Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.

Neoctangium travassosi (Digenea: Microscaphidiidae) in sea turtles from South America / Neoctangium travassosi (Digenea: Microscaphidiidae) em tartarugas marinhas da América do Sul

Sea turtles are endangered animals that present cosmopolitan distribution. Anthropic actions have been considered important causes for the reduction of sea turtle population, but natural aspects such as parasitism may also contribute to their decline. This study aimed to report the occurrence of parasites in stranded dead sea turtles found in an area known as Potiguar Basin, northeastern Brazil, from 2010 to 2019. They were identified and classified according to the carapace length. At post-mortem analyses all organs were examined, parasites collected and morphologically identified. Ecological parasitic indexes as prevalence (P), mean intensity (MI) and mean abundance (MA) were calculated. A total of 80 Chelonia mydas and 5 Eretmochelys imbricata were assessed. Neoctangium travassosi was detected in both species presenting P = 20%, MI = 4.19 and MA = 0.84 for C. mydas and P = 60%, MI = 1.67 and MA = 1.0 for E. imbricata. This is the first report of N. travassosi parasitizing E. imbricata in South America. Finally, the retrieval of these parasites is a warning regarding the need for further studies to assess the impact of this parasitism on the health and conservation of sea turtles.

As tartarugas marinhas são animais ameaçados de extinção que apresentam distribuição cosmopolita. Ações antrópicas têm sido consideradas causas importantes para a redução da população de tartarugas marinhas, mas aspectos naturais, como o parasitismo, também, podem contribuir para o seu declínio. Este estudo objetivou relatar a ocorrência de parasitos em tartarugas marinhas, encalhadas mortas, encontradas em uma área conhecida como Bacia Potiguar, nordeste do Brasil, de 2010 a 2019. Essas foram identificadas e classificadas de acordo com o comprimento da carapaça. Nas análises post mortem, todos os órgãos foram examinados, e os parasitos coletados e identificados morfologicamente. Foram calculados índices parasitários ecológicos, como prevalência (P), intensidade média (IM) e abundância média (AM). Um total de 80 Chelonia mydas e cinco Eretmochelys imbricata foi estudado. Neoctangium travassosi foi detectado em ambas as espécies, apresentando P = 20%, MI = 4,19 e MA = 0,84 para C. mydas e P = 60%, IM = 1,67 e AM = 1,0 para E. imbricata. Este é o primeiro relato de N. travassossi parasitando E. imbricata na América do Sul. Conclui-se que a recuperação desses parasitos soa como um alerta para a necessidade de mais estudos para avaliar o impacto desse parasitismo na saúde e na conservação das tartarugas marinhas.

Biomechanical comparison of a modified TPLO plate, a locking compression plate, and plate-rod constructs applied medially in a proximal gap model in canine synthetic tibias / [Comparação biomecânica entre placa de TPLO modificada, placa bloqueada e construção placa-pino intramedular aplicadas medialmente em modelo de fratura proximal em tíbias sintéticas caninas]

The aim of this study was to develop a modified tibial plateau leveling osteotomy (TPLO) plate and to compare its biomechanical properties with a locking compression plate (LCP) and plate-rod constructs for the stabilization of experimentally induced gap fractures in canine synthetic tibias. The tibial models were assigned to either repair with a modified TPLO plate (Group 1), locking compression plate construct (Group 2), or plate-rod construct (Group 3). The specimens were loaded to failure in axial compression, three-point mediolateral and craniocaudal bending. There was no statistical difference between the three groups regarding stiffness (N/mm) and deformation (mm) in axial compression. The modified TPLO plate achieved load to failure similar to the plate-rod construct in craniocaudal bending. There was no significant difference between groups on mediolateral bending tests regarding load to failure and deformation. Furthermore, there was no significant difference in stiffness between groups 1 and 2. In conclusion, the modified TPLO plate had similar mechanical properties to LCP and plate-rod construct in the axial compression and bending tests. Nonetheless, clinical studies with a large population of dogs are required to determine the value of this new implant in proximal tibial fracture repair.

Objetivou-se desenvolver uma placa de osteotomia niveladora do platô tibial (TPLO) modificada e compará-la biomecanicamente à placa de compressão bloqueada (LCP) e à construção placa-pino intramedular na estabilização da fratura cominutiva proximal em tíbias sintéticas caninas. Para tal, tíbias caninas sintéticas foram divididas em três grupos, sendo o grupo 1 formado pela placa de TPLO modificada, o grupo 2 por placas LCP e o grupo 3 pela construção placa-pino intramedular. Os espécimes foram submetidos à carga até a falha em compressão axial, flexão mediolateral e craniocaudal em três pontos. Não houve diferença estatística entre os três grupos quanto à rigidez (N/mm) e à deformação (mm) nos testes de compressão axial. A placa de TPLO modificada obteve carga até a falha semelhante à construção placa-pino intramedular em flexão craniocaudal. Não houve diferença significativa entre os grupos nos testes de flexão mediolateral em relação à carga até a falha e a deformação, e a variável rigidez não apresentou diferenças significativas entre os grupos 1 e 2. Em conclusão, a placa de TPLO modificada apresentou similaridade mecânica em comparação com a LCP e a construção placa-pino. No entanto, estudos clínicos são necessários para determinar o valor desse novo implante na fixação de fraturas tibiais proximais.

Comparison of radiographic and tomographic evaluations for measurement of the Canal Flare Index in dogs / [Comparação entre avaliação radiográfica e tomográfica para mensuração do Canal Flare Index em cães]

The outcome of total hip arthroplasty (THA) in dogs is directly related to surgical planning. Templating of radiographs prior to THA should help the surgeon anticipate prosthesis size and femoral shape allowing canal fill of the proximal metaphysis by the implant ensuring primary stable fixation. The canal flare index (CFI) obtained from radiograph has been used as a measure of risk of complications for the technique in human beings and dogs. However, standard radiographs only provide limited data for the selection of cementless prostheses and the assessment of their fit within the femoral canal, due to factors like radiographic magnification and femoral rotation. Therefore, three-dimensional evaluation based on computed tomography (CT) may be a better tool for CFI measurement. The aim of this study was to compare anatomical measurement with CFI values obtained from craniocaudal radiography and CT. Craniocaudal radiographs using a horizontal radiographic beam (CR), CT, and anatomical macroscopic measurements (A) were obtained from 45 femurs from 23 canine cadavers. The differences between the values of CFI obtained from radiograph (CFI-R), computed tomography on transverse (CFI- TT) and longitudinal axis (CFI-TL) compared to the CFI obtained from macroscopic measurements - gold standard - (CFI-A), and 95% limits of agreement (LOA) between the values, were evaluated by the Bland-Altman method. Dimensions obtained from CT techniques had a greatest mean difference from anatomical and CFI values were also different (P=0.032). Under the experimental conditions, the craniocaudal radiograph, provided the most accurate measurement of the CFI (mean difference: 0.087 ± 0.42).(AU)

O resultado da artroplastia total do quadril (ATQ) em cães está diretamente relacionado ao planejamento cirúrgico. O templating radiográfico pré-operatório da ATQ deve ajudar o cirurgião a prever o tamanho da prótese e o formato do fêmur, o que permitirá um preenchimento ideal da metáfise proximal pelo implante, garantindo, assim, fixação primária estável. O índice de alargamento do canal (Canal Flare Index - CFI) obtido em radiografias tem sido utilizado como fator de risco de complicações para a técnica em humanos e cães. No entanto, as radiografias podem fornecer apenas dados limitados para a seleção de próteses não cimentadas e a avaliação do seu encaixe no canal femoral, devido a fatores como ampliação radiográfica e rotação femoral. Portanto, a avaliação tridimensional baseada na tomografia computadorizada (TC) pode ser uma ferramenta vantajosa para a mensuração do CFI. O objetivo deste estudo foi comparar a medida anatômica com os valores de CFI obtidos na radiografia craniocaudal e na TC. Radiografias craniocaudais utilizando feixe radiográfico horizontal (CR), tomografia computadorizada e medidas macroscópicas anatômicas (A) foram obtidas de 45 fêmures de 23 cadáveres caninos. As diferenças entre os valores de CFI obtidos na radiografia (CFI-R), na tomografia computadorizada no eixo transversal (CFI-TT) e no eixo longitudinal (CFI-TL), em comparação com os valores de CFI obtidos nas medições macroscópicas - padrão-ouro - (CFI-A) e os limites de concordância de 95% (LOA) entre os valores, foram avaliadas pelo método de Bland-Altman. As dimensões obtidas pelas técnicas de TC apresentaram maior diferença média dos valores anatômicos, e as do CFI também foram diferentes (P=0,032). Nas condições experimentais, a radiografia craniocaudal forneceu a medida mais precisa do CFI (diferença média: 0,087 ± 0,42) para representar o padrão-ouro deste estudo.(AU)

Comparison of two methods for the optimization of the analytical conditions for the determination of total sulfur.

Response surface and simplex methods were used for optimizing the determination of total sulfur present in gaseous samples using a quartz crystal microbalance. The optimization methodology increased the analytical signal from three to five times. The simplex method showed the highest efficiency in the search for the maximum sensor response. However, the response surface allows ranking the variables according