From External to Local: Opportunities and Lessons Learned from Transitioning COMSA-Mozambique.

Donor transitions, where externally funded programs transfer to country ownership and management, are increasingly common. The Countrywide Mortality Surveillance for Action - Mozambique (COMSA) project established a nationwide surveillance system capturing vital events at the community level with funding from the Bill and Melinda Gates Foundation. COMSA was implemented in partnership between Johns Hopkins University (a U.S.-based academic institution) and the Instituto Nacional de Saúde (National Institute for Health) and Instituto Nacional de Estatística (National Institute for Statistics), two Mozambican public institutions. Midway through the project, the Gates Foundation directed COMSA's partners to develop and implement a transition plan that ensured COMSA's activities could be institutionalized after Gates Foundation funding ended. Here we describe the process and activities that COMSA underwent for transition planning, including stakeholder engagement and advocacy, securing financial commitments, documenting operational activities, capacity building, and supporting strategic planning. Facilitators included a project model that already embedded significant implementation and management responsibility with local agencies, high-level commitment to COMSA's activities from local stakeholders, establishing dedicated personnel and budget to manage transition, and fortuitous timing for financing. Challenges included needing to engage multiple government agencies to ensure buy-in, navigating tensions around future roles and responsibilities, reviewing and adjusting existing implementation structures, and the reality that this transition involved shifting financing from one development partner to another. Transition implementation was also constrained by the COVID-19 pandemic because key stakeholders were engaged in response efforts. COMSA's experience highlights lessons and threats for future programs facing donor transition in uncertain environments.

Completeness and Factors Affecting Community Workers' Reporting of Births and Deaths in the Countrywide Mortality Surveillance for Action in Mozambique.

Since March 2018, the Countrywide Mortality Surveillance for Action project, implemented as a national sample registration system by the Mozambique Instituto Nacional de Saude and the Instituto Nacional de Estatistica in 700 geographic clusters randomly distributed across the 11 provinces, has trained and deployed community surveillance agents (CSAs) to report births and deaths in each cluster prospectively. An independent, retrospective data collection was conducted to assess the completeness of surveillance data. Record linkage procedures were used to match households and vital events reported in the two data sources. We calculated birth and death reporting rates and used a regression model to determine factors associated with the likelihood of vital events being reported by the CSAs. Between March 2018 and December 2019, CSAs reported 54% of births (8,787/16,421) and 45% of deaths (1,726/3,867). Births of smaller cluster sizes (< 1,000 people) were more likely to be reported (adjusted odds ratio [aOR] = 1.45; 95% CI = 1.15-1.83) compared with those of larger cluster sizes (> 1,500 people). Deaths of rural clusters were more likely to be reported (aOR = 1.41; 95% CI = 1.07-1.85) than those of urban clusters. Adult deaths were more likely to be reported (aOR = 1.49; 95% CI = 1.10-2.02) than child deaths. Our findings suggest that a fully functioning sample vital registration system must adopt a dual system with high-quality surveys or other ways to estimate underregistration periodically, consider a smaller cluster size manageable by a community worker, and pay special attention to urban clusters as underreporting is larger.

Countrywide Mortality Surveillance for Action in Mozambique: Results from a National Sample-Based Vital Statistics System for Mortality and Cause of Death.

Sub-Saharan Africa lacks timely, reliable, and accurate national data on mortality and causes of death (CODs). In 2018 Mozambique launched a sample registration system (Countrywide Mortality Surveillance for Action [COMSA]-Mozambique), which collects continuous birth, death, and COD data from 700 randomly selected clusters, a nationally representative population of 828,663 persons. Verbal and social autopsy interviews are conducted for COD determination. We analyzed data collected in 2019-2020 to report mortality rates and cause-specific fractions. Cause-specific results were generated using computer-coded verbal autopsy (CCVA) algorithms for deaths among those age 5 years and older. For under-five deaths, the accuracy of CCVA results was increased through calibration with data from minimally invasive tissue sampling. Neonatal and under-five mortality rates were, respectively, 23 (95% CI: 18-28) and 80 (95% CI: 69-91) deaths per 1,000 live births. Mortality rates per 1,000 were 18 (95% CI: 14-21) among age 5-14 years, 26 (95% CI: 20-31) among age 15-24 years, 258 (95% CI: 230-287) among age 25-59 years, and 531 (95% CI: 490-572) among age 60+ years. Urban areas had lower mortality rates than rural areas among children under 15 but not among adults. Deaths due to infections were substantial across all ages. Other predominant causes by age group were prematurity and intrapartum-related events among neonates; diarrhea, malaria, and lower respiratory infections among children 1-59 months; injury, malaria, and diarrhea among children 5-14 years; HIV, injury, and cancer among those age 15-59 years; and cancer and cardiovascular disease at age 60+ years. The COMSA-Mozambique platform offers a rich and unique system for mortality and COD determination and monitoring and an opportunity to build a comprehensive surveillance system.

