Intramuscular Hemangioma: A Rare Cause of Omalgia / Hemangioma intramuscular: Uma causa rara de Omalgia

Abstract Intramuscular hemangiomas (IHs) are benign soft-tissue tumors that represent less than 1% of all hemangiomas. This clinical entity is rarely considered as a differential diagnosis in cases of musculoskeletal pain. A healthy 38-year-old woman presented to our office with complaint of left omalgia, with 8 months of evolution, limiting her daily activities. She reported the appearance of tumefaction in the previous 4 months. She was medicated with analgesic and antiinflammatory drugs with no clinical improvement. The objective examination showed limitation of left shoulder abduction (0-90°). The patient underwent a magnetic resonance imaging (MRI), in which a well-circumscribed nodular formation was detected in the deltoid muscle. Then, she underwent a biopsy, which confirmed the diagnosis of hemangioma. The patient was referred for sclerotherapy. Intramuscular hemangiomas are usually observed in young patients. The gold-standard examination for diagnosis is MRI, which often forestalls the need for a biopsy. In many cases, IHs are asymptomatic and tend to involute over time. Despite the low frequency of this clinical entity, it is important to place it as a diagnostic hypothesis in cases of chronic pain of the limbs in young patients with poor therapeutic response to antiinflammatory drugs and analgesia.

Resumo Os hemangiomas intramusculares (HIs) são tumores benignos de tecidos moles que representam menos de 1% de todos os hemangiomas. Esta entidade clínica raramente é considerada como diagnóstico diferencial nos casos de dor musculoesquelética. Uma paciente do sexo feminino, de 38 anos de idade, saudável, se apresentou ao nosso consultório com queixa de omalgia esquerda, com 8 meses de evolução, que limitava suas atividades diárias. Ela relatou o aparecimento de tumefação 4 meses antes da consulta. A paciente estava medicada com analgésico e antiinflamatório sem melhoria clínica. Ao exame objetivo, ela apresentava limitação da abdução do ombro esquerdo (0-90°). A paciente foi submetida a uma ressonância nuclear magnética (RNM) na qual foi detectada uma formação nodular bem circunscrita no músculo deltoide,. Em seguida, foi realizada uma biópsia que confirmou o diagnóstico de hemangioma. A paciente foi então encaminhada para a realização de escleroterapia. Os HIs normalmente são observados em pacientes jovens. O exame padrão-ouro para o diagnóstico é a RNM, que muitas vezes torna a realização de biópsia desnecessária. Em muitos casos, os HIs são assintomáticos e tendem a involuir com o tempo. Apesar da baixa frequência desta entidade clínica, é importante colocá-la como hipótese de diagnóstico em casos de dor crônica dos membros em pacientes jovens com má resposta terapêutica a antiinflamatórios e analgesia.

Estado nutricional e consumo alimentar de vegetarianos estritos e não estritos / Nutritional status and food consumption of strict and non-strict vegetarians

Introdução: O número de adeptos ao vegetarianismo tem crescido consideravelmente. Observa-se que, entre as vantagens de se adotar uma dieta vegetariana, está o menor risco de desenvolver sobrepeso e obesidade, o que pode estar relacionado com o alto consumo de vegetais e práticas importantes de estilo de vida. Objetivos: Avaliar o estado nutricional e a frequência do consumo alimentar de vegetarianos não estritos e estritos. Métodos: Estudo transversal descritivo, realizado com participantes do grupo "Vegans SLZ", de ambos os sexos e com idade a partir de 18 anos. A coleta de dados ocorreu de janeiro a março de 2020. Foi realizada aplicação de questionários sobre dados de frequência do consumo alimentar, socioeconômico e de estilo de vida e a aferição de medidas de peso corporal, estatura e de percentuais de gordura corporal e massa muscular. Os dados foram tabulados no Excel 2010® e analisados no programa estatístico R Studio versão 3.6.1. Resultados: Dos 43 vegetarianos avaliados, a maioria seguia a dieta vegetariana estrita (55,81%) e era eutrófica (62,79%), 32,56% apresentaram alto percentual de gordura corporal e 53,49% percentual de massa magra corporal normal. Foi frequente o consumo de pães, cereais, tubérculos, leguminosas, oleaginosas, frutas e verduras, e 41% consumiam alimentos industrializados de 4 a 7 vezes por semana. Conclusões: A maioria da amostra tinha estado nutricional eutrófico e consumo regular de todos os grupos alimentares, porém com importante consumo de alimentos industrializados.

