Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019. / Razão oferta/necessidade de consultas médicas, exames de diagnóstico e acompanhamento da doença renal crônica no Sistema Único de Saúde: estudo descritivo, estado de São Paulo, 2019.

OBJECTIVE: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. METHODS: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. RESULTS: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). CONCLUSION: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

Schwannoma de nervio facial con reanimación facial con Neurotizacion Hipoglosofacial / SCHWANNOMA OF THE FACIAL NERVE WITH FACIAL RESUSCITATION WITH FACIAL HYPOGLOSSAL NEUROTIZATION

El schwannoma es una patología rara del nervio facial. Su diagnóstico preoperatorio es dificultoso dado que no tiene síntomas ni signos patognomónico de la enfermedad. La disección del nervio facial en su tronco y sus ramas con electroestimulacion es la forma de quirúrgica de sospecharlo intraoperatoriamente. La descompresión parcial o exeresis completa deberá ser considerado de acuerdo a la experiencia del equipo quirúrgico en reconstrucción nerviosa. La reparación del nervio facial como primera opción debe el injerto inmediato o sutura termino terminal. La neurotización es un procedimiento quirúrgico que le provoca al paciente simetría facial con manejo de oclusión ocular y manejo de comisura bucal, debe ser realizado antes del año de la injuria nerviosa. La rehabilitación del nervio facial necesita de un equipo multidisciplinario y la colaboración permanente del paciente para conseguir los objetivos propuestos.

Schwannoma is a rare pathology of the facial nerve. Its preoperative diagnosis is difficult since it has no symptoms or pathognomonic signs of the disease. The dissection of the facial nerve in its trunk and its branches with electrostimulation is the surgical way to suspect it intraoperatively. Partial decompression or complete exeresis should be considered according to the experience of the surgical team in nerve reconstruction. The repair of the facial nerve as a first option should be the immediate graft or end-to-end suture. Neurotization is a surgical procedure that causes the patient facial symmetry with management of ocular occlusion and management of the corner of the mouth, it must be performed within a year of the nerve injury. The rehabilitation of the facial nerve requires a multidisciplinary team and the permanent collaboration of the patient to achieve the proposed objectives.

Razão oferta/necessidade de consultas médicas, exames de diagnóstico e acompanhamento da doença renal crônica no Sistema Único de Saúde: estudo descritivo, estado de São Paulo, 2019 / Relación oferta/necesidad de consultas médicas, pruebas diagnósticas y seguimiento de la enfermedad renal crónica en el Sistema Único de Salud: estudio descriptivo, São Paulo, Brasil, 2019 / Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019

Objetivo: Determinar a razão oferta/necessidade de procedimentos relacionados com o diagnóstico e assistência à doença renal crônica no Sistema Único de Saúde (SUS), no estado de São Paulo, Brasil, 2019. Métodos: Estudo descritivo, utilizando dados dos sistemas de informações ambulatoriais e hospitalares do SUS. Os números de consultas médicas e exames diagnósticos e de acompanhamento da doença renal realizados no período foram comparados com as estimativas de necessidade obtidas por diretrizes ministeriais. Resultados: Usuários exclusivos do SUS eram 28.791.244, e indivíduos com hipertensão e/ou diabetes mellitus, 5.176.188. O número de procedimentos realizados e a razão entre esse número e a necessidade da população foram de 389.414 consultas com nefrologista (85%); 11.540.371 dosagens de creatinina sérica (223%); 705.709 dosagens de proteinúria (14%); 438.123 ultrassonografias renais (190%); e 1.045 biópsias renais (36%). Conclusão: Na assistência à doença renal crônica no SUS existem, simultaneamente, falta de oferta, desperdício e rastreamento deficiente de procedimentos importantes.