Avaliação e elucidação do mecanismo de ação de polímeros naturais modificados utilizados na agricultura / Evaluation and mode of action elucidation for modified natural polymers used in agriculture

Atualmente a agricultura ocupa um papel de extrema importância na conjuntura global e nacional e está inserida em um contexto de enormes desafios devido ao aumento da população mundial e maior demanda por alimentos. Ao mesmo tempo, é o setor mais afetado pelos impactos negativos das mudanças climáticas, que têm espalhado suas consequências de maneira cada vez mais frequente e intensa. Um dos principais efeitos é a alteração do regime de chuvas ao redor do globo, ocasionando estiagens intensas e duradouras, capazes de reduzir a produtividade de safras e comprometer a produção alimentícia. As abordagens atualmente existentes no mercado para mitigar as consequências negativas da escassez hídrica demandam alto investimento de implementação e manutenção, ou possuem um perfil ecotoxicológico insatisfatório. Polímeros de origem natural modificados quimicamente foram avaliados em termos de desempenho e capacidade de prover às plantas uma maior disponibilidade de água através de retenção hídrica. Os resultados alcançados demonstraram que os polímeros modificados com grupos iônicos foram capazes de promover um melhor gerenciamento hídrico no microambiente ao redor de sementes e entregar ganhos de produtividade a lavouras de soja. O mecanismo de ação da tecnologia estudada foi elucidado através de ensaios de determinação de capacidade de campo, análise de elipsometria, microscopia de força atômica, ensaios de germinação de soja sob estresse hídrico e implementação de áreas de soja a céu aberto a partir da aplicação em tratamento de sementes e sulco de plantio. As interações intra e intermoleculares entre as partículas de solo, moléculas de polímero e de água se mostraram ponto chave para a mudança de patamar de desempenho de polímeros naturais modificados utilizados na agricultura, quando comparados com os grupos controle. A tecnologia aqui estudada é, portanto, recomendada para utilização na agricultura, com capacidade de potencializar o efeito de tecnologias dependentes de água, resultando em maior produtividade na colheita

Nowadays agriculture occupies an extremely important role both in the global and national scenarios. Its included in a very challenging context due to the forecast of increased world population and consequent higher demand for food. At the same time, it is the most affected economic sector by the climate change effects, which have been causing frequent and harsh impacts. One of the main effects is the change in the rainfall pattern worldwide, which causes severe and long-lasting droughts, responsible for causing crops to fail and therefore putting food production at risk. The current available mitigation measures to address hydric scarcity require a huge investment for implementation and maintenance or do not present a satisfactory and safe ecotoxicological profile. Chemically modified natural polymers have been evaluated in terms of performance and ability to provide the plants with higher water availability through hydric retention. The results obtained show that such ionic group modified polymers are able to promote better water management in a given microenvironment surrounding the seeds and ultimately delivery a higher yield to soy crops. The technology's mode of action has been elucidated through field capacity determination trials, ellipsometry, atomic force microscopy, soy germination trials under hydric stress and, finally, implementation of soy areas under actual field conditions by applying the polymers via seed treatment and in-furrow methods. Both intra- and intermolecular interaction between soil particles, polymer and water molecules have been proven as key to understanding the agricultural performance improvement of the modified polymers when compared to the control. The technology is recommended for agricultural applications due to its ability to boost the effect of water-dependent technologies, promoting higher yields

Morphogenic responses and biochemical alterations induced by the cover crop Urochloa ruziziensis and its component protodioscin in weed species.