Introduction: The number of adherents to vegetarianism has grown considerably. It is observed that, among the advantages of adopting a vegetarian diet, there is a lower risk of developing overweight and obesity, which may be related to the high consumption of vegetables and important lifestyle practices. Objectives: To assess the nutritional status and frequency of food consumption of non-strict and strict vegetarians. Methods: Descriptive cross-sectional study carried out with participants of the "Vegans SLZ" group, of both sexes and aged 18 years and over. Data collection took place from January to March 2020. Questionnaires were applied to data on frequency of food, socioeconomic and lifestyle consumption and measurements of body weight, height and percentages of body fat and muscle mass were measured. Data were tabulated in Excel 2010® and analyzed in the statistical program R Studio version 3.6.1. Results: Of the 43 vegetarians evaluated, the majority followed the strict vegetarian diet (55.81%) and were eutrophic (62.79%), 32.56% had a high percentage of body fat and 53.49% percentage of lean body mass normal. The consumption of breads, cereals, tubers, legumes, oilseeds, fruits and vegetables was frequent, and 41% consumed processed foods 4 to 7 times a week. Conclusions: Most of the sample had a eutrophic nutritional status and regular consumption of all food groups, but with a significant consumption of industrialized foods.

A cell-based assay for detection of anti-fibrillarin autoantibodies with performance equivalent to immunoprecipitation.

Anti-fibrillarin autoantibodies are useful for the diagnosis and prognosis of systemic sclerosis (SSc). Anti-fibrillarin produces a clumpy nucleolar pattern in indirect immunofluorescence assay on HEp-2 cells (HEp-2 IFA). Here we develop and validate a reliable cell-based anti-fibrillarin assay (Fibrillarin/CBA) for use in clinical diagnostic laboratories. A TransMembrane Signal was fused to the human fibrillarin gene (TMS-fibrillarin). HEp-2 cells overexpressing transgenic TMS-fibrillarin at the cytoplasmic membrane were used as IFA substrate in the Fibrillarin/CBA. Sixty-two serum samples with nucleolar pattern in the HEp-2 IFA (41 clumpy; 21 homogeneous/punctate) were tested for anti-fibrillarin using Fibrillarin/CBA, immunoprecipitation (IP), line-blot and ELISA. In addition, samples from 106 SSc-patients were evaluated with Fibrillarin/CBA and the results were correlated with disease phenotypes. Thirty-eight of 41 samples with the clumpy nucleolar pattern (92.7%) were positive in the Fibrillarin/CBA, while all 21 samples with other nucleolar patterns were negative. Fibrillarin/CBA results agreed 100% with IP results. Among the 38 Fibrillarin/CBA-positive samples, only 15 (39.5%) and 11 (29%) were positive for anti-fibrillarin in line-blot and ELISA, respectively. Higher frequency of diffuse cutaneous SSc (dcSSc) phenotype (72.7% vs 36.8%; p=0.022), cardiac involvement (36.4% vs 6.5%; p=0.001) and scleroderma renal crisis (18.2% vs 3.3% p = 0.028) was observed in SSc patients with positive compared to negative Fibrillarin/CBA result. Performance of Fibrillarin/CBA in the detection of anti-fibrillarin autoantibodies was comparable to the gold standard IP. Positive Fibrillarin/CBA results correlated with disease phenotypes known to be associated with anti-fibrillarin autoantibodies, underscoring the clinical validation of this novel assay.

Bioactive compounds as potential angiotensin-converting enzyme II inhibitors against COVID-19: a scoping review.

