Primary health care performance according to clusters of convergent municipalities in the state of São Paulo.

OBJECTIVE: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. METHODS: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. RESULTS: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. CONCLUSION: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

Functional Complications of Patellar Instability Treatment with Medial Patellofemoral Ligament Reconstruction with the Medial Third of the Patellar Tendon with a Minimum 5-Year Follow-Up.

Objective To evaluate major complications after a minimum of 5 years of follow-up after acute or recurrent patellar dislocation treated with medial patellofemoral ligament (MPFL) reconstruction with the medial third of the patellar tendon, with or without associated medialization of the tibial anterior tuberosity (TAT). Methods A total of 50 patients were included, with a minimum follow-up of 5 years. The patients were evaluated regarding complications such as joint stiffness, recurrence of patellar dislocation, subjective instability reported by patients, and inability to return to the previous level of physical activity. Results The mean follow-up was of 8.9 ± 2.6 years, with a minimum of 6 and maximum of 15 years; 64% of the patients were women, with a mean age of 27 ± 11.2 years old; 24% were submitted to TAT osteotomy for simultaneous medialization; and 46% were acute cases. Only 9 poor results (18%) were found, all resulting from recurrence of dislocation (12%) and complaint of subjective instability (6%) at between 36 and 60 months of follow-up. No other complications occurred. Among the poor results, five occurred in cases of acute dislocation, and four in recurrent cases, and only one had undergone TAT osteotomy. Conclusion Reconstruction of the MPFL with the medial third of the patellar tendon, associated or not with TAT medialization osteotomy, is an alternative in the treatment of acute or chronic patellar instability, with a failure rate of only 18% in at least 5 years of follow-up. In addition, it is safe treatment, that does not present other complications.

Functional Complications of Patellar Instability Treatment with Medial Patellofemoral Ligament Reconstruction with the Medial Third of the Patellar Tendon with a Minimum 5-Year Follow-Up / Complicações funcionais do tratamento da instabilidade patelar com reconstrução do ligamento femoropatelar medial com terço medial do tendão patelar com acompanhamento mínimo de 5 anos

Abstract Objective To evaluate major complications after a minimum of 5 years of follow-up after acute or recurrent patellar dislocation treated with medial patellofemoral ligament (MPFL) reconstruction with the medial third of the patellar tendon, with or without associated medialization of the tibial anterior tuberosity (TAT). Methods A total of 50 patients were included, with a minimum follow-up of 5 years. The patients were evaluated regarding complications such as joint stiffness, recurrence of patellar dislocation, subjective instability reported by patients, and inability to return to the previous level of physical activity. Results The mean follow-up was of 8.9 2.6 years, with a minimum of 6 and maximum of 15 years; 64% of the patients were women, with a mean age of 27 11.2 years old; 24% were submitted to TAT osteotomy for simultaneous medialization; and 46% were acute cases. Only 9 poor results (18%) were found, all resulting from recurrence of dislocation (12%) and complaint of subjective instability (6%) at between 36 and 60 months of follow-up. No other complications occurred. Among the poor results, five occurred in cases of acute dislocation, and four in recurrent cases, and only one had undergone TAT osteotomy. Conclusion Reconstruction of the MPFL with the medial third of the patellar tendon, associated or not with TAT medialization osteotomy, is an alternative in the treatment of acute or chronic patellar instability, with a failure rate of only 18% in at least 5 years of follow-up. In addition, it is safe treatment, that does not present other complications.

Resumo Objetivo Avaliar complicações maiores após um mínimo de 5 anos de acompanhamento após luxação aguda ou recidivante da patela tratada com reconstrução do ligamento femoropatelar medial (LFPM) com terço medial do tendão patelar, com ou sem medialização da tuberosidade anterior da tíbia (TAT) associada. Métodos Um total de 50 pacientes foram incluídos, com acompanhamento mínimo de 5 anos. Os pacientes foram avaliados em relação à ocorrência de complicações como rigidez articular, recidiva de luxação patelar ou instabilidade subjetiva relatada pelos pacientes, e incapacidade de retorno ao nível prévio de atividades físicas. Resultados O acompanhamento médio foi de 8,9 2,6 anos, com mínimo de 6 e máximo de 15 anos; 64% dos pacientes eram mulheres, com média de idade de 27 11,2 anos; 24% dos pacientes foram submetidos a osteotomia da TAT para medialização concomitantemente; e 46% eram casos agudos. Foram constatados apenas 9 maus resultados (18%), todos decorrentes de recidiva da luxação (12%) e de queixa de instabilidade subjetiva (6%), ocorridos entre 36 e 60 meses de acompanhamento. Não ocorreram outras complicações. Dentre os maus resultados, cinco ocorreram em casos de luxação aguda, e quatro em casos recidivantes, e apenas um havia sido submetido a osteotomia da TAT. Conclusão AreconstruçãodoLFPMcomterçomedialdotendãopatelar,associadaounãoà osteotomia de medialização da TAT, é uma alternativa no tratamento da instabilidade patelar aguda ou crônica, com falha de apenas 18% em acompanhamento mínimo de 5 anos. Além disso, é um tratamento seguro, sem apresentar outras complicações.

Diastereomeric dinickel(II) complexes with non-innocent bis(octaazamacrocyclic) ligands: isomerization, spectroelectrochemistry, DFT calculations and use in catalytic oxidation of cyclohexane.

Diastereomeric dinickel(II) complexes with bis-octaazamacrocyclic 15-membered ligands [Ni(L1-3-L1-3)Ni] (4-6) have been prepared by oxidative dehydrogenation of nickel(II) complexes NiL1-3 (1-3) derived from 1,2- and 1,3-diketones and S-methylisothiocarbohydrazide. The compounds were characterized by elemental analysis, ESI mass spectrometry, and IR, UV-vis, 1H NMR, and 13C NMR spectroscopy. Single crystal X-ray diffraction (SC-XRD) confirmed the isolation of the anti and syn isomers of bis-octaazamacrocyclic dinickel(II) complexes 4a and 4s, the syn-configuration of 5s and the anti-configuration of the dinickel(II) complex 6a. Dimerization of prochiral nickel(II) complexes 1-3 generates two chiral centers at the bridging carbon atoms. The anti-complexes were isolated as meso-isomers (4a and 6a) and the syn-compounds as racemic mixtures of R,R/S,S-enantiomers (4s and 5s). The syn-anti isomerization (epimerization) of the isolated complexes in chloroform was disclosed. The isomerization kinetics of 5a was monitored at five different temperatures ranging from 20 °C to 50 °C by 1H NMR spectroscopy indicating the clean conversion of 5a into 5s. The activation barrier determined from the temperature dependence of the rate constants via the Eyring equation was found to be ΔH‡ = 114 ± 1 kJ mol-1 with activation entropy ΔS‡ = 13 ± 3 J K-1 mol-1. The complexes contain two low-spin nickel(II) ions in a square-planar coordination environment. The electrochemical behavior of 4a, 4s, 5s and 6a and the electronic structure of the oxidized species were studied by UV-vis-NIR-spectroelectrochemistry (SEC) and DFT calculations indicating the redox non-innocent behavior of the complexes. The dinickel(II) complexes 4a, 4s, 5s and 6a/6s were investigated as catalysts for microwave-assisted solvent-free oxidation of cyclohexane by tert-butyl hydroperoxide to produce a mixture of cyclohexanone and cyclohexanol (KA oil). The best value for KA oil yield (16%) was obtained with a mixture of 6a/6s after 2 h of microwave irradiation at 100 °C.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo / Desempenho da atenção primária à saúde, segundo clusters de municípios convergentes no estado de São Paulo

ABSTRACT: Objective: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. Methods: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. Results: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. Conclusion: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

RESUMO: Objetivo: Descrever o desempenho da atenção primária à saúde, segundo clusters de municípios paulistas que apresentaram indicadores homogêneos. Métodos: Trata-se de um estudo descritivo, com base em dados secundários extraídos de fontes oficiais do Sistema Único de Saúde, referentes ao ano de 2018. Foi elaborada uma matriz de análise, com a proposição de indicadores de desempenho (acesso, efetividade e adequação) e contexto (população, determinantes de saúde e financiamento), selecionados e organizados em dimensões e subdimensões. Para identificar os grupos de municípios homogêneos, foi utilizada a análise de cluster Resultados: Dos 645 municípios, constituíram-se seis clusters. Os clusters 2 e 3 foram formados, predominantemente, por municípios pequenos e com maior acesso; entre eles, o cluster 3 apresentou menor vulnerabilidade social e maior investimento em saúde. Os clusters 1, 4 e 5, em contrapartida, foram formados por municípios maiores e com menor acesso; entre eles, o cluster 4 apresentou maior vulnerabilidade social, menor cobertura de planos privados de saúde e maior percentual de recursos utilizados em saúde; e o cluster 5, maior produto interno bruto per capita e maior cobertura de planos privados de saúde. O cluster 6, formado pelo município de São Paulo, demonstrou ser um caso particular. Ainda, o cluster 2 chamou atenção. Apresentando maior cobertura, sinalizou menor efetividade e adequação. Entre todos os clusters, o cluster 3 alcançou o melhor desempenho. Conclusão: Os resultados podem subsidiar a gestão regional e municipal, diante da complexidade do território paulista, apontando para cenários que demandam maiores inciativas de gestão pública.

RESULTS OF TREATMENT OF PLICA SYNDROME OF THE KNEE.

OBJECTIVE: The synovial fold is an intra-articular structure found in more than 50% of the knees, which can cause symptoms similar to meniscal injuries. These symptoms are mostly related to hypertrophy of the synovial fold resulting from inadequate physical activity. Conservative treatment with readjustment of sports activity and muscle rebalancing solves most cases. Rare cases require surgical treatment, which is indicated due to the persistence of instability, blockage and pain. We present our experience in the treatment of this pathology. METHODS: 58 patients (70 knees), with 62 knees treated conservatively and 8 treated surgically exclusively for the pathological synovial fold. Results: Description of the series and treatment results are reported. CONCLUSION: The non-surgical treatment of the pathological synovial fold of the knee provided good results within 60 days of rehabilitation program in almost 90% of the patients. Arthroscopic resection of the synovial fold is a surgery that has a longer and laborious rehabilitation period, despite good results in most cases. Level of Evidence IV, Case series.

OBJETIVO: A prega sinovial é uma estrutura intra-articular encontrada em mais de 50% dos joelhos, que pode provocar sintomas semelhantes aos da lesão meniscal. Esses sintomas estão relacionados, na maioria dos casos, à hipertrofia da prega sinovial decorrente de atividade física inadequada. O tratamento conservador com a readequação da atividade esportiva e reequilíbrio muscular resolve a maioria dos casos. Raros casos demandam tratamento cirúrgico, que é indicado pela persistência de falseios, bloqueios e dor. Apresentamos nossa experiência no tratamento dessa patologia. MÉTODOS: 58 pacientes (70 joelhos), com 62 joelhos tratados conservadoramente e 8 tratados cirurgicamente exclusivamente para a prega sinovial patológica. RESULTADOS: São apresentados descrição da série e resultados do tratamento. CONCLUSÃO: O tratamento não cirúrgico da prega sinovial patológica do joelho propiciou bons resultados com 60 dias de programa de reabilitação em quase 90% dos pacientes. A ressecção artroscópica da prega sinovial é uma cirurgia que tem um período de reabilitação mais longo e trabalhoso, apesar do bom resultado na maioria dos casos. Nível de Evidência IV, Série de casos.

Oxido- and Dioxido-Vanadium(V) Complexes Supported on Carbon Materials: Reusable Catalysts for the Oxidation of Cyclohexane.

Oxidovanadium(V) and dioxidovanadium(V) compounds, [VO(OEt)L] (1) and [Et3NH][VO2L] (2), were synthesized using an aroylhydrazone Schiff base (5-bromo-2-hydroxybenzylidene)-2-hydroxybenzohydrazide (H2L). They were characterized by elemental analysis, Fourier-transform infrared spectroscopy (FT-IR), (1H and 51V) nuclear magnetic resonance (NMR), electrospray ionization mass spectrometry (ESI-MS) and single crystal X-ray diffraction analyses. Both complexes were immobilized on functionalized carbon nanotubes and activated carbon. The catalytic performances of 1 and 2, homogenous and anchored on the supports, were evaluated for the first time towards the MW-assisted peroxidative oxidation (with tert-butylhydroperoxide, TBHP) of cyclohexane under heterogeneous conditions. The immobilization of 1 and 2 on functionalized carbon materials improved the efficiency of catalytic oxidation and allowed the catalyst recyclability with a well-preserved catalytic activity.

Selective Styrene Oxidation to Benzaldehyde over Recently Developed Heterogeneous Catalysts.

The selective oxidation of styrene under heterogeneous catalyzed conditions delivers environmentally friendly paths for the production of benzaldehyde, an important intermediate for the synthesis of several products. The present review explores heterogeneous catalysts for styrene oxidation using a variety of metal catalysts over the last decade. The use of several classes of supports is discussed, including metal-organic frameworks, zeolites, carbon materials and silicas, among others. The studied catalytic systems propose as most used oxidants tert-butyl hydroperoxide, and hydrogen peroxide and mild reaction conditions. The reaction mechanism proceeds through the generation of an intermediate reactive metal-oxygen species by catalyst-oxidant interactions. Overall, most of the studies highlight the synergetic effects among the metal and support for the activity and selectivity enhancement.

Results of treatment of plica syndrome of the knee / Resultados do tratamento da prega sinovial (plica) patológica do joelho

ABSTRACT Objective: The synovial fold is an intra-articular structure found in more than 50% of the knees, which can cause symptoms similar to meniscal injuries. These symptoms are mostly related to hypertrophy of the synovial fold resulting from inadequate physical activity. Conservative treatment with readjustment of sports activity and muscle rebalancing solves most cases. Rare cases require surgical treatment, which is indicated due to the persistence of instability, blockage and pain. We present our experience in the treatment of this pathology. Methods: 58 patients (70 knees), with 62 knees treated conservatively and 8 treated surgically exclusively for the pathological synovial fold. Results: Description of the series and treatment results are reported. Conclusion: The non-surgical treatment of the pathological synovial fold of the knee provided good results within 60 days of rehabilitation program in almost 90% of the patients. Arthroscopic resection of the synovial fold is a surgery that has a longer and laborious rehabilitation period, despite good results in most cases. Level of Evidence IV, Case series.

RESUMO Objetivo: A prega sinovial é uma estrutura intra-articular encontrada em mais de 50% dos joelhos, que pode provocar sintomas semelhantes aos da lesão meniscal. Esses sintomas estão relacionados, na maioria dos casos, à hipertrofia da prega sinovial decorrente de atividade física inadequada. O tratamento conservador com a readequação da atividade esportiva e reequilíbrio muscular resolve a maioria dos casos. Raros casos demandam tratamento cirúrgico, que é indicado pela persistência de falseios, bloqueios e dor. Apresentamos nossa experiência no tratamento dessa patologia. Métodos: 58 pacientes (70 joelhos), com 62 joelhos tratados conservadoramente e 8 tratados cirurgicamente exclusivamente para a prega sinovial patológica. Resultados: São apresentados descrição da série e resultados do tratamento. Conclusão: O tratamento não cirúrgico da prega sinovial patológica do joelho propiciou bons resultados com 60 dias de programa de reabilitação em quase 90% dos pacientes. A ressecção artroscópica da prega sinovial é uma cirurgia que tem um período de reabilitação mais longo e trabalhoso, apesar do bom resultado na maioria dos casos. Nível de Evidência IV, Série de casos.

New Trends in C-C Cross-Coupling Reactions: The Use of Unconventional Conditions.

The ever-growing interest in the cross-coupling reaction and its applications has increased exponentially in the last decade, owing to its efficiency and effectiveness. Transition metal-mediated cross-couplings reactions, such as Suzuki-Miyaura, Sonogashira, Heck, and others, are powerful tools for carbon-carbon bond formations and have become truly fundamental routes in catalysis, among other fields. Various greener strategies have emerged in recent years, given the widespread popularity of these important reactions. The present review comprises literature from 2015 onward covering the implementation of unconventional methodologies in carbon-carbon (C-C) cross-coupling reactions that embodies a variety of strategies, from the use of alternative energy sources to solvent- free and green media protocols.

Assessing the applicability of a new carob waste-derived powdered activated carbon to control pharmaceutical compounds in wastewater treatment.

This paper assesses the applicability of a new carob waste-derived powdered activated carbon (PAC) obtained by steam activation for pharmaceutical compounds (PhCs) removal in urban wastewater treatment plants (WWTPs) with activated sludge (AS) secondary treatment. The new carob-derived PAC presents chemical and textural properties similar to a high-performing commercial PAC produced from vegetable source by physical activation. The adsorption isotherms of three target PhCs, carbamazepine, diclofenac and sulfamethoxazole, spiked (at around 100 µg/L) in mixed liquor (ML) and in clarified-ML from the AS-bioreactor of a WWTP show: (i) minor reduction of PAC capacity with real MLs compared to clarified MLs; (ii) the higher the PhC hydrophobicity, the higher the PAC adsorption capacity in both water matrices; (iii) hydrophobic interactions probably overweight electrostatic interactions between the PhCs and the slightly positively charged PAC in these real water matrices with background organics and inorganics. The PhC adsorption results with ML and clarified-ML are used to calibrate the IAST-based tracer model (TRM) and predict the new PAC performance when added to AS-bioreactor vs. in post-secondary treatment, at the PhC naturally-occurring trace concentrations. The modelling projections show (i) one needs higher PAC doses than those reported in the literature, particularly in post-treatment, and (ii) the benefits of PAC dosing to the bioreactor, with only a slightly higher PAC dose being needed when compared to its post-secondary dosing and minimising the capital investment.

[Co/Fe(α-Alkyl-tpdt)2]x-: Alkyl-Substituted Cobalt and Iron Bis-dithiolenethiophenic Complexes.

Tetraphenylphosphonium salts of Co and Fe complexes with alkyl-substituted, tert-butyl (tb), and isopropyl (dp) 2,3-thiophenedithiolate (α-tpdt) ligands, namely, TPP[Co(α-tb-tpdt)2] (3), TPP2[Fe(α-tb-tpdt)2]2 (4a-b), TPP[Co(α-dp-tpdt)2] (5), and TPP[Fe(α-dp-tpdt)2] (6) were prepared and characterized by cyclic voltammetry, single crystal X-ray diffraction, magnetic susceptibility measurements, and 57Fe Mössbauer spectroscopy. Compound 3 and 5 are isostructural with their Au and Ni analogues with a square-planar coordination geometry. Compound 4 presents two polymorphs (4a-b) both showing a Fe(III) bisdithiolene dimerization. The magnetic susceptibility of 3 and 5 exhibits behavior dominated by antiferromagnetic interactions, with room-temperature magnetic moments of 3.40 and 3.36 µB, respectively, indicating that these square-planar Co(III) complexes assume an intermediate spin electronic configuration (S = 1) as supported by multiconfigurational and DFT calculations.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions.

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

Cardiac Angiosarcoma: From Cardiac Tamponade to Ischaemic Stroke - A Diagnostic Challenge.

Cardiac angiosarcoma (CA) is the most common primary malignant heart tumour. Its atypical symptoms and rapidly progressive nature contribute to delayed diagnosis and poor outcome. We report the case of a 52-year-old woman admitted with a large pericardial effusion. An extensive study of the aetiology of the pericardial effusion was inconclusive. Two months later the patient returned with ischaemic stroke. An echocardiogram revealed a probable right atrium contained rupture. The patient was submitted to surgical correction but died 9 days later. Histology revealed an angiosarcoma. This case exemplifies the atypical presentation of CA and highlights the importance of a multimodal diagnostic work-up in patients with idiopathic pericardial effusion. LEARNING POINTS: Cardiac angiosarcoma is often overlooked as an initial diagnosis because of its rarity and atypical symptoms, which, in association with its aggressiveness, contribute to delayed diagnosis and fatal outcome.Pericardial biopsy is an important technique that may help to disclose the aetiology of pericardial effusion and should be considered for the confirmation of malignant pericardial disease.Patients presenting with pericardial effusion with cardiac tamponade with an unclear cause after diagnostic work-up should be followed closely.

Novel Chemotherapeutic Agents - The Contribution of Scorpionates.

The development of safe and effective chemotherapeutic agents is one of the uppermost priorities and challenges of medicinal chemistry and new transition metal complexes are being continuously designed and tested as anticancer agents. Scorpionate ligands have played a great role in coordination chemistry, since their discovery by Trofimenko in the late 1960s, with significant contributions in the fields of catalysis and bioinorganic chemistry. Scorpionate metal complexes have also shown interesting anticancer properties, and herein, the most recent (last decade) and relevant scorpionate complexes reported for application in medicinal chemistry as chemotherapeutic agents are reviewed. The current progress on the anticancer properties of transition metal complexes bearing homo- or hetero- scorpionate ligands, derived from bis- or tris-(pyrazol-1-yl)-borate or -methane moieties is highlighted.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions / A intervenção QualiRede: melhoria do desempenho do contínuo do cuidado em HIV, sífilis congênita e hepatite C em regiões de saúde

ABSTRACT Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. Conclusion: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

RESUMO Introdução: Modelos de cuidado contínuo baseiam recentes estratégias em HIV, infecções sexualmente transmissíveis e hepatite C (HCV). Métodos: Desenvolveram-se modelos de contínuo do cuidado em HIV, HCV e sífilis congênita incluindo todas as etapas da atenção, desde a promoção e a prevenção até o controle clínico/cura. O modelo baseou a intervenção QualiRede, desenvolvida em parceria entre universidade e Sistema Único de Saúde (SUS), direcionada a gestores e demais profissionais de 6 regiões de saúde prioritárias em São Paulo e Santa Catarina. Selecionaram-se indicadores para cada etapa do contínuo do cuidado, provenientes dos sistemas de informação do SUS e dos questionários de avaliação de processo Qualiaids e QualiAB. Os indicadores formaram a base técnica de duas oficinas com profissionais e gestores de cada região: a primeira para identificar problemas e formar um Grupo Técnico Regional; e a segunda para construir planos de ação e metas a fim de melhorar o desempenho regional. Resultados: Os indicadores estão disponíveis no website www.qualirede.org. As oficinas ocorreram em quatro regiões de São Paulo (Alto Tietê, Baixada Santista, Grande ABC e Registro) e uma região de Santa Catarina (Foz do Rio Itajaí), resultando em planos regionais em São Paulo, mas não em Santa Catarina. Observou-se domínio limitado dos novos protocolos para HIV e HCV e uso incipiente de indicadores na rotina dos serviços. Conclusão: Melhorar o desempenho do contínuo do cuidado exige apropriação dos indicadores de desempenho e coordenação integrada dos fluxos de atenção em todos os níveis de gestão.

Hemodynamic and clinical performance of Solo stentless bioprosthetic aortic valves.

OBJECTIVE: To report the hemodynamic profile and short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves implanted at our center. METHODS: Between 2009 and 2015, all patients undergoing aortic valve replacement using Solo stentless valves at our center were enrolled. Clinical and echocardiographic follow-up was carried out six months postoperatively. Survival and major events, including structural valve deterioration and non-structural valve dysfunction, endocarditis, reoperation and stroke, were assessed through medical records or telephone interview with the referring cardiologist up to November 2015 (mean and maximum follow-up 39±22 and 78 months, respectively). RESULTS: Patients' (n=345) mean age was 72±8 years, 52% were female and median euroSCORE II was 2.7 (1.5-4.7). There was no intraoperative mortality and in-hospital mortality was 2.6%. Postoperatively, mean transvalvular gradient was 11.9±4.5 mmHg and effective orifice area was 1.9±0.5 cm2. Patient-prosthesis mismatch occurred in 14% but was severe in only one patient. Cumulative survival at six years was 72%. Six patients were reoperated: three due to endocarditis, two for structural prosthesis deterioration and one because of periprosthetic fistula. Five patients suffered stroke, three had medically-treated endocarditis and one had structural valve deterioration but was not considered suitable for reoperation. None of the remainder had structural valve deterioration or non-structural valve dysfunction. CONCLUSIONS: Solo stentless aortic valves are safe to implant, with promising clinical outcomes in short- and medium-term assessment. Moreover, they show an excellent hemodynamic performance: low transvalvular gradients, large effective orifice areas and low incidence of patient-prosthesis mismatch.

Gold and Nickel Extended Thiophenic-TTF Bisdithiolene Complexes.

Gold and nickel bisdithiolene complexes with methyl and tert-butyl substituted thiophenetetrathiafulavalenedithiolate ligands (α-mtdt and α-tbtdt) were prepared and characterized. These complexes were obtained, under anaerobic conditions, as tetrabutylammonium salts. The diamagnetic gold monoanion (n-Bu4N)[Au(α-mtdt)2] (3) and nickel dianionic species (n-Bu4N)x[Ni(α-mtdt)2] (x = 1,2) (4) were similar to the related non-substituted extended thiophenic-TTF (TTF = tetrathiafulvalene) bisdithiolenes. However the introduction of the large, bulky substituent tert-butyl, led to the formation of a Au (I) dinuclear complex, (n-Bu4N)2[Au2(α-tbtdt)2] (5). The neutral methyl substituted gold and nickel complexes were easily obtained through air or iodine exposure as polycrystalline or amorphous fine powder. [Au(α-mtdt)2] (6) and [Ni(α-mtdt)2] (7) polycrystalline samples display properties of a metallic system with a room temperature electrical conductivity of 0.32 S/cm and ≈4 S/cm and a thermoelectric power of ≈5 µV/K and ≈32 µV/K, respectively. While [Au(α-mtdt)2] (6) presented a Pauli-like magnetic susceptibility typical of conducting systems, in [Ni(α-mtdt)2] (7) large magnetic susceptibilities indicative of high spin states were observed. Both electric transport properties and magnetic properties for gold and nickel [M(α-mtdt)2] are indicative that these compounds are single component molecular conductors.

Freedom Solo® versus Trifecta® bioprostheses: clinical and haemodynamic evaluation after propensity score matching.

OBJECTIVES: The goal of this study was to compare the stentless Freedom Solo® (FS) and the stented Trifecta® (TF) aortic bioprostheses with regard to haemodynamic profile, left ventricular mass regression and early and late postoperative outcomes and survival. METHODS: A longitudinal cohort study of consecutive patients undergoing aortic valve replacement (2009-16) with either the FS or TF at 1 centre was performed. Local databases and national records were queried. Prosthesis haemodynamics and left ventricular dimensions were obtained from postoperative echocardiograms. After propensity score matching (21 covariates), the Kaplan-Meier and competing risk analyses were performed for survival and the combined outcome of structural valve deterioration and endocarditis, respectively. Haemodynamics and mass regression were assessed by a mixed-effects model including propensity score as a covariate. RESULTS: From a total sample of 397 patients with the FS and 525 TF bioprostheses with a median follow-up time of 4.0 (2.2-6.0) and 2.4 (1.4-3.7) years, respectively, a matched sample of 329 pairs was obtained. Matched groups showed no differences in survival (hazard ratio = 1.04, 95% confidence interval = 0.69-1.56) or cumulative hazards of combined outcome (subdistribution hazard ratio = 0.54, 95% confidence interval = 0.21-1.39). Although the TF showed an improved haemodynamic profile, no difference was found in mass regression. Patients with TF bioprostheses had higher rates of prolonged mechanical ventilation, whereas patients with the FS bioprosthesis showed higher rates of thrombocytopenia. CONCLUSIONS: The TF showed an improved haemodynamic profile compared to the FS, but this did not translate into further reverse remodelling. Postoperative outcomes and survival rates were comparable for both bioprostheses. Long-term follow-up is needed for comparisons with classical bioprosthesis models.