Urochloa ruziziensis, a cover plant used in no-till systems, can suppress weeds in the field through their chemical compounds, but the mode of action of these compounds is still unknown. The present study aimed to investigate the effects of a saponin-rich butanolic extract from U. ruziziensis straw (BfUr) and one of its components, protodioscin on an eudicot Ipomoea grandifolia and a monocot Digitaria insularis weed. The anatomy and the morphology of the root systems and several parameters related to energy metabolism and antioxidant defense systems were examined. The IC50 values for the root growth inhibition by BfUr were 108 µg mL-1 in D. insularis and 230 µg mL-1 in I. grandifolia. The corresponding values for protodioscin were 34 µg mL-1 and 54 µg mL-1. I. grandifolia exhibited higher ROS-induced peroxidative damage in its roots compared with D. insularis. In the roots of both weeds, the BfUr and protodioscin induced a reduction in the meristematic and elongation zones with a precocious appearance of lateral roots, particularly in I. grandifolia. The roots also exhibited features of advanced cell differentiation in the vascular cylinder. These alterations were similar to stress-induced morphogenic responses (SIMRs), which are plant adaptive strategies to survive in the presence of toxicants. At concentrations above their IC50 values, the BfUr or protodioscin strongly inhibited the development of both weeds. Such findings demonstrated that U. ruziziensis mulches may contribute to the use of natural and renewable weed control tools.

Measurement of wound area for early analysis of the scar predictive factor.

OBJECTIVE: to evaluate the use of the 2D-FlexRuler as a facilitating tool for the early calculation of the predictive scar factor of chronic wounds. METHOD: a descriptive study with a quantitative, experimental, longitudinal and prospective approach. The sample consisted of 22 outpatients. 32 chronic wounds were analyzed. The wound edges were identified and drawn on the 2D-FlexRuler. The calculations of the areas of chronic wounds were obtained by manual, traditional methods, by software and Matlab algorithm. These areas were compared with each other to determine the efficiency of the proposed ruler in relation to traditional methods. RESULTS: the calculation of the wound area by the traditional method and Kundin's coefficient show average errors greater than 40%. The manual estimation of the area with the 2D-FlexRuler is more accurate in relation to traditional measurement methods, which were considered quantitatively disqualified. When compared with the reference method, for example, the Klonk software, the data obtained by 2D-FlexRuler resulted in an error of less than 1.0%. CONCLUSION: the 2D-FlexRuler is a reliable metric platform for obtaining the anatomical limits of chronic wounds. It facilitated the calculation of the wound area under monitoring and allowed to obtain the scar predictive factor of chronic wounds with precocity in two weeks.

Chemical Characterization and Phytotoxic Effects of the Aerial Parts of Ruzigrass (Urochloa ruziziensis).

Studies of the phytotoxic effects between plants can be a crucial tool in the discovery of innovative compounds with herbicide potential. In this sense, we can highlight ruzigrass (Urochloa ruziziensis), which is traditionally used in the crop rotation system in order to reduce weed emergence. The aim of this work was to characterize the secondary metabolites of ruzigrass and to evaluate its phytotoxic effects. In total, eight compounds were isolated: friedelin, oleanolic acid, α-amyrin, 1-dehydrodiosgenone, sitosterol and stigmasterol glycosides, tricin and p-coumaric acid. Phytotoxic effects of the crude methanolic extract and fractions of ruzigrass were assessed using germination rate, initial seedling growth, and biomass of Bidens pilosa, Euphorbia heterophylla and Ipomoea grandifolia. Chemometric analysis discriminated the weed species into three groups, and B. pilosa was the most affected by fractions of ruzigrass. The phytotoxic activities of 1-dehydrodiosgenone, tricin, and p-coumaric acid are also reported, and p-coumaric acid and 1-dehydrodiosgenone were active against B. pilosa.