OBJECTIVE AND DESIGN: The current study aimed to summarize the evidence of compounds contained in plant species with the ability to block the angiotensin-converting enzyme 2 (ACE-II), through a scoping review. METHODS: PubMed and Scopus electronic databases were used for the systematic search and a manual search was performed RESULTS: Studies included were characterized as in silico. Among the 200 studies retrieved, 139 studies listed after the exclusion of duplicates and 74 were included for the full read. Among them, 32 studies were considered eligible for the qualitative synthesis. The most evaluated class of secondary metabolites was flavonoids with quercetin and curcumin as most actives substances and terpenes (isothymol, limonin, curcumenol, anabsinthin, and artemisinin). Other classes that were also evaluated were alkaloid, saponin, quinone, substances found in essential oils, and primary metabolites as the aminoacid L-tyrosine and the lipidic compound 2-monolinolenin. CONCLUSION: This review suggests the most active substance from each class of metabolites, which presented the strongest affinity to the ACE-II receptor, what contributes as a basis for choosing compounds and directing the further experimental and clinical investigation on the applications these compounds in biotechnological and health processes as in COVID-19 pandemic.

Títulos de impacto social como política pública: panorama internacional e contribuições para a implementação no Brasil / Títulos de impacto social como política pública: panorama internacional y contribuciones para la implementación en Brasil / Social impact bonds as public policy: international panorama and contributions to implementation in Brazil

Resumo Apesar de lançado em 2011, o título de impacto social (SIB, na sigla em inglês social impact bonds) é um instrumento ainda em desenvolvimento e que encontra inúmeros desafios. Este artigo tem como objetivo apresentar características dos SIBs e desafios relativos à sua implementação como mecanismo para financiamento de projetos públicos com propósito social. Após revisão bibliográfica e documental, foram identificadas e apresentadas as principais críticas ao modelo. Três casos internacionais de SIBs que já encerraram seus ciclos de maturidade foram selecionados para a análise de aspectos éticos e metodológicos, de métricas, de resultados e de atores. Implicações para projetos no Brasil foram consideradas com base nas análises dos casos internacionais.

Resumen A pesar de haber sido lanzado en 2011, el contrato de impacto social (SIB, acrónimo del término inglés social impact bond) es un instrumento inmaduro que enfrenta numerosos desafíos. Este artículo tiene como objetivo presentar las características de los SIB y los desafíos relativos a su implementación como mecanismos para financiar proyectos públicos con propósito social. Después de la revisión bibliográfica y documental, se identificaron y presentaron las principales críticas al modelo. Se seleccionaron tres casos internacionales de SIB que ya completaron sus ciclos de madurez para el análisis de aspectos éticos, metodológicos, de métricas de resultados y de actores. Las implicaciones para proyectos en Brasil se consideraron a partir del análisis de estos casos internacionales.

Abstract Despite being launched in 2011, the social impact bond (SIB) is an instrument under development that faces numerous challenges. This article presents the characteristics of SIBs and challenges related to their implementation as mechanisms to finance public projects with a social purpose. After a bibliographical and documentary review, three international cases of SIBs that have completed their maturity cycles, relevant for critical analysis of possible projects in Brazil, were selected. Ethical, methodological, metrics, results, and actor networks are analyzed in the three SIBs. Implications for projects in Brazil were considered from the analysis of these international cases.

High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry.

OBJECTIVES: To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. METHODS: Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. RESULTS: 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). CONCLUSIONS: Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.

Qualidade do sono dos estudantes de medicina de uma faculdade do sul de Minas Gerais / Quality of sleep among students at a medical school in Minas Gerais

Resumo: Introdução: O sono é um estado fisiológico que se dá de forma cíclica em grande quantidade de seres vivos do reino animal, tendo sido analisados comportamentos de repouso e atividade, que compõem um ciclo vigília-sono. Na universidade, os acadêmicos de Medicina se deparam com falta de tempo e com exaustão, visto que o curso possui carga horária integral, fato que faz com que os graduandos deixem as atividades básicas cada vez mais para o final do dia, o que os leva a desenvolver distúrbios do sono. Objetivo: Este estudo teve como objetivo analisar a qualidade de sono e a incidência de distúrbio de sono em estudantes de Medicina. Método: A pesquisa foi realizada individualmente com os estudantes de Medicina de uma faculdade do sul de Minas Gerais, via plataforma Google Forms, em que eles responderam a dois questionários autoaplicáveis. O primeiro englobava perguntas sobre gênero e ano de graduação, e o segundo, denominado Índice de Qualidade do Sono de Pittsburgh, avaliou a qualidade de sono. Foram utilizados os programas Bioestat 5 e Excel 365 para a análise estatística. Resultado: A análise do estudo demonstrou distúrbio de sono em 20,5% dos estudantes e qualidade subjetiva de sono ruim ou muito ruim em 40,2% dos discentes. Conclusão: Por meio da presente pesquisa, observou-se que a qualidade de sono dos estudantes de Medicina é inferior à da população geral, estando diretamente relacionada à progressão do curso. Foi concluído que os estudantes deste estudo têm, além disso, em média, menos horas de sono que o restante dos brasileiros.

