE) patients, the levels of sCD154 have been shown to be increased, however, few reports have dealt with the biologically active tetramer. Here, we assessed the biological activity of the serum CD154 tetramer using bioassays for BC activation and production nitrite or peroxide. The patients showed a markedly increased total sCD154 serum concentration (12.5 +/- 8.2 vs. 3.9 +/- 1.2 ng/ml; p < 0.001). ba-sCD154 was significantly increased in non-treated patients (7.4 +/- 3.4 ng/ml, n = 22; p < 0.001) and patients with the highest SLE disease activity index (SLEDAI) scores (5.3 +/- 2.9 ng/ml, n = 8), but not in stable patients (1.3 +/- 1.2 ng/ml, n = 30) whose values were similar to normal healthy donors (NHD; 0.8 +/- 0.2 ng/ml). Patients with SLEDAI above 8 that recovered after successful treatment displayed significantly decreased levels of ba-sCD154. We conclude that the bioassay is a useful tool discriminating active and stable SLE, as well as non-treated patients.
Assuntos
Ligante de CD40/sangue , Lúpus Eritematoso Sistêmico/sangue , Biomarcadores/análise , Ligante de CD40/imunologia , Ligante de CD40/metabolismo , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Humanos , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/metabolismo , Macrófagos/imunologiaRESUMO
The low-density lipoprotein receptor (LDLR) is directly involved in the metabolism of low-density lipoprotein (LDL) and its impairment causes accumulation of plasmatic LDL leading to atherosclerosis, a prevalent disease in patients with systemic lupus erythematosus (SLE). We studied LDLR transcription, expression and function in leukocytes patients with SLE and normal healthy donors (NHD). The ratio LDLR/glyceraldehyde-3-phosphate dehydrogenase (GADPH) mRNAs the expression of LDLR and the uptake of LDL-DiI were significantly lower (p < 0.001) in the patients with SLE. On the contrary, patients with SLE had significantly higher (p < 0.0001) levels of total cholesterol, LDL cholesterol and anti-oxLDL autoantibodies (AAb) as compared to NHD. No correlation between LDLR transcription, expression and function with the SLE disease activity index or with treatment was found. The decreased function of LDLR was independent of treatment. It seems dependent on the sterol regulatory binding protein and may be responsible for the increase of plasma LDL cholesterol and oxLDL AAb further increasing the risk of vascular diseases.
Assuntos
Leucócitos/metabolismo , Lúpus Eritematoso Sistêmico/metabolismo , Receptores de LDL/biossíntese , Adulto , Autoanticorpos/sangue , Northern Blotting , Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Citometria de Fluxo , Expressão Gênica , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/genética , Masculino , Receptores de LDL/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transcrição GênicaRESUMO
In patients with systemic lupus erythematosus (SLE) metabolic alterations are often observed, which may be due to either the disease, the genetic background or the treatment. We studied the serum levels of the adipokines leptin, adiponectin, resistin, visfatin and ghrelin in patients with SLE and controls. Leptin levels were lower and adiponectin, ghrelin and visfatin levels were higher in the patients. No significant differences were encountered for resistin. The values of adipokines were independent of treatment, even after correction for body mass index. Inverse correlations were found among leptin and adiponectin, ghrelin and visfatin. We conclude that adipokines are involved in the metabolic imbalance of patients with SLE.
Assuntos
Adiponectina/sangue , Grelina/sangue , Leptina/sangue , Lúpus Eritematoso Sistêmico/sangue , Nicotinamida Fosforribosiltransferase/sangue , Resistina/sangue , Adulto , Índice de Massa Corporal , Feminino , Humanos , MasculinoRESUMO
Los comprimidos para empleo oral de misoprostol se están usando en nuestro país como en otros para la inducción del trabajo de parto en que la experiencia acumulada ha mostrado ser una alternativa segura y eficiente. Es necesario precisar las exactas indicaciones del medicamento y se presenta la experiencia del Hospital de Castro. Se destaca que los malos resultados perinatales ocurren en el grupo en que fracasa la inducción con misoprostol como en aquellos en que se sospecha una insuficiencia placentaria (síndrome hipertensivo, oligoamnios y retardo del crecimiento intrauterino)