Measurement of wound area for early analysis of the scar predictive factor / Mensuração da área de feridas para análise precoce do fator preditivo cicatricial / Medición del área de heridas para el análisis temprano del factor predictivo de cicatriz

Objective: to evaluate the use of the 2D-FlexRuler as a facilitating tool for the early calculation of the predictive scar factor of chronic wounds. Method: a descriptive study with a quantitative, experimental, longitudinal and prospective approach. The sample consisted of 22 outpatients. 32 chronic wounds were analyzed. The wound edges were identified and drawn on the 2D-FlexRuler. The calculations of the areas of chronic wounds were obtained by manual, traditional methods, by software and Matlab algorithm. These areas were compared with each other to determine the efficiency of the proposed ruler in relation to traditional methods. Results: the calculation of the wound area by the traditional method and Kundin's coefficient show average errors greater than 40%. The manual estimation of the area with the 2D-FlexRuler is more accurate in relation to traditional measurement methods, which were considered quantitatively disqualified. When compared with the reference method, for example, the Klonk software, the data obtained by 2D-FlexRuler resulted in an error of less than 1.0%. Conclusion: the 2D-FlexRuler is a reliable metric platform for obtaining the anatomical limits of chronic wounds. It facilitated the calculation of the wound area under monitoring and allowed to obtain the scar predictive factor of chronic wounds with precocity in two weeks.

Objetivo: avaliar o uso da régua 2D-FlexRuler como ferramenta facilitadora para o cálculo precoce do fator preditivo cicatricial de feridas crônicas. Método: estudo descritivo com abordagem quantitativa, experimental, longitudinal e prospectiva. A amostra foi de 22 pacientes ambulatoriais. Foram analisadas 32 feridas crônicas. As bordas das feridas foram identificadas e desenhadas na 2D-FlexRuler. Os cálculos das áreas das feridas crônicas foram obtidos pelos métodos manuais, tradicionais, por softwares e algoritmo Matlab. Essas áreas foram comparadas entre si para determinar a eficiência da régua proposta em relação aos métodos tradicionais. Resultados: o cálculo da área da ferida pelo método tradicional e coeficiente de Kundin demonstram erros médios maiores do que 40%. A estimativa manual da área com a 2D-FlexRuler é mais exata em relação aos métodos tradicionais de medição, os quais foram considerados quantitativamente desqualificados. Quando comparada com o método de referência, i.e., o software Klonk, os dados obtidos pela 2D-FlexRuler resultaram em um erro menor que 1,0%. Conclusão: a régua 2D-FlexRuler é uma plataforma métrica confiável para a obtenção dos limites anatômicos de feridas crônicas. Facilitou o cálculo da área da ferida sob monitoramento e permitiu obter o fator preditivo cicatricial de feridas crônicas com precocidade em duas semanas.

Objetivo: evaluar el uso de la regla 2D-FlexRuler como herramienta facilitadora para el cálculo temprano del factor predictivo de cicatrices en heridas crónicas. Método: estudio descriptivo con enfoque cuantitativo, experimental, longitudinal y prospectivo. La muestra consistió en 22 pacientes ambulatorios. Se analizaron 32 heridas crónicas. Los bordes de la herida fueron identificados y dibujados en 2D-FlexRuler. Los cálculos de las áreas de heridas crónicas se obtuvieron por métodos manuales, tradicionales, por software y algoritmo Matlab. Estas áreas se compararon entre sí para determinar la eficiencia de la regla propuesta en relación con los métodos tradicionales. Resultados: el cálculo del área de la herida por el método tradicional y el coeficiente de Kundin muestran errores promedio superiores al 40%. La estimación manual del área con 2D-FlexRuler es más precisa en relación con los métodos de medición tradicionales, que se consideraron descalificados cuantitativamente. Al ser comparados con el método de referencia, es decir, el software Klonk, los datos obtenidos por 2D-FlexRuler arrojaron un error de menos del 1,0%. Conclusión: la regla 2D-FlexRuler es una plataforma métrica confiable para obtener los límites anatómicos de las heridas crónicas. Facilitó el cálculo del área de la herida bajo monitoreo y permitió obtener el factor predictivo de cicatriz de heridas crónicas con precocidad en dos semanas.

Diabetes mellitus and the increased risk of foot injuries.

With one person dying from diabetes-related preventable complications, including foot complications, every 7 seconds across the world, it is clear this is a major health challenge. Foot ulceration in diabetes remains the commonest reason for hospital admission in Western countries. From neuropathy to peripheral vascular disease, the challenges are significant and can result in premature death, but early diagnosis by aware health-care professionals, combined with supporting people in self-care, can help reduce the problems of diabetes to manageable proportions.

Resveratrol-derived stilbenoids and biological activity evaluation of seed extracts of Cenchrus echinatus L.

A phytochemical study of the ethyl acetate fractions from the partition of seeds and roots methanol extracts of Cenchrus echinatus L. led to the isolation of three resveratrol-derived stilbenoids: pallidol (1), carasiphenol C (2) and nepalensinol B (3). The results of a topic anti-inflammatory evaluation, DPPH assay and antiproliferative activity against adenocarcinoma cells (Caco 2) are described.

Reflexões sobre a regulamentação jurídica do setor tabagista e saúde pública / Reflections on legal regulation of tabacco industry and public health

A atividade empresarial encontra um de seus fundamentos na circulação de bens ou serviços; todavia, no caso da atividade tabagista, tal produto está vinculado à presença da nicotina que é uma substância que gera dependência. Este estudo objetiva investigar a regulamentação jurídica do setor tabagista, especialmente com relação às normas federais que cuidam da matéria relativa à nicotina e seus danos à saúde pública. Trata-se de um estudo exploratório descritivo, com procedimento de pesquisa bibliográfico e documental e abordagem qualitativa dos dados. No caso do setor tabagista, o tabaco tem forte poder viciogênico que gera graves danos à saúde, além de constituir o principal fator de morte evitável no mundo. A legislação federal regula sobre diferentes formas a atividade econômica do setor tabagista, alerta sobre os perigos da nicotina, fixa limites para seu consumo, mas não determina a proibição da presença de nicotina nos produtos derivados de tabaco, embora reconheça que a mesma causa dependência química ou psíquica.

[Alcohol consumption by university students]. / Consumo de álcool entre estudantes universitários.

Consumption of alcoholic beverages is widely encouraged by the mass media, despite the related health risks. Today's students in the health fields are the professionals of tomorrow who will be providing advice and serving as role models for patients. The aim of this study was to analyze alcohol consumption and related factors among these students. A total of 608 male and female university students from Maceió, the capital of Alagoas State, Brazil, completed a self-administered questionnaire. Data analysis included Poisson regression and multinomial logistic models. Prevalence of lifetime use of alcohol was 90.4%. Prevalence of alcohol abuse was 18.3% in men and 6.1% in women. Heavier alcohol consumption and alcohol abuse were observed in males, older students, non-natives of Maceió, smokers, and those exposed to alcohol advertising. The results emphasized the vulnerability of these young people to risky health behaviors. Their future social role highlights distinct needs in their university education to enable them to act professionally in this area.

Consumo de álcool entre estudantes universitários / Alcohol consumption by university students

Consumption of alcoholic beverages is widely encouraged by the mass media, despite the related health risks. Today's students in the health fields are the professionals of tomorrow who will be providing advice and serving as role models for patients. The aim of this study was to analyze alcohol consumption and related factors among these students. A total of 608 male and female university students from Maceió, the capital of Alagoas State, Brazil, completed a self-administered questionnaire. Data analysis included Poisson regression and multinomial logistic models. Prevalence of lifetime use of alcohol was 90.4 percent. Prevalence of alcohol abuse was 18.3 percent in men and 6.1 percent in women. Heavier alcohol consumption and alcohol abuse were observed in males, older students, non-natives of Maceió, smokers, and those exposed to alcohol advertising. The results emphasized the vulnerability of these young people to risky health behaviors. Their future social role highlights distinct needs in their university education to enable them to act professionally in this area.

O consumo de álcool é estimulado pela mídia apesar dos riscos inerentes à saúde. Estudantes da área de saúde serão os futuros profissionais a orientar a população ou servir de exemplo. O objetivo deste estudo foi analisar o consumo de álcool e fatores relacionados nestes estudantes. Participaram 608 estudantes universitários de Maceió, Alagoas, Brasil, de ambos os sexos, mediante a aplicação de um questionário autopreenchível. Foram empregados modelos de regressão de Poisson e logística multinomial. A prevalência de uso na vida de álcool foi de 90,4 por cento. O abuso de álcool teve uma prevalência de 18,3 por cento nos homens e 6,1 por cento nas mulheres. Os que apresentaram maior consumo e abuso de álcool foram os do sexo masculino, de maior idade, naturais de outras cidades, fumantes e os expostos à publicidade do álcool. Os resultados deste estudo indicam uma vulnerabilidade destes jovens para condutas com risco para a saúde. Seu papel social futuro suscita necessidades distintas de formação universitária para que possam atuar profissionalmente nesta área.

As organizações de saúde e o processo de aprendizagem da gestão / The health organizations and the management learning process / Las organizaciones de salud y el proceso de aprendizaje de la gestión

As condições de competitividade cada vez maiores, o nível de tecnologia mais elevado, as dificuldades de remuneração por partedos tomadores de serviços, a demanda por uma melhor qualidade de atenção, o aumento da expectativa média de vida da população e a descoberta de novas opções terapêuticas resumem a necessidade da organização de saúde em acolher níveis de gestão de carátermais profissional. Como os recursos econômicos destinados à saúde são, frequentemente, inferiores às necessidades, é fundamental queos gestores dessas organizações adotem práticas de trabalho voltadas para a contínua capacitação dos indivíduos que nelas trabalham.É mister que nessas organizações exista além de um ambiente voltado para o aprendizado, o envolvimento e o comprometimento das lideranças, de modo que os indivíduos sejam estimulados e convidados a participar desse processo de desenvolvimento. Este trabalho se propôs a identificar os processos de aprendizagem organizacional adotados em hospitais privados de saúde, a partir do referencial teórico sobre a aprendizagem organizacional e cultura organizacional. Procura-se aprofundar a análise dos fatores facilitadores daaprendizagem, a partir do modelo de DiBella e Nevis.

The increasing competitiveness conditions, the highest technology level, the remuneration difficulties of the service providers,the demand for a better attention quality, the increase in the average life expectancy of the population, and the discovery of new therapeutic options summarize the need of the health organization for accepting more professional management levels. As the economic resources destined for health are usually lower than the needs, it is fundamental that the managers of these organizationsadopt working practices towards the continuous qualification of the employees. It is imperative that, in addition to an environmentturned to learning, there are the involvement and the commitment of the leaders in these organizations, so that the employees are stimulated and invited to participate in this development process. This paper proposed identifying the organizational learning processesadopted in private hospitals from the theoretical background about organizational learning and culture. The analysis of the facilitatingfactors in learning from the DiBella and Nevis model is sought to be deepened.

Las condiciones de competitividad cada vez mayores, el nivel de tecnología más elevado, las dificultades de remuneraciónpor parte de los tomadores de servicios, la demanda por una mejor calidad de atención, el aumento de la expectativa media de vidade la población y la descubierta de nuevas opciones terapéuticas resumen la necesidad de la organización de salud en acoger niveles de gestión de carácter más profesional. Como los recursos económicos destinados a la salud son frecuentemente inferiores a las necesidades, es fundamental que los gestores de esas organizaciones adopten prácticas de trabajo volcadas a la continua capacitación de los individuos que trabajan en ellas. Es imperioso que en esas organizaciones exista además de un ambiente volcado al aprendizaje, el involucro y el comprometimiento de los liderazgos, de modo a que los individuos sean estimulados e invitados a participar de ese proceso de desarrollo. Este trabajo se propuso a identificar los procesos de aprendizaje organizacional adoptados en hospitales privadosde salud, a partir del referencial teórico sobre el aprendizaje organizacional y cultura organizacional. Se busca profundizar el análisis de los factores facilitadores da aprendizaje a partir del modelo de DiBella y Nevis.

Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba / Management of Fournier's gangrene: experience of a university hospital of Curitiba

OBJETIVO: Analisar os resultados obtidos no Serviço de Cirurgia Geral do Hospital Universitário Cajuru - PUCPR, com o tratamento da gangrena de Fournier. MÉTODOS: Foram revisados os prontuários de 40 pacientes com diagnóstico de Gangrena de Fournier internados no hospital universitário Cajuru de Novembro de 1999 a Abril de 2006, analisando-se as variáveis: sexo, idade, fatores predisponentes, etiologia, localização da lesão, exames laboratoriais, procedimentos cirúrgicos realizados, antibioticoterapia e utilização de câmara hiperbárica. RESULTADOS: A etiologia mais comum foi de origem anorretal. O agente etiológico mais prevalente foi a E. coli. O fator predisponente predominantes foi a diabetes mellitus, A maioria dos pacientes eram do sexo masculino. A localização e extensão da lesão mais freqüente foi a perineal. Todos foram submetidos à desbridamento cirúrgico, 17 à colostomia e dois à cistostomia. Todos os pacientes utilizaram antibiótico, sendo os mais usados: metronidazol e gentamicina. Vinte e seis pacientes submeteram-se à terapia hiperbárica. A mortalidade global foi de 20%. CONCLUSÃO: A Síndrome de Fournier, apesar de todos os avanços terapêuticos atuais, continua apresentando altos índices de mortalidade. O reconhecimento precoce da infecção associado a tratamento agressivo e invasivo são medidas essenciais para se tentar diminuir esses índices prognósticos.

OBJECTIVE: To analyze the results obtained in the Department of General Surgery, Cajuru University Hospital - PUCPR, with the treatment of Fournier's gangrene. METHODS: We reviewed the charts of 40 patients diagnosed with Fournier's gangrene admitted to the Cajuru University Hospital from November 1999 to April 2006, analyzing gender, age, predisposing factors, etiology, lesion location, laboratory tests , surgical procedures, antibiotic use and hyperbaric oxygen therapy. RESULTS: The most common etiology was the anorectal origin. The most prevalent etiological agent was E. coli. The predominant predisposing factor was diabetes mellitus. The majority of patients were male. The location and extent of injury was usually in the perineum. All underwent surgical debridement, 17 with associated colostomy and two with combined cystostomy. All patients received antibiotics, the most used being metronidazole and gentamicin. Twenty-six patients underwent hyperbaric therapy. The overall mortality was 20%. CONCLUSION: Fournier's syndrome, despite all the advances in treatment today, continues to show high mortality rates. Early recognition of infection associated with invasive and aggressive treatment are essential for attempting to reduce these prognostic indices.

Management of Fournier's gangrene: experience of a university hospital of Curitiba.

OBJECTIVE: To analyze the results obtained in the Department of General Surgery, Cajuru University Hospital-PUCPR, with the treatment of Fournier's gangrene. METHODS: We reviewed the charts of 40 patients diagnosed with Fournier's gangrene admitted to the Cajuru University Hospital from November 1999 to April 2006, analyzing gender, age, predisposing factors, etiology, lesion location, laboratory tests, surgical procedures, antibiotic use and hyperbaric oxygen therapy. RESULTS: The most common etiology was the anorectal origin. The most prevalent etiological agent was E. coli. The predominant predisposing factor was diabetes mellitus. The majority of patients were male. The location and extent of injury was usually in the perineum. All underwent surgical debridement, 17 with associated colostomy and two with combined cystostomy. All patients received antibiotics, the most used being metronidazole and gentamicin. Twenty-six patients underwent hyperbaric therapy. The overall mortality was 20%. CONCLUSION: Fournier's syndrome, despite all the advances in treatment today, continues to show high mortality rates. Early recognition of infection associated with invasive and aggressive treatment are essential for attempting to reduce these prognostic indices.

Perfil epidemiológico do consumo de álcool e fatores relacionados em estudantes universitários das ciências da saúde de Maceió / Epidemiology of alcohol consumption and related factors in college students of health sciences of Maceió

O consumo de bebidas alcoólicas, o tabaco e o comportamento sexual de risco são alguns dos principais fatores relacionados com o estado de saúde dos indivíduos e das populações. Na atualidade, constituem um enorme problema de saúde pública na maioria dos países, pelos efeitos nocivos que produzem e suas conseqüências de ordem física, mental e social. O consumo de substâncias, sobretudo de álcool e cigarros, encontra-se presente, e é frequentemente estimulado, em anúncios comerciais, filmes, letras de música e outros meios de comunicação de massa. O objetivo deste estudo é descrever o perfil epidemiológico do consumo de álcool e fatores relacionados em estudantes universitários das Ciências da Saúde de Maceió/Alagoas. Participaram 608 estudantes de ambos os sexos, com idades entre 17 e 36 anos. Os dados foram obtidos mediante a aplicação de um questionário autopreenchido, adaptado a esta população. Os grupos que apresentaram maior consumo de álcool, especialmente o abuso de álcool, foram os estudantes universitários do sexo masculino (RP = 2,90), os de maior idade (RP = 3,24), os naturais de outras cidades (RP = 1,77), os fumantes (RP = 1,87) e aqueles que estavam expostos a publicidade do álcool (RP = 3,94). A prevalência de uso na vida de álcool foi de 90,4%. O abuso de álcool teve uma prevalência de 18,3% nos homens e 6,1% nas mulheres. A média de consumo de álcool foi de 0,98 unidades/dia, com um consumo muito mais elevado no fim de semana (1,98 unidades/dia). A cerveja, os combinados e o vinho foram as bebidas mais consumidas. Por se tratar de um grupo de universitários, em especial por serem da área da saúde, é esperado um melhor entendimento das implicações do uso e abuso de álcool, do tabagismo e do comportamento sexual...

The consumption of alcoholic beverages, tobacco products and sexual activity are major factors related to the health of individuals and populations. At present, they constitute major public health problems in most countries, for theirharmful effects on physical, mental and social spheres. The consumption ofsubstances, particularly alcohol and cigarettes, is often encouraged, inadvertisement, movies, music lyrics and other means of mass communication.The aim of this study is to analyze the epidemiological profile of alcoholconsumption and related factors in college students of Health Sciences ofMaceió / Alagoas. Study subjects comprised 608 students of both sexes, aged between 17 and 36 years. The data were obtained by applying a selfadministered questionnaire, which targeted university students. The groups that had higher alcohol consumption, especially alcohol abuse, were the malecollege students (RP = 2.90), the older subjects (RP = 3.24), the natives ofother cities (RP = 1.77), the smokers (RP = 1.87) and those who were exposed to alcohol advertising (RP = 3.94). The prevalence of lifetime use of alcohol was 90.4%. The abuse of alcohol had a prevalence of 18.3% in men and 6.1% in women. The average consumption of alcohol was 0.98 units / day, with a much higher consumption over the weekend (1.98 units / day). Beer, the combination of alcohol and soda, and wine were the most widely consumed beverages...

Lutzomyia longipalpis (Diptera, Psychodidae) em Cuesta Basáltica, na bacia hidrográfica do Rio Corumbataí, Região Centro-leste do Estado de São Paulo / Lutzomyia longipalpis (Diptera, Psychodidae) in the Basaltic Cuesta at the hydrographic basin of the Corumbataí River, Central East Region of the State of São Paulo, Brazil

A incidência das leishmanioses tegumentar e visceral americanas, em especial esta última (LVA), em hospedeiros caninos e humanos, encontra-se em crescente processo de expansão no Estado de São Paulo. Para a vigilância epidemiológica dessas endemias, torna-se fundamental o conhecimento da distribuição e da ecologia das diferentes espécies da fauna flebotomínea vetoras. Assim, a divulgação de novos encontros de seus vetores, sobretudo da Lutzomyia longipalpis, o principal vetor da LVA, é fundamental para apontar novas áreas de risco para a transmissão dessas doenças. Neste estudo, capturas de flebotomíneos foram realizadas em ambiente domiciliar, peridomiciliar e de mata, em diferentes localidades rurais dos municípios de Ipeúna e Itirapina, entre outubro de 2001 e fevereiro de 2004. Foram utilizadas armadilhas luminosas automáticas do tipo CDC, das 18h às 8h, em 14 noites, resultando 420 horas de exposição. Foram capturados 177 flebotomíneos pertencentes a doze espécies. A espécie mais abundante, Nyssomyia neivai, apontada como a principal vetora de LTA no Estado, contribuiu com 85,4 por cento dos espécimes capturados em Ipeúna. O encontro de Lutzomyia longipalpis em uma caverna em Itirapina, aponta para o risco de estabelecimento da LVA na área e a necessidade de mais estudos locais sobre sua ecologia, sobretudo em relação à ocupação de ambientes antrópicos.