Abstract: Introduction: Sleep is a physiological state that occurs cyclically in many living beings of the animal kingdom, and the behaviours of rest and activity, that form the sleep-wake cycle, have been the subject of studies. Undergraduate medical students are faced with a lack of time and exhaustion, since the course entails full time study, which fact means that the students put off basic activities more and more until the end of the day, and thus develop sleeping disorders. Objective: To analyze the quality of sleep and the incidence of sleeping disorders among medical students. Method: The research was conducted individually with medical students from a college in the south of Minas Gerais, via the Google Forms platform, whereby the student answered two self-administered questionnaires. The first encompassed questions about gender and year of undergraduate study and the second assessed quality of sleep, referring to the Pittsburgh Sleep Quality Index. Bioestat 5 and Excel 365 programs were used for statistical analysis. Result: Analysis of the study found sleep disturbance among 20.5% of the students and poor or very poor quality of sleep among 40.2% of the students. Conclusion: The research showed that the quality of sleep among medical students is lower than that of the general population, and is directly related to the progression of the course. It was concluded that the students in this study have, on average, fewer hours of sleep than the rest of Brazilians.

Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus.

BACKGROUND: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. METHODS: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. RESULTS AND CONCLUSIONS: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.

The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification.

OBJECTIVE: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. METHODS: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. RESULTS: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period. CONCLUSION: This study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery.

OBJETIVO: Identificar as complicações clínicas e cirúrgicas associadas ao uso de torniquete na artroplastia total de joelho em pacientes com ou sem calcificação da artéria poplítea. MÉTODOS: O estudo foi feito de modo retrospectivo, analisou 64 pacientes com calcificação da artéria poplítea e 57 pacientes como grupo controle. RESULTADOS: Os pacientes do grupo de casos eram significativamente mais velhos do que os pacientes do grupo controle. Entretanto, tal fato não teve repercussão quanto ao desfecho clínico no período analisado. Não houve complicações durante o ato cirúrgico nos grupos estudados, bem como não houve diferenças estatisticamente significantes entre a incidência de intercorrências locais ou sistêmicas no período analisado. CONCLUSÃO: O presente estudo observou baixos índices de complicações em pacientes submetidos a artroplastia total do joelho com uso de torniquete com ou sem calcificação da artéria poplítea.

Bilateral knee dislocation with associated bilateral popliteal arterial injury.

Tibiofemoral unilateral knee dislocations are uncommon, making bilateral dislocations even rarer injuries. Knee dislocation is considered one of the most serious injuries that can affect this joint. Associated complications such as popliteal artery injury are responsible for the important morbidity in these patients. The authors report the case of a 52-year-old man with a traumatic bilateral knee dislocation with associated bilateral popliteal arterial injury. His clinical presentation along with radiographic and angiographic findings are described. Surgical and non-surgical treatment and functional outcomes are also reported.

As luxações unilaterais tibiofemurais do joelho são incomuns, o que torna as luxações bilaterais ainda mais raras. A luxação do joelho é considerada um dos ferimentos mais graves nesta articulação. As complicações associadas, tais como a lesão da artéria poplítea, são responsáveis pela importante morbidade observada nesses pacientes. Os autores relatam o caso de um homem de 52 anos com luxação traumática bilateral do joelho associada a lesão bilateral da artéria políptea. O estudo descreve a apresentação clínica e os achados radiográficos e angiográficos. O tratamento cirúrgico e não-cirúrgico e os resultados funcionais também são relatados.