Objetivo: Determinar la relación oferta/necesidad de procedimientos relacionados con el diagnóstico y atención de la enfermedad renal crónica en Sistema Único de Salud (SUS) del Estado de São Paulo, Brasil, en 2019. Métodos: Estudio descriptivo utilizando datos de los sistemas de información ambulatoria y hospitalaria del SUS. Se comparó el número de consultas médicas, pruebas de diagnóstico y seguimiento de la enfermedad renal realizados con las estimaciones de necesidad recomendadas por directrices ministeriales. Resultados: Los usuarios exclusivos de SUS fueron 28.791.244 e hipertensos y/o diabéticos, 5.176.188. El número de procedimientos realizados y la relación entre este número y la necesidad de la población fueran de 389.414 consultas con nefrólogo (85%); 11.540.371 determinaciones de creatinina sérica (223%); 705.709 determinaciones de proteinuria (14%); 438.123 ecografías renales (190%); y 1.045 biopsias renales (36%). Conclusión: En la atención de enfermedad renal en SUS existe, simultáneamente, falta de oferta, desperdicio y seguimiento deficiente de procedimientos importantes.

Objective: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. Methods: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. Results: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). Conclusion: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

The Effect of Salmon Food-Derived DOM and Glacial Melting on Activity and Diversity of Free-Living Bacterioplankton in Chilean Patagonian Fjords.

Fjord ecosystems cycle and export significant amounts of carbon and appear to be extremely sensitive to climate change and anthropogenic perturbations. To identify patterns of microbial responses to ongoing natural and human-derived changes in the fjords of Chilean Patagonia, we examined the effect of organic enrichment associated with salmon aquaculture and freshening produced by glacial melting on bacterial production (BP), extracellular enzymatic activity (EEA), and community diversity of free-living bacterioplankton. We assayed the effects of salmon food-derived dissolved organic matter (SF-DOM) and meltwaters through microcosm experiments containing waters from Puyuhuapi Fjord and the proglacial fjords of the Southern Patagonia Icefield, respectively. Rates of BP and EEA were 2 times higher in the presence of SF-DOM than in controls, whereas the addition of autochthonous organic matter derived from diatoms (D-DOM) resulted in rates of BP and EEA similar to those measured in the controls. The addition of SF-DOM also reduced species richness and abundance of a significant fraction of the representative taxa of bacterioplankton of Puyuhuapi Fjord. In the proglacial fjords, bacterioplankton diversity was reduced in areas more heavily influenced by meltwaters and was accompanied by moderate positive changes in BP and EEA. Our findings strongly suggest that SF-DOM is highly reactive, promoting enhanced rates of microbial activity while could be influencing the diversity of bacterioplankton communities in Patagonian fjords with a strong salmon farming activity. These findings challenge the traditional view of phytoplankton production as the primary source of labile DOM that fuels heterotrophic activity in coastal ecosystems impacted by anthropogenic organic enrichment. Given the intensive local production of salmon, we analyze the significance of this emerging source of rich "allochthonous" organic substrates for autotrophic/heterotrophic balance, carbon exportation, and hypoxia in Patagonian fjords. The effect of human DOM enrichment can be enhanced in proglacial fjords, where progressive glacial melting exerts additional selective pressure on bacterioplankton diversity.

Water column circulation drives microplastic distribution in the Martínez-Baker channels; A large fjord ecosystem in Chilean Patagonia.

We investigated the distribution of microplastics in the water column along a large remote estuarine system located between the Northern and Southern Patagonian Ice Fields in Chilean Patagonia, and connected with the Pacific Ocean through the Gulf of Penas. Microplastic particles were found in all samples, with abundances ranging from 0.1 to 7 particles/m3. Polymers identified were principally acrylics, PET, and cellophane. The average abundance of microplastics in surface waters was similar along the whole estuary (0.4 ± 0.3 particles/m3) with acrylics and epoxy resins being more abundant near Caleta Tortel, the only small village in the area. The observed higher abundance of microplastics in the deeper waters towards the Gulf of Penas points to intrusions of subsurface waters transporting plastic particles from the ocean into the channel system. This underlines the potential of ocean currents in transporting plastic pollution into pristine fjords and channels in Chilean Patagonia.

