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Resumen Introducción: El tronco arterial persistente es una rara malformación cardíaca congénita que provoca diversas complicaciones en el sistema cardiovascular. Se caracteriza por la presencia de un tabique ventricular defectuoso, una única válvula troncal y un tronco arterial común entre la arteria pulmonar y aorta, conllevando a una mezcla entre la sangre arterial y venosa, debido a un cortocircuito cardíaco bidireccional predominante de izquierda a derecha que compromete el suministro de flujo sanguíneo, nutrientes y oxigenación sistémica. Las manifestaciones clínicas incluyen desaturación con cianosis, hipoxemia, taquicardia, taquipnea, alteraciones en la contractilidad cardíaca, pulsos distales anómalos, pérdida de peso, fatiga y hepatomegalia. Objetivo: El propósito de esta investigación es establecer hipótesis sobre los diversos mecanismos compensatorios que se activan a nivel sistémico para contrarrestar los efectos de esta malformación. Reflexión: Se sugiere que se producen respuestas biomoleculares similares en los sistemas cardiovascular, pulmonar y renal, reduciendo la producción de óxido nítrico y provocando respuestas vasoconstrictoras. A nivel hepático, se generan factores de crecimiento y se inician procesos de angiogénesis para aumentar la perfusión sanguínea. En el cerebro, se activan enzimas para incrementar el flujo sanguíneo y proporcionar oxígeno y nutrientes esenciales. Conclusión: A pesar de estos mecanismos compensatorios, no logran contrarrestar por completo las manifestaciones clínicas, conduciendo a una serie de problemas de salud, como hipertensión pulmonar, insuficiencia cardíaca, hepatomegalia, hipoperfusión de órganos y déficits neurológicos. Estos factores convergen para generar una compleja condición cardíaca que desencadena respuestas adaptativas en el cuerpo que terminan siendo una afección médica desafiante y potencialmente grave.
Abstract Introduction: Persistent truncus arteriosus is a rare congenital cardiac malformation that causes various complications in the cardiovascular system. It is characterized by the presence of a defective ventricular septum, a single truncal valve and a common truncus arteriosus between the pulmonary artery and aorta, leading to a mixture between arterial and venous blood, due to a predominantly left-to-right bidirectional cardiac shunt that compromises the supply of blood flow, nutrients, and systemic oxygenation. Clinical manifestations include desaturation with cyanosis, hypoxemia, tachycardia, tachypnea, alterations in cardiac contractility, abnormal distal pulses, weight loss, fatigue, and hepatomegaly. Aim: The purpose of this research is to establish hypotheses about the various compensatory mechanisms that are activated at a systemic level to counteract the effects of this malformation. Reflection: It is suggested that similar biomolecular responses occur in the cardiovascular, pulmonary, and renal systems, reducing nitric oxide production and causing vasoconstrictive responses. At the liver level, growth factors are generated and angiogenesis processes are initiated to increase blood perfusion. In the brain, enzymes are activated to increase blood flow and provide oxygen and essential nutrients. Conclusion: Despite these compensatory mechanisms, they fail to completely counteract the clinical manifestations, leading to a series of health problems such as pulmonary hypertension, heart failure, hepatomegaly, organ hypoperfusion, and neurological deficits. These factors converge to generate a complex cardiac condition that triggers adaptive responses in the body that end up being a challenging and potentially serious medical condition.
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A Saúde Única é uma crescente abordagem sistêmica para aumentar indissociavelmente os níveis de saúde das pessoas, dos animais e do ambiente no planeta. Por sua característica interdisciplinar e multidisciplinar, a Saúde Única tem arregimentado cada vez mais novos agentes na área de saúde, ampliando novas fronteiras de prática profissional. Objetivo: tendo em vista de que a abordagem sistêmica da Saúde Única (One Health) é holística, objetivou-se descrever e refletir sobre o papel da fonoaudiologia nesse contexto. Métodos: fez-se uma revisão de escopo sobre as ligações da fonoaudiologia com as desordens de saúde que são o foco em Saúde Única. Realizou-se uma procura de artigos nas plataformas PubMed e SciELO, com a combinação booleana dos indexadores "fonoaudiologia" e "Saúde Única", em idioma português; e as palavras "speech-language therapy" e "One Health" em idioma inglês. O operador booleano foi "E" e "AND". Adicionalmente, procurou-se teses e dissertações com esses mesmos operadores e combinações no Catálogo de Teses e Dissertações da CAPES. Analisou-se os dados por uma abordagem qualitativa, por isso os métodos estatísticos não foram aplicados. A partir dessa abordagem, complementou-se a argumentação com uma reflexão crítica sobre a inclusão da fonoaudiologia na estratégia de Saúde Única. Resultados: apenas na plataforma SciELO encontrou-se cinco obras com os descritores e a combinação "Saúde Única AND fonoaudiologia"; esse resultado é fortemente sugestivo de que o profissional em fonoaudiologia não tem sido incluído como um agente na abordagem Saúde Única. Contrariando esse cenário, argumenta--se que a fonoaudiologia pode preencher um nicho de trabalho e atuação acadêmica na abordagem de Saúde Única, cujo foco são desordens de saúde que podem resultar em distúrbios da comunicação nas pessoas. Considerações finais: há um nicho para a fonoaudiologia na abordagem da Saúde Única para a prevenção, o tratamento e a investigação científica das desordens da comunicação humana.
One Health is a growing systemic approach aimed at increasing the health levels of people, animals and the environment on the planet. Due to its inter- and multidisciplinary characteristics, One Health has been recruiting an increasing number of new agents in the health area, expanding new frontiers of professional practice. Objective: considering that the systemic approach of One Health is holistic, the objective is to describe and reflect on the role of speech therapy in this context. Methods: a scoping review was conducted to explore the connections between speech therapy and the health disorders that are the focus of One Health. A search for articles was carried out on the PubMed and SciELO platforms, using the Boolean combination of the terms "fonoaudiologia" (speech therapy) and "Saúde Única" (One Health), in Portuguese; and the words "speech-language therapy" and "One Health" in English using the Boolean operator "E" and "AND". Additionally, we searched for theses and dissertations with these same operators and combinations, in the CAPES Catalog of Theses and Dissertations. The data was analyzed using a qualitative approach, therefore statistical methods were not applied. Based on this approach, the argument was complemented with a critical reflection on the inclusion of speech therapy in the One Health strategy. Results: five works were found on the SciELO platform using the descriptors and combination "Saúde Única AND fonoaudiologia". This result suggests that the speech therapy professional has not been included as an agent in the One Health approach. Contrary to this scenario, it is argued that speech therapy can play a significant professional and academic role in One Health, which focuses on health disorders that may result in communication disorders. Final considerations: there is a niche for speech therapy in the One Health approach to the prevention, treatment and scientific investigation of human communication disorders.
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Humanos , AnimaisRESUMO
Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.
Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.
Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.
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BACKGROUND: This study evaluated the expression of ACE and ACE2 in the placenta and white adipose tissue in lean and obese women, and correlated their levels with anthropometric, clinical, and laboratory parameters, and tissue count of inflammatory cells. METHODS: A cross-sectional analytical study was performed with 49 pregnant women and their respective newborns. Samples of placenta and adipose tissue were used for measuring mRNA expression for ACE and ACE2 through qRT-PCR. Inflammatory cell counting was performed through conventional microscopy. RESULTS: An increase in ACE expression and a decrease in ACE2 were observed in the placenta and adipose tissue of women with obesity. ACE2 levels showed a negative correlation with pre-pregnancy BMI and total cholesterol. CONCLUSION: Maternal obesity can modulate the expression of RAS components in the placenta and white adipose tissue, with ACE2 correlated with pre-pregnancy BMI and total cholesterol.
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LASER é um acrônimo que sumariza a amplificação da luz por emissão estimulada de radiação (eletromagnética). O Programa Saúde em Ação equipou diversas Unidades Básicas de Saúde com aparelhos de laser diodo. Cirurgiões Dentistas têm aplicado a laserterapia de baixa potência para acelerar a remissão de várias condições clínicas, sem necessidade de encaminhamento imediato para Atenção Secundária. O objetivo deste artigo é apresentar protocolos de laserterapia de baixa potência empregados por Cirurgiões Dentistas da Atenção Primária à Saúde de Campinas-SP, por meio da ilustração com casos clínicos atendidos em consultas de urgência. Aplicações para ulceração traumática e desordem temporomandibular foram realizadas em uma senhora de 60 anos de idade, que aguardava a substituição das próteses totais. Irradiou-se por laser vermelho (660nm) com energia de 1J as margens da ulceração. Após palpação da articulação e dos músculos mastigatórios para mapeamento, os pontos álgicos foram irradiados por laser infravermelho (808nm) com energia de 4J. Um homem de 50 anos de idade queixava-se de paralisia hemifacial havia 10 dias. A tentativa de recuperação do nervo facial ocorreu com irradiação por laser infravermelho com energia de 8J por ponto, em 22 pontos dos ramos do nervo facial. Em ambos os casos, a regressão do quadro clínico desconfortável foi observada. Os Profissionais do Sistema Único de Saúde (SUS) que são aptos ao uso dos equipamentos para laserterapia de baixa potência podem utilizar este recurso de modo seguro e bem sucedido, observando comprimento de onda do laser e doses protocolares para cada alteração a ser tratada.
LASER is an acronym which means light amplification by stimulated emission of radiation (electromagnetic). Many Primary Health Care Units received diode laser devices from the Brazilian Health in Action Program. Dental practitioners have applied low-level laser therapy for accelerating the resolution of several clinical problems, without the need to prompt referral for Secondary Attention. This manuscript aimed at presenting low-level laser therapy protocols, used by Dentists in Primary Health Care Units from Campinas-SP, illustrated with case reports of urgency consultations. Applications for traumatic ulcers and temporomandibular disorder were performed in a 60-year-old woman who was waiting for dental prosthesis replacement. Red laser irradiation (660nm) with 1J energy was delivered at the margins of the ulcer. Upon articular and masticatory muscles palpation for mapping, trigger points were irradiated with infrared laser (808nm), 4J energy. A 50-year-old man complained of hemifacial paresis for 10 days. The recovery attempt of the facial nerve was carried out by infrared laser irradiation with 8J energy per point in 22 points of the facial nerve branches. In both case reports, regression of the uncomfortable clinical problem was noted. Professionals from the Unified Health System (SUS) who are able to use a low-level laser device may safe and successfully operate this equipment, selecting the appropriate laser wavelength and protocol doses for managing each clinical problem.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Sistema Único de Saúde , Transtornos da Articulação Temporomandibular , Saúde Bucal , Terapia com Luz de Baixa Intensidade/métodos , Paralisia FacialRESUMO
Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.
Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients
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Humanos , Sistema Urogenital , Gangrena de Fournier , Reto , Fasciite Necrosante , CeluliteRESUMO
O sistema imunológico é formado por um conjunto de células que protege o organismo contra patógenos e outros agentes estranhos. A imunidade pode atuar de maneira correta e eficaz, entretanto é necessário o consumo adequado de alimentos que têm como função fortalecer e regular o sistema imunológico. Dessa forma, questiona-se: qual o conhecimento dos estudantes universitários de uma faculdade em Sete Lagoas/MG acerca dos alimentos, fontes de vitaminas A, C, D, zinco, glutamina e ômega-3, como nutrientes reguladores na manutenção do sistema imune? Trata-se de um estudo de natureza descritiva e exploratória, por meio de uma pesquisa de campo, realizada com 50 acadêmicos matriculados em uma faculdade localizada em Sete Lagoas/MG. Dos entrevistados, a maioria reconheceu os grupos de alimentos que possuíam os nutrientes estudados: vitamina A (76%), vitamina C e D (70%), zinco (52%), glutamina e ômega-3 (76%). Os resultados evidenciaram que a maioria dos estudantes universitários (84%) apresentou conhecimento acerca da relação entre os nutrientes e suas ações regulatórias no sistema imune. Conclui-se que é importante a pesquisa de temáticas como esta, no sentido de informar e conscientizar os indivíduos sobre os benefícios da ingestão de vitaminas e minerais e sua relação com a manutenção do sistema imune, a fim de influenciar em melhores escolhas alimentares.
The immune system is made up of a set of cells that protect the body against pathogens and other foreign agents. Immunity can act correctly and effectively, however, adequate consumption of foods that have the function of strengthening and regulating the immune system is necessary. Thus, the question is: what is the knowledge of academics from a college in Minas Gerais about food, sources of vitamins A, C, D, zinc, glutamine and omega-3 as regulatory nutrients in the maintenance of the immune system? This is a descriptive and exploratory study, through field research, carried out with 50 academics enrolled in a college located in a municipality of Minas Gerais. Of the respondents, most recognized the food groups that had the nutrients studied: vitamin A (76%), vitamin C and D (70%), zinc (52%), glutamine and omega-3 (76%). The results showed that most academics (84%) had accurate knowledge of the relationship between nutrients and their regulatory actions in the immune system. It is concluded that it is important to research topics such as these, in order to inform and make individuals aware of the benefits of the intake of vitamins and minerals and their relationship with the maintenance of the immune system, in order to influence better food choices.
El sistema inmunológico está formado por un conjunto de células que protegen al organismo contra patógenos y otros agentes extraños. La inmunidad puede actuar de forma correcta y efectiva, sin embargo, es necesario consumir alimentos adecuados cuya función sea fortalecer y regular el sistema inmunológico. Por lo tanto, surge la pregunta: ¿qué conocimiento tienen los estudiantes universitarios de una facultad de Sete Lagoas/MG sobre alimentos, fuentes de vitaminas A, C, D, zinc, glutamina y omega-3, como nutrientes reguladores en el mantenimiento del sistema inmunológico? Se trata de un estudio descriptivo y exploratorio, a través de investigación de campo, realizado con 50 académicos matriculados en una facultad ubicada en Sete Lagoas/MG. De los entrevistados, la mayoría reconoció los grupos de alimentos que contenían los nutrientes estudiados: vitamina A (76%), vitamina C y D (70%), zinc (52%), glutamina y omega-3 (76%). Los resultados mostraron que la mayoría de los estudiantes universitarios (84%) tenía conocimiento sobre la relación entre los nutrientes y sus acciones reguladoras sobre el sistema inmunológico. Se concluye que es importante investigar temas como este, con el fin de informar y concientizar a los individuos sobre los beneficios de la ingesta de vitaminas y minerales y su relación con el mantenimiento del sistema inmunológico, para incidir en mejores elecciones alimentarias.
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RESUMEN Introducción: la meningitis es una emergencia médica la cual requiere un diagnóstico y tratamiento oportunos para evitar complicaciones. Objetivo: determinar las características epidemiológicas y clínicas de la meningitis en los pacientes hospitalizados en el Centro Médico Nacional en el periodo 2021-2023. Metodología: estudio observacional descriptivo transversal de pacientes mayores de 18 años con fichas completas, se recolectaron características epidemiológicas, clínicas, paraclínicas y terapéuticas. Se compararon las características según grupos etarios Resultados: de los 70 pacientes reclutados el 74 % eran del sexo masculino; EL 73 % presentaron aislamiento microbiológico y sin aislamiento microbiológico (27 %) el germen más frecuentemente aislado fue el S. pneumoniae. El tratamiento antibiótico de elección fue la terapia combinada con ceftriaxona más vancomicina (39 %). Con una mortalidad del 37 %. Conclusiones: la meningitis bacteriana fue la más frecuente (50 %) seguida por las micóticas y por último lugar las virales. En cuanto a las manifestaciones clínicas podemos concluir que el síntoma más frecuentemente hallada fue la cefalea (51 %).
ABSTRACT Introduction: meningitis is a medical emergency which requires timely diagnosis and treatment to avoid complications. Objective: determine the clinical and epidemiological characteristics of meningitis in patients hospitalized at the Centro Médico Nacional. Materials and methods: Cross-sectional study that evaluated patients over 18 years of age with complete records; epidemiological, clinical, paraclinical and therapeutic characteristics were collected. Differences in patient characteristics were explored according to age group. Results: of the 70 patients, 74 % were male; 72.88 had microbiological isolation and without microbiological isolation (27 %), the most frequently isolated germ was S. pneumoniae. The antibiotic treatment of choice was combined therapy with ceftriaxone plus vancomycin (39 %) with a mortality of 37 %. Conclusions: bacterial meningitis was the most frequent (50 %) followed by fungal and lastly viral, combined therapy proved to be the most useful.
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O objetivo desse estudo foi descrever o comportamento do indicador de proporção de gestantes com atendimento odontológico realizado em todos os estados brasileiros antes e após a implantação do Programa Previne Brasil e correlacionando os achados com variáveis. Trata-se de um estudo ecológico, analítico, com dados secundários, cujas unidades de análise são 26 as unidades federativas do Brasil e o Distrito Federal. As variáveis proporção de gestantes com atendimento odontológico realizado entre os anos de 2018 e 2022 (por quadrimestre), número de equipes de Estratégia de Saúde da Família, cobertura de eSF e cobertura da Atenção Básica (AB) no ano de 2020, número de equipes da saúde da família de saúde bucal (eSB) no ano de 2021, tamanho populacional estimado para 2021 e Índice de Desenvolvimento Humano para o ano de 2010, foram coletadas do Sistema de Informação da Saúde da Atenção Básica (SISAB), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema e-Gestor do Ministério da Saúde. Os resultados obtidos mostram que durante os anos analisados o indicador teve crescimento em todas as unidades federativas e no Distrito Federal, no entanto alguns estados tiveram crescimento do indicador acima da média nacional: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná e Santa Catarina. O indicador teve correlação negativa com IDH e positiva com as coberturas de equipes de saúde da família e de saúde bucal. Houve um aumento na proporção de atendimentos odontológicos a gestantes na APS entre os anos estudados, no entanto, esse indicador não permite a avaliação da qualidade desse atendimento e nem o impacto na morbimortalidade materna e infantil.
The aim of this study was to describe the behavior of the indicator of the proportion of pregnant women with dental care performed in all Brazilian states before and after the implementation of the Prevent Brazil Program and correlate the findings with variables. This is an ecological, analytical study with secondary data, whose units of analysis are 26 of the federative units of Brazil and the Federal District. The variables proportion of pregnant women with dental care performed between the years 2018 and 2022 (per four months), number of Family Health Strategy teams, FHS coverage and Primary Care (PHC) coverage in 2020, number of oral health family health teams (eSB) in 2021, estimated population size for 2021 and Human Development Index for 2010, were collected from the Primary Care Health Information System (SISAB), the Brazilian Institute of Geography and Statistics (IBGE) and the e-Manager System of the Ministry of Health. The results obtained show that during the years analyzed the indicator had growth in all federative units and in the Federal District, however, some states had growth of the indicator above the national average: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná and Santa Catarina. The indicator had a negative correlation with HDI and a positive correlation with the coverage of family health and oral health teams. There was an increase in the proportion of dental care to pregnant women in PHC between the years studied, however, this indicator does not allow the evaluation of the quality of this care nor the impact on maternal and infant morbidity and mortality.
El objetivo de este estudio fue describir el comportamiento del indicador de proporción de gestantes con atención odontológica realizada en todos los estados brasileños antes y después de la implementación del Programa Prevent Brazil y correlacionar los hallazgos con variables. Se trata de un estudio ecológico, analítico, con datos secundarios, cuyas unidades de análisis son 26 unidades federativas de Brasil y del Distrito Federal. Las variables proporción de gestantes con atención odontológica realizadas entre los años 2018 y 2022 (por cuatro meses), número de equipos de la Estrategia Salud de la Familia, cobertura de la ESF y cobertura de Atención Primaria (APS) en 2020, número de equipos de salud familiar de salud bucal (eSB) en 2021, tamaño estimado de la población para 2021 e Índice de Desarrollo Humano para 2010, fueron recolectados del Sistema de Información en Salud de Atención Primaria (SISAB), del Instituto Brasileño de Geografía y Estadística (IBGE) y del Sistema e-Manager del Ministerio de Salud. Los resultados obtenidos muestran que durante los años analizados el indicador tuvo crecimiento en todas las unidades federativas y en el Distrito Federal, sin embargo algunos estados tuvieron crecimiento del indicador por encima del promedio nacional: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná y Santa Catarina. El indicador tuvo una correlación negativa con el IDH y una correlación positiva con la cobertura de los equipos de salud de la familia y salud bucal. Hubo un aumento en la proporción de atención odontológica a gestantes en APS entre los años estudiados, sin embargo, este indicador no permite evaluar la calidad de esta atención ni el impacto en la morbilidad y mortalidad materna e infantil.
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No Brasil, o direito à saúde passou a ser universal e integral conforme previsão constitucional. No entanto, a via judicial passou a ser utilizada para garantia do acesso a tratamentos de saúde frente à necessidade da população, sem o emprego de muito rigor técnico. Objetivo: revisar a literatura sobre os pontos positivos e negativos encontrados na judicialização da saúde. Metodologia: realizou-se um levantamento na Base de Dados da Biblioteca Virtual em Saúde, com estudos entre 2010 e 2021. Foram encontrados 59 artigos, aplicando os critérios de inclusão para esse estudo, selecionamos 39 para análise. Após aprofundada leitura dos artigos, foram eleitos os temas organizados nas seguintes categorias: medicamentos e tratamentos padronizados pelo Sistema Único de Saúde; medicamentos e tratamentos não padronizados pelo Sistema Único de Saúde; e interferência das indústrias farmacêuticas e diálogos interinstitucionais. Resultados: A maioria dos artigos identificaram pontos positivos e negativos da judicialização da saúde ou mencionaram a existência da contradição que versa esse assunto. Os estudos apontaram que parte da judicialização decorre de falhas da própria gestão. Percebe-se, assim, um conflito presente na dicotomia entre o garantido e a estruturação e capacidade do sistema para a sua realização. Conclusão: Os entes envolvidos na judicialização da saúde devem dialogar entre si, no intuito de compreender o fenômeno e enfrentar os desafios. É necessário reconhecer as demandas judiciais como fonte provocadora para a melhoria da gestão do direito à saúde efetivamente Sistema Único de Saúde, visando sempre ao melhor atendimento aos usuários, promovendo assim a equidade com eficiência no gasto de dinheiro público.
In Brazil, the right to health became universal and comprehensive, as per the constitutional provision. However, the judicial route began to be used to guarantee access to health treatments in response to the population's needs, without the use of much technical rigor. Objective: to review the literature on the positive and negative points found in the Judicialization of health. Methodology: a survey was carried out in the Virtual Health Library Database, with studies between 2010 and 2021. 59 articles were found, applying the inclusion criteria for this study, we selected 39 for analysis. After in-depth reading of the articles, themes organized into the following categories were chosen: medicines and treatments standardized by the SUS; medicines and treatments not standardized by the SUS; and interference from pharmaceutical industries and interinstitutional dialogues. Results: Most articles identified positive and negative points of the Judicialization of health or mentioned the existence of the contradiction regarding this subject. The studies showed that part of the Judicialization results from failures in the management itself. Therefore, a conflict can be seen in the dichotomy between the right to health effectively guaranteed and the structure and capacity of the system to achieve it. Conclusion: The entities involved in the Judicialization of health must dialogue with each other, in order to understand the phenomenon and face the challenges. It is necessary to recognize legal demands as a provocative source for improving SUS management, always aiming to provide better service to users, thus promoting equity and efficiency in spending public money.
En Brasil, el derecho a la salud pasó a ser universal e integral, según disposición constitucional. Sin embargo, se empezó a utilizar la vía judicial para garantizar el acceso a tratamientos de salud que respondieran a las necesidades de la población, sin el uso de mucho rigor técnico. Objetivo: revisar la literatura sobre los puntos positivos y negativos encontrados en la Judicialización de la salud. Metodología: se realizó una encuesta en la Base de Datos de la Biblioteca Virtual en Salud, con estudios entre 2010 y 2021. Se encontraron 59 artículos, aplicando los criterios de inclusión de este estudio, se seleccionaron 39 para el análisis. Después de la lectura en profundidad de los artículos, se eligieron temas organizados en las siguientes categorías: medicamentos y tratamientos estandarizados por el SUS; medicamentos y tratamientos no estandarizados por el SUS; y la interferencia de las industrias farmacéuticas y los diálogos interinstitucionales. Resultados: La mayoría de los artículos identificaron puntos positivos y negativos de la Judicialización de la salud o mencionaron la existencia de la contradicción respecto a este tema. Los estudios demostraron que parte de la Judicialización resulta de fallas en la propia gestión. Por lo tanto, se puede ver un conflicto en la dicotomía entre el derecho a la salud efectivamente garantizado y la estructura y capacidad del sistema para lograrlo. Conclusión: Las entidades involucradas en la Judicialización de la salud deben dialogar entre sí, para comprender el fenómeno y afrontar los desafíos. Es necesario reconocer las demandas legales como una fuente de provocación para mejorar la gestión del SUS, siempre con el objetivo de brindar un mejor servicio a los usuarios, promoviendo así la equidad y la eficiencia en el gasto del dinero público.
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Direito SanitárioRESUMO
Objetivo: compreender a judicialização da saúde no Brasil e analisar, na perspectiva da desjudicialização da saúde, o Acordo de Cooperação Técnica, firmado em 02 de dezembro de 2021, entre a Secretaria de Estado de Saúde de Minas Gerais, a Advocacia Geral do Estado de Minas Gerais e a Defensoria Pública Estadual de Minas Gerais para a gestão dos medicamentos Ranibizumabe e Aflibercept. Método: realizou-se revisão narrativa da literatura sobre a judicialização da saúde e um estudo exploratório baseado em anaÌlise documental dos antecedentes do Acordo de Cooperação Técnica. Resultados e discussões: a autocomposição e solução consensual de conflitos por parte da Administração Pública possui amplo respaldo legal e, no atual cenário jurídico e administrativo, é o meio mais eficaz e eficiente para concretizar o interesse público subjacente, notadamente o direito à saúde, promovendo sua desjudicialização. Esse cenário aponta para o potencial de novas soluçoÌes, entre elas a implementação de diálogos interinstitucionais, como é exemplo o Acordo de Cooperação Técnica estudado, o qual projeta-se poder servir de embrião para uma tendência permanente na gestão da judicialização da saúde no âmbito da Secretaria de Estado da Saúde de Minas Gerais. Considerações finais: o acordo de cooperação estudado tem grande potencial para a desjudicialização das ações com pedidos dos medicamentos oftalmológicos, além de outros cujas incorporações forem propostas em seu bojo. Ele também promove a atuação sinérgica e convergente dos atores que atuam na judicialização. A perspectiva é que, a partir desse marco, estas ações judiciais diminuam e os pacientes passem a ser atendidos pela via de fornecimento administrativo do Sistema Único de Saúde.
Objective: to understand the judicialization of health in Brazil and analyze, from the perspective of health de-judicialization, the Technical Cooperation Agreement signed on December 2, 2021, between the State Health Departmentof Minas Gerais , the State Attorney General's Office of Minas Gerais, and the State Public Defender's Office of Minas Gerais for the management of the medications Ranibizumab and Aflibercept. Method: a narrative review of the literature on the judicialization of health and an exploratory study based on documentary analysis of the antecedents of the Technical Cooperation Agreement were carried out. Results and discussions: Self-composition and consensual resolution of conflicts by the Public Administration has broad legal support and, in the current legal and administrative scenario, is the most effective and efficient means of realizing the underlying public interest, notably the right to health, promoting its dejudicialization. This scenario points to the potential for new solutions, including the implementation of interinstitutional dialogues, such as the Technical Cooperation Agreement studied, which is expected to serve as the embryo for a permanent trend in the management of the judicialization of health within the scope of State Health Departmentof Minas Gerais. Final considerations: ahe cooperation agreement studied has great potential for the dejudicialization of actions with requests for ophthalmological medicines, in addition to others whose incorporations are proposed within it. It also promotes synergistic and convergent action by actors involved in judicialization. The perspective is that, from this milestone, these legal actions will decrease and patients will begin to be served through the United Health System administrative supply route.
Objetivo: comprender la judicialización de la salud en Brasil y analizar, desde la perspectiva de la desjudicialización de la salud, el Acuerdo de Cooperación Técnica firmado el 2 de diciembre de 2021 entre la Secretaría de Estado de Saludde Minas Gerais, la Procuraduría General del Estado de Minas Gerais (AGE-MG) y la Defensoría Pública Estatal de Minas Gerais para la gestión de los medicamentos Ranibizumab y Aflibercept. Método: Se realizó una revisión narrativa de la literatura sobre la judicialización de la salud y un estudio exploratorio basado en un análisis documental de los antecedentes del Acuerdo de Cooperación Técnica. Resultados y discusiones: La autocomposición y resolución consensuada de conflictos por parte de la Administración Pública tiene un amplio respaldo legal y, en el actual escenario jurídico y administrativo, es el medio más eficaz y eficiente para realizar el interés público subyacente, en particular el derecho a la salud. promoviendo su desjudicialización. Este escenario apunta al potencial de nuevas soluciones, incluida la implementación de diálogos interinstitucionales, como el Acuerdo de Cooperación Técnica estudiado, que se espera sirva como embrión de una tendencia permanente en la gestión de la judicialización de la salud en el ámbito de la Secretaría de Estado de Salud de Minas Gerais. Consideraciones finales: el convenio de cooperación estudiado tiene un gran potencial para la desjudicialización de acciones con solicitudes de medicamentos oftalmológicos, además de otras cuyas incorporaciones se proponen dentro del mismo. También promueve acciones sinérgicas y convergentes por parte de los actores involucrados en la judicialización. La perspectiva es que, a partir de este hito, esas acciones legales disminuyan y los pacientes comiencen a ser atendidos a través de la vía administrativa de abastecimiento del Sistema de Salud Unido.
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Direito SanitárioRESUMO
This report aims to describe the identification of porcine astrovirus 3 (PAstV3) RNA in the central nervous system (CNS) of weaned pigs with clinical signs of neurological disease associated with polioencephalomyelitis in southeastern Brazil. Three, 20 -35 days-old piglets that died after clinical manifestations of a neurological syndrome were submitted to post-mortem evaluations. Tissue samples were examined by histopathology, bacteriology, and molecular assays (RT-PCR, nested-PCR, RT-qPCR, and Sanger sequencing) to detect the primary infectious disease agents associated with neurological disease in pigs. The principal neuropathological alterations occurred in the grey matter of the spinal cord and brainstem resulting in nonsuppurative poliomyelitis and rhombencephalitis. PAstV3 RNA was detected in the CNS samples of all piglets with histopathological evidence of disease and was confirmed by nucleotide sequencing. Nucleic acids from pathogens commonly associated with neurological diseases in pigs, such as porcine teschovirus, porcine sapelovirus, porcine enterovirus G, atypical porcine pestivirus, senecavirus A, and encephalomyocarditis virus was not detected by molecular assays in the three piglets. This is the first report of PAstV3 in piglets with neurological disease and lesions consistent with polioencephalomyelitis in Brazil. This report highlights the importance of monitoring health events that could compromise pig farming productivity and animal welfare.
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Encefalomielite , Mamastrovirus , RNA Viral , Doenças dos Suínos , Animais , Suínos , Brasil , Doenças dos Suínos/virologia , Doenças dos Suínos/patologia , RNA Viral/genética , Mamastrovirus/isolamento & purificação , Mamastrovirus/genética , Encefalomielite/veterinária , Encefalomielite/virologia , Encefalomielite/patologia , Infecções por Astroviridae/veterinária , Infecções por Astroviridae/virologia , Infecções por Astroviridae/patologia , Filogenia , Sistema Nervoso Central/virologia , Sistema Nervoso Central/patologia , Medula Espinal/patologia , Medula Espinal/virologiaRESUMO
This study aimed to assess the formation of nevirapine (NVP) co-amorphs systems (CAM) with different co-formers (lamivudine-3TC, citric acid-CAc, and urea) through combined screening techniques as computational and thermal studies, solubility studies; in addition to develop and characterize suitable NVP-CAM. NVP-CAM were obtained using the quench-cooling method, and characterized by differential scanning calorimetry (DSC), X-ray diffractometry (XRD), Fourier Transform Infrared Spectroscopy (FTIR), and polarized light microscopy (PLM), in addition to in vitro dissolution in pH 6.8. The screening results indicated intermolecular interactions occurring between NVP and 3TC; NVP and CAc, where shifts in the melting temperature of NVP were verified. The presence of CAc impacted the NVP equilibrium solubility, due to hydrogen bonds. DSC thermograms evidenced the reduction and shifting of the endothermic peaks of NVP in the presence of its co-formers, suggesting partial miscibility of the compounds. Amorphization was proven by XRD and PLM assays. In vitro dissolution study exhibited a significant increase in solubility and dissolution efficiency of NVP-CAM compared to free NVP. Combined use of screening studies was useful for the development of stable and amorphous NVP-CAM, with increased NVP solubility, making CAM promising systems for combined antiretroviral therapy.
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Varredura Diferencial de Calorimetria , Química Farmacêutica , Nevirapina , Solubilidade , Difração de Raios X , Nevirapina/química , Varredura Diferencial de Calorimetria/métodos , Difração de Raios X/métodos , Química Farmacêutica/métodos , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Composição de Medicamentos/métodos , Lamivudina/química , Ligação de Hidrogênio , Fármacos Anti-HIV/químicaRESUMO
The double burden of diseases and scarce resources in developing countries highlight the need to change the conceptualization of health problems and translational research. Contrary to the traditional paradigm focused on genetics, the exposome paradigm proposed in 2005 that complements the genome is an innovative theory. It involves a holistic approach to understanding the complexity of the interactions between the human being's environment throughout their life and health. This paper outlines a scalable framework for exposome research, integrating diverse data sources for comprehensive public health surveillance and policy support. The Chilean exposome-based system for ecosystems (CHiESS) project proposes a conceptual model based on the ecological and One Health approaches, and the development of a technological dynamic platform for exposome research, which leverages available administrative data routinely collected by national agencies, in clinical records, and by biobanks. CHiESS considers a multilevel exposure for exposome operationalization, including the ecosystem, community, population, and individual levels. CHiESS will include four consecutive stages for development into an informatic platform: (1) environmental data integration and harmonization system, (2) clinical and omics data integration, (3) advanced analytical algorithm development, and (4) visualization interface development and targeted population-based cohort recruitment. The CHiESS platform aims to integrate and harmonize available secondary administrative data and provide a complete geospatial mapping of the external exposome. Additionally, it aims to analyze complex interactions between environmental stressors of the ecosystem and molecular processes of the human being and their effect on human health. Moreover, by identifying exposome-based hotspots, CHiESS allows the targeted and efficient recruitment of population-based cohorts for translational research and impact evaluation. Utilizing advanced technologies such as Artificial Intelligence (AI), Internet of Things (IoT), and blockchain, this framework enhances data security, real-time monitoring, and predictive analytics. The CHiESS model is adaptable for international use, promoting global health collaboration and supporting sustainable development goals.
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Ecossistema , Expossoma , Humanos , Chile , Saúde Pública , Exposição AmbientalRESUMO
The complement system, a vital component of innate immunity, consists of various proteins and pathways crucial for the recognition and elimination of pathogens. In addition, it plays a major role in the initiation of adaptive response through the opsonization of antigens, contributing to B-cell activation and memory maintenance. Deficiencies in complement proteins, particularly C3, can lead to severe and recurrent infections as well as immune complex disorders. Here, we present a case report of two siblings with total C3 deficiency resulting from compound heterozygous mutations in C3 (NM_000064.4): c.305dup; [p.Asn103GlnfsTer66] and c.1269 + 5G>T, previously unreported in C3-related diseases. Both, the index case and her sister, presented a history of recurrent infections since early childhood and one of them developed hemolytic uremic syndrome (HUS). Immunological evaluation revealed absent plasma C3 levels, decreased memory B cells, hypogammaglobulinemia, and impaired response to polysaccharide antigens. The siblings showed partial responses to antimicrobial prophylaxis and vaccination, requiring intravenous immunoglobulin replacement therapy, resulting in clinical improvement. Genetic analysis identified additional risk polymorphisms associated with atypical HUS. This case highlights the importance of comprehensive genetic and immunological evaluations in complement deficiencies, along with the potential role of immunoglobulin replacement therapy in managing associated antibody defects.
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The application of innovative systems using low-cost microcontrollers in human biometeorology studies is a promising alternative to conventional monitoring devices, which are usually cost-intensive and provide measurements at specific points, as in stationary meteorological stations. A Portable Low-cost Environmental Monitoring System (PLEMS) aimed at the pedestrian scale is introduced. The backpack-type equipment consists of a microcontroller with attached sensors that assess environmental conditions in a broad sense, integrating measurements of air quality, lighting and noise levels alongside variables typically measured at meteorological stations. The application of the system took place in altogether 12 environmental walks carried out with questionnaire-surveys with concurrent environmental monitoring with the PLEMS in Curitiba, Brazil, a subtropical location characterized by a Cfb climate type. Results allowed us to test the equipment and method of data gathering within a limited period (approximately 50 min) and for a short walking circuit of 800 m. The equipment was successfully able to capture even slightest differences in environmental conditions among points of interest, whereas subjective responses (n= 3843 responses to a total of 11 questions) showed consistency with measured data. From a multi-domain perspective, relevant insights could be obtained for the measured variables.
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The use of exotic grasses of African origin for pastures in Brazil has been a major advancement in livestock production, but little is known about the responses of these grasses to nitrogen fertilizers associated with shading. In this study, the morphogenetic, structural, and leaf anatomical characteristics of Megathyrsus maximus cultivars' Tamani and Quênia were investigated as a function of N dose and shade. Morphogenetic and structural characteristics and leaf anatomy were studied under three shading levels (0, 30, and 50 %) and four N doses (0, 100, 200, and 300 kg N ha-1) to simulate growth in a silvopastoral system. When comparing the cultivars, Quênia was more efficient in terms of phyllochron up to fertilization with 100 kg N ha-1. The leaf senescence rate of Tamani was higher than that of Quênia at the 30 and 50 % shade levels. The total area (TA) occupied by leaf tissues decreased in Quênia as a function of the increase in N fertilization, whereas the TA of Tamani did not change. The thickness of the adaxial epidermis was greater in Quênia (0.68 µm) than in Tamani (0.50 µm) when not fertilized. The area occupied by the mesophyll was greater in both cultivars when they received fertilization equivalent to 300 kg N ha-1. Quênia grass has a smaller phyllochron than Tamani grass, due to the rapid reconstruction of its photosynthetic apparatus, especially when it receives higher levels of nitrogen fertilization. However, Tamani grass has a greater distribution of plant tissues. The mesophyll area is larger in Tamani grass due to the greater presence of chloroplasts, which facilitates digestion by animals. The Tamani modified the leaf anatomical tissues more significantly in relation to shading, whereas the Quênia modified them in relation to N fertilization, which reinforces the suggestion of a more appropriate use of Tamani in silvopastoral systems.
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Toxicological studies are important to investigate the genotoxic effects of various substances. Allium cepa can be used as test model for this purpose. This review summarizes the scope and applications for this A. cepa test model. For this, an up-to-date (April 2023) literature search was made in the Science Direct, PubMed, and Web of Science databases to find published evidence on studies performed using A. cepa as a test model. Out of 3,748 studies, 74 fit the inclusion criteria. The results showed that the use of the test model A. cepa contributed considerably to measuring the toxicological potential of plant extracts, proving the efficacy of the test as a potent bioindicator of toxic effects. In addition, 27 studies used more than one test system to verify the toxicological potential of extracts and fractions. Studies have shown that the A. cepa model has the potential to replace other test systems that make use of animals and cell cultures, besides having other advantages such as low cost, ease of execution, and good conditions for the observation of chromosomes. In conclusion, the A. cepa test can be considered one of the potential biomonitoring systems in toxicological studies of crude extracts.
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BACKGROUND: Implementing encapsulation techniques is pivotal in safeguarding bioactive molecules against environmental conditions for drug delivery systems. Moreover, the food-grade nanocarrier is a delivery system and food ingredient crucial in creating nutraceutical foods. Nano α-lactalbumin has been shown to be a promissory nanocarrier for hydrophobic molecules. Furthermore, the nanoprotein can enhance the tecno-functional properties of food such as foam and emulsion. The present study investigated the nanostructured α-lactalbumin protein (nano α-la) as a delivery and controlled release system for bioactive molecules in a gastric-intestinal in vitro mimic system. RESULTS: The nano α-la was synthesized by a low self-assembly technique, changing the solution ionic strength by NaCl and obtaining nano α-la 191.10 ± 21.33 nm and a spherical shape. The nano α-la showed higher encapsulation efficiency and loading capacity for quercetin than riboflavin, a potential carrier for hydrophobic compounds. Thermal analysis of nano α-la resulted in a ΔH of -1480 J g-1 for denaturation at 57.44 °C. The nanostructure formed by self-assembly modifies the foam volume increment and stability. Also, differences between nano and native proteins in emulsion activity and stability were noticed. The release profile in vitro showed that the nano α-la could not hold the molecules in gastric fluid. The Weibull and Korsmeyer-Peppas model better fits the release profile behavior in the studied fluids. CONCLUSION: The present study shows the possibility of nano α-la as an alternative to molecule delivery systems and nutraceutical foods' formulation because of the high capacity to encapsulate hydrophobic molecules and the improvement of techno-functional properties. However, the nanocarrier is not perfectly suitable for the sustainable delivery of molecules in the gastrointestinal fluid, demanding improvements in the nanocarrier. © 2024 Society of Chemical Industry.
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BACKGROUND: Computational assessment of the energetics of protein-ligand complexes is a challenge in the early stages of drug discovery. Previous comparative studies on computational methods to calculate the binding affinity showed that targeted scoring functions outperform universal models. OBJECTIVE: The goal here is to review the application of a simple physics-based model to estimate the binding. The focus is on a mass-spring system developed to predict binding affinity against cyclin-dependent kinase. METHOD: Publications in PubMed were searched to find mass-spring models to predict binding affinity. Crystal structures of cyclin-dependent kinases found in the protein data bank and two web servers to calculate affinity based on the atomic coordinates were employed. RESULTS: One recent study showed how a simple physics-based scoring function (named Taba) could contribute to the analysis of protein-ligand interactions. Taba methodology outperforms robust physics-based models implemented in docking programs such as AutoDock4 and Molegro Virtual Docker. Predictive metrics of 27 scoring functions and energy terms highlight the superior performance of the Taba scoring function for cyclin- dependent kinase. CONCLUSION: The recent progress of machine learning methods and the availability of these techniques through free libraries boosted the development of more accurate models to address protein-ligand interactions. Combining a naïve mass-spring system with machine-learning techniques generated a targeted scoring function with superior predictive performance to estimate pKi.