The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification / O uso do manguito pneumático em pacientes submetidos a artroplastia total do joelho com ou sem calcificação da artéria poplítea

ABSTRACT Objective: Identify the clinical and surgical complications associated with the use of a tourniquet in total knee arthroplasty in patients with or without calcification of the popliteal artery. Methods: The study was performed retrospectively, analyzing 58 patients with calcification of the popliteal artery and 57 patients as a control group. Results: The case group patients were significantly older than patients in the control group; however, this had no impact on the clinical outcome in the analyzed period.There were no complications during surgery in the groups studied, as there were no statistically significant differences between the incidence of local or systemic intercurrences in the analyzed period. Conclusion: This study found low rates of complications in patients undergoing total knee arthroplasties with use of a tourniquet, with or without calcification of the popliteal artery.

RESUMO Objetivo: Identificar as complicações clínicas e cirúrgicas associadas ao uso de torniquete na artroplastia total de joelho em pacientes com ou sem calcificação da artéria poplítea. Métodos: O estudo foi feito de modo retrospectivo, analisou 64 pacientes com calcificação da artéria poplítea e 57 pacientes como grupo controle. Resultados: Os pacientes do grupo de casos eram significativamente mais velhos do que os pacientes do grupo controle. Entretanto, tal fato não teve repercussão quanto ao desfecho clínico no período analisado. Não houve complicações durante o ato cirúrgico nos grupos estudados, bem como não houve diferenças estatisticamente significantes entre a incidência de intercorrências locais ou sistêmicas no período analisado. Conclusão: O presente estudo observou baixos índices de complicações em pacientes submetidos a artroplastia total do joelho com uso de torniquete com ou sem calcificação da artéria poplítea.

Bilateral knee dislocation with associated bilateral popliteal arterial injury / Luxação bilateral dos joelhos com lesão bilateral da artéria poplítea

ABSTRACT Tibiofemoral unilateral knee dislocations are uncommon, making bilateral dislocations even rarer injuries. Knee dislocation is considered one of the most serious injuries that can affect this joint. Associated complications such as popliteal artery injury are responsible for the important morbidity in these patients. The authors report the case of a 52-year-old man with a traumatic bilateral knee dislocation with associated bilateral popliteal arterial injury. His clinical presentation along with radiographic and angiographic findings are described. Surgical and non-surgical treatment and functional outcomes are also reported.

RESUMO As luxações unilaterais tibiofemurais do joelho são incomuns, o que torna as luxações bilaterais ainda mais raras. A luxação do joelho é considerada um dos ferimentos mais graves nessa articulação. As complicações associadas, tais como a lesão da artéria poplítea, são responsáveis pela importante morbidade observada nesses pacientes. Os autores relatam o caso de um homem de 52 anos com luxação traumática bilateral do joelho associada a lesão bilateral da artéria políptea. O estudo descreve a apresentação clínica e os achados radiográficos e angiográficos. Os tratamentos cirúrgico e não cirúrgico e os resultados funcionais também são relatados.

Contrato de gestão: O impacto da contratualização no Centro de Referência da Saúde da Mulher de Ribeirão Preto - MATER / Contract management: the impact of contracts in the Reference Centerfor Women’s Health Ribeirão Preto - Mater

Introdução: Contrato de gestão é um instrumento firmado entre o Poder Público e as Organizações Sociais de Saúde (OSS), pelo qual se transfere a gestão de serviços e equipamentos do primeiro para a execução das atividades pelo segundo. Objetivo: analisar os indicadores de desempenho do contrato entre a Secretaria Estadual de Saúde de São Paulo e a FAEPA (OSS), na administração do Centro de Referência da Saúde da Mulher de Ribeirão Preto – MATER. Metodologia: Por meio de um estudo exploratório na modalidade estudo de caso, realizou-se entrevistas com os gestores da MATER e análise de dados referentes ao número de saídas hospitalares, atendimento e cirurgias ambulatoriais, além de indicadores qualitativos dos serviços de atenção ao usuário. Resultados: Entre os contratos de gestão de 2009 e 2013 houve aumento nos valores pactuados. Entretanto, ao ajustar as metas entre Março à Dezembro de 2009 e Janeiro a Fevereiro de 2013, houve redução das saídas hospitalares, cirurgias ambulatoriais e exames radiológicos; com aumento no atendimento ambulatorial, de urgências e de exames endoscópicos. Esses resultados estão atrelados ao repasse de verbas. Conclusão: nossos dados sugerem a necessidade de uma busca ativa da real demanda da população atendida, para que haja planejamento estratégico na oferta de serviços aos usuários do Sistema Único de Saúde...