Diversity of culturable filamentous Ascomycetes in the eastern South Pacific Ocean off Chile.

Our study reports the diversity of culturable mycoplankton in the eastern South Pacific Ocean off Chile to contribute with novel knowledge on taxonomy of filamentous fungi isolated from distinct physicochemical and biological marine environments. We characterized spatial distribution of isolates, evaluated their viability and assessed the influence of organic substrate availability on fungal development. Thirty-nine Operational Taxonomic Units were identified from 99 fungal strains isolated from coastal and oceanic waters by using Automatic Barcode Gap Discovery. All Operational Taxonomic Units belonged to phylum Ascomycota and orders Eurotiales, Dothideales, Sordariales and Hypocreales, mainly Penicillium sp. (82%); 11 sequences did not match existing species in GenBank, suggesting occurrence of novel fungal taxa. Our results suggest that fungal communities in the South Pacific Ocean off Chile appear to thrive in a wide range of environmental conditions in the ocean and that substrate availability may be a factor influencing fungal viability in the ocean.

Fungal parasites infect marine diatoms in the upwelling ecosystem of the Humboldt current system off central Chile.

This is the first report of fungal parasitism of diatoms in a highly productive coastal upwelling ecosystem, based on a year-round time series of diatom and parasitic Chytridiomycota abundance in the Humboldt Current System off Chile (36°30.80'S-73°07.70'W). Our results show co-variation in the presence of Skeletonema, Thalassiosira and Chaetoceros diatoms with attached and detached chytrid sporangia. High abundance of attached sporangia was observed during the austral spring, coinciding with a predominance of Thalassiosira and Skeletonema under active upwelling conditions. Towards the end of austral spring, a decreasing proportion of attached sporangia was accompanied by a decline in abundance of Skeletonema and Thalassiosira and the predominance of Chaetoceros, suggesting specificity and host density dependence of chytrid infection. The new findings on fungal parasitism of diatoms provide further support for the inclusion of Fungi in the current model of the role played by the marine microbial community in the coastal ocean. We propose a conceptual model where Fungi contribute to controlling the dynamics of phytoplankton populations, as well as the release of organic matter and the transfer of organic carbon through the pelagic trophic web in coastal upwelling ecosystems.

Melting glacier impacts community structure of Bacteria, Archaea and Fungi in a Chilean Patagonia fjord.

Jorge Montt glacier, located in the Patagonian Ice Fields, has undergone an unprecedented retreat during the past century. To study the impact of the meltwater discharge on the microbial community of the downstream fjord, we targeted Bacteria, Archaea and Fungi communities during austral autumn and winter. Our results showed a singular microbial community present in cold and low salinity surface waters during autumn, when a thicker meltwater layer was observed. Meltwater bacterial sequences were related to Cyanobacteria, Proteobacteria, Actinobacteria and Bacteriodetes previously identified in freshwater and cold ecosystems, suggesting the occurrence of microorganisms adapted to live in the extreme conditions of meltwater. For Fungi, representative sequences related to terrestrial and airborne fungal taxa indicated transport of allochthonous Fungi by the meltwater discharge. In contrast, bottom fjord waters from autumn and winter showed representative Operational Taxonomic Units (OTUs) related to sequences of marine microorganisms, which is consistent with current models of fjord circulation. We conclude that meltwater can significantly modify the structure of microbial communities and support the development of a major fraction of microorganisms in surface waters of Patagonian fjords.

A oferta de tomógrafo computadorizado para o tratamento do acidente vascular cerebral agudo, no Brasil, sob o ponto de vista das desigualdades geográficas e sociais / Provision of tomography scanners, x-ray computed for the treatment of cerebrovascular accident, Brazil, from a geographical and social inequalities

O acidente vascular cerebral (AVC) é uma das principais causas de morbidade e mortalidade, tanto em países desenvolvidos quanto nos menos desenvolvidos. No Brasil essa patologia tem sido responsável por mais óbitos que a doença coronária. Algunsaspectos do cuidado com o AVC são comuns para todos os tipos patológicos, mas existem diferenças fundamentais no tratamento de pacientes com AVC isquêmico e AVC hemorrágico. Assim, o cuidado com o paciente com sintomas de AVC depende muito de um diagnóstico rápido e acurado do processo patológico em andamento. Nesse contexto, o exame de imagem do cérebro por tomografia computadorizada podeproporcionar um diagnóstico acurado da natureza e da extensão do problema, eidentificar se ele é isquêmico ou hemorrágico. Todavia, tomógrafos computadorizados (TC) são equipamentos de custo relativamente alto, o que se torna um problema diantedo quadro comum de escassez de recursos econômicos para os sistemas de saúde. Isso reflete a necessidade de se ofertar essa tecnologia para a população, da forma mais racional e equitativa possível. Nesse cenário, por intermédio do levantamento deinformações em bancos de dados públicos, sobre internação, mortalidade, população, índice de desenvolvimento humano e oferta de TC; e da utilização de sistemas de informação geográfica para o mapeamento desses parâmetros no território nacional; procurou-se caracterizar a oferta de TC no Brasil e a sua adequação às necessidades desaúde dos pacientes com AVC. Os resultados encontrados no universo pesquisado mostram uma distribuição geográfica de TC pouco equitativa, e uma concentração da oferta dessa tecnologia nos municípios mais populosos e de melhor situaçãosocioeconômica. A metodologia adotada permitiu, ainda, observar uma associação da condição socioeconômica e do local de residência com a internação em municípios comserviços de saúde mais bem equipados para o cuidado com o AVC, o que caracteriza uma situação de desigualdade geográfica e social no acesso aos serviços de saúde para oatendimento ao AVC.

Two-step upflow anaerobic sludge bed system for sewage treatment under subtropical conditions with posttreatment in waste stabilization ponds.

A pilot-scale sewage treatment system consisting of two upflow anaerobic sludge bed (UASB) reactors followed by five waste stabilization ponds (WSPs) in series was studied under subtropical conditions. The first UASB reactor started up in only 1 mo (stable operation, high chemical oxygen demand [COD] removal efficiency, low volatile fatty acids concentration in the effluent, alkalinity ratio above 0.7, biogas production above 0.1 Nm3/kg of CODremoved). Removal efficiencies up to 90% were obtained in the anaerobic steps at a hydraulic retention time of 6 + 4 h (80% removal in the first step). Fecal coliform removal in the whole system was 99.9999% (99.94% in anaerobic steps and 99.98% in WSPs). COD balances over UASB reactors are provided. A minimum set of data necessary to build COD balances is proposed. Intermittent sludge washout was detected in the reactors with the COD balances. Sludge washout from single-step UASB reactors should be monitored and minimized in order to ensure constant compliance with discharge standards, especially when no posttreatment is provided. The system combined high COD and fecal coliform removal efficiency with an extremely low effluent concentration, complying with discharge standards, and making it an attractive option for sewage treatment in subtropical regions.

Tratamiento de líquidos cloacales en reactores UASB y lagunas de estabilización

Los objetivos del trabajo fueron: evaluar la puesta en marcha y consiguiente operación de un sistema de tratamientos de líquidos cloacales consistente en dos reactores UASB (Upflow Anaerobic Sludge Blanket) seguidos de cinco lagunas de estabilización en serie, en condiciones de clima subtropical; y construir y contribuir a la estandarización de los balances de DQO para reactores UASB

Propuesta de articulación del Programa de salud sexual y reproductiva y vigilancia epidemiológica para disminuir la mortalidad materna en la red de servicios de salud Pacajes-José Manuel Pando. La Paz

Un gran porcentaje de las defunciones maternas que acontece en domicilio (85%) es resultado de barreras geográficas, culturales, institucionales, que dificultan la oferta y demanda de los servicios de salud ya que existen problemas y dificultades con la referencia, el transporte, la comunicación que o no existen y si existen no funcionan adecuadamente.