Introduction: The interaction between the Brazilian Government and Social Health Organization (SHO) has been used as an instrument to transfer services and facilities from the first to implement the activities by the second. Objective: To analyze the indicators of one contract between the Department of Health of São Paulo State and FAEPA, a SHO, in administering the Reference Center for Women’s Health at Ribeirão Preto - MATER. Methods: Using an exploratory case control study, interviews were performed with the managers of MATER. Analysis of data were performed on the number of hospital outputs, outpatient careand surgeries and qualitative indicators of care services to the user. Results: Among the management contracts of 2009 and 2013, there was an increase in money values. However, when setting goals between March to December of 2009 and January and February of 2013, there was a reduction of hospital outputs, outpatient surgeries, and imaging exams and an increased outpatient care, emergency care, and endoscopy. These results are linked to the transfer of funds from governament to SHO. Conclusion: Our data suggest a strategic planning in order to offer to the Unified Health System users their real needs...

La oclusión quirúrgica de la arteria carótida primitiva, su repercusión neurológica y rehabilitación médica: presentación de un caso / Surgical occlusion in carotid primitive artery, its neurological repercussion and medical rehabilitation: a case

Se realiza la presentación del caso de una paciente que acudió a consulta externa por presentar tumor cervical de crecimiento lento que no fue posible hacer un diagnóstico clínico pre quirúrgico a pesar de su valoración por múltiples especialistas vinculados a tumores de cuello. Se propone intervención quirúrgica con fines diagnóstico y terapéutico dado por el volumen y localización anterior para laríngea de cuello sugestiva de proceso neo formativo no benigno. Se realizó exéresis total de la tumoración. La evaluación de la pieza anatómica por el departamento de anatomía patológica que informó un tumor que infiltraba la arteria carótida primitiva con marcada estenosis de la luz vascular, condición que impedía disecar la tumoración del vaso afectado pero de carácter benigno. La ligadura de la carótida lleva implícito la supresión vascular absoluta de gran parte del hemicerebro homolateral, por lo que el riesgo quirúrgico es elevado. La recuperación ha sido progresiva y estable(AU)

Presenting the case, patient who came to the consultation presenting cervical tumor with slow growth that was not possible to make a preoperative clinical diagnosis despite its valuation by different specialists. Surgery is proposed taking into account the volume and location of suggestive anterior and paralaryngeal neck, not benign process. Total excision of the tumor was performed. The evaluation of the anatomical part by the pathology department reported that a tumor inside of the carotid artery with stenosis of the vascular light, a condition that stopped the dissection of the tumor from the affected vessel but benign. Ligation of the carotid links the absolute suppression of the lateral-brain, so the surgical risk is high. Recovery has been gradual and steady

Histopathological changes in liver and gill epithelium of Nile tilapia, Oreochromis niloticus, exposed to waterborne copper

Nile tilapia, Oreochromis niloticus, of both sexes were reared in freshwater and exposed to 0.5, 1.0 and 2.5mg L-1 of waterborne copper for a period of 21 days. Liver and gill samples were collected after 21 days of exposure to copper and lesions were analyzed by light microscopy. The main histopathological changes observed in gills exposed to the highest concentration were edema, lifting of lamellar epithelia and an intense vasodilatation of the lamellar vascular axis. Although less frequent, lamellar fusion caused by the filamentar epithelium proliferation and some lamellar aneurisms were also found. The liver of control group exhibited a quite normal architecture, while the fish exposed to copper showed vacuolation and necrosis. These hepatic alterations were more evident in fish exposed to 1.0 and 2.5mg L-1 copper concentrations. The number of hepatocytes nucleus per mm² of hepatic tissue decreased with the increase of copper concentration. In contrast, the hepatic somatic index was high in fish exposed at 2.5mg L-1 of copper. In short, this work advance new knowledge as influence of copper in the gill and liver histology of O. niloticus and demonstrated that their effects could be observed at different concentrations.

Tilápia do Nilo, Oreochromis niloticus, de ambos os sexos foram mantidas em água doce e expostas a concentrações de 0.5, 1.0 e 2.5mg L-1 de sulfato de cobre durante um período de 21 dias. Amostras de fígado e de brânquia foram coletadas após o tempo de exposição e as lesões foram analisadas por microscopia óptica. As principais alterações histopatológicas observadas nas brânquias foram edema, "lifting" do epitélio lamelar e uma intensa vasodilatação do eixo lamelar. Embora menos freqüentes, a fusão lamelar causada pela proliferação do epitélio filamentar e alguns aneurismas lamelares também foram observadas. O fígado do grupo controle exibiu uma arquitetura normal, enquanto os dos peixes expostos ao cobre apresentaram vacuolização e necrose. Estas lesões hepáticas foram mais evidentes nos peixes expostos a concentrações de cobre de 1.0 e 2.5mg L-1. O número dos núcleos dos hepatócitos / mm² de tecido hepático decresceu com o aumento da concentração de cobre. Em contraste, o índice hepatossomático foi mais elevado nos peixes expostos a 2.5mg L-1 de cobre. Em resumo, este trabalho acrescenta nova informação sobre a influência do cobre ao nível da histologia da brânquia e do fígado de O. niloticus e demonstra que os seus efeitos podem ser observados em diferentes concentrações.

Histopathological changes in liver and gill epithelium of Nile tilapia, Oreochromis niloticus, exposed to waterborne copper

Nile tilapia, Oreochromis niloticus, of both sexes were reared in freshwater and exposed to 0.5, 1.0 and 2.5mg L-1 of waterborne copper for a period of 21 days. Liver and gill samples were collected after 21 days of exposure to copper and lesions were analyzed by light microscopy. The main histopathological changes observed in gills exposed to the highest concentration were edema, lifting of lamellar epithelia and an intense vasodilatation of the lamellar vascular axis. Although less frequent, lamellar fusion caused by the filamentar epithelium proliferation and some lamellar aneurisms were also found. The liver of control group exhibited a quite normal architecture, while the fish exposed to copper showed vacuolation and necrosis. These hepatic alterations were more evident in fish exposed to 1.0 and 2.5mg L-1 copper concentrations. The number of hepatocytes nucleus per mm² of hepatic tissue decreased with the increase of copper concentration. In contrast, the hepatic somatic index was high in fish exposed at 2.5mg L-1 of copper. In short, this work advance new knowledge as influence of copper in the gill and liver histology of O. niloticus and demonstrated that their effects could be observed at different concentrations.(AU)

Tilápia do Nilo, Oreochromis niloticus, de ambos os sexos foram mantidas em água doce e expostas a concentrações de 0.5, 1.0 e 2.5mg L-1 de sulfato de cobre durante um período de 21 dias. Amostras de fígado e de brânquia foram coletadas após o tempo de exposição e as lesões foram analisadas por microscopia óptica. As principais alterações histopatológicas observadas nas brânquias foram edema, "lifting" do epitélio lamelar e uma intensa vasodilatação do eixo lamelar. Embora menos freqüentes, a fusão lamelar causada pela proliferação do epitélio filamentar e alguns aneurismas lamelares também foram observadas. O fígado do grupo controle exibiu uma arquitetura normal, enquanto os dos peixes expostos ao cobre apresentaram vacuolização e necrose. Estas lesões hepáticas foram mais evidentes nos peixes expostos a concentrações de cobre de 1.0 e 2.5mg L-1. O número dos núcleos dos hepatócitos / mm² de tecido hepático decresceu com o aumento da concentração de cobre. Em contraste, o índice hepatossomático foi mais elevado nos peixes expostos a 2.5mg L-1 de cobre. Em resumo, este trabalho acrescenta nova informação sobre a influência do cobre ao nível da histologia da brânquia e do fígado de O. niloticus e demonstra que os seus efeitos podem ser observados em diferentes concentrações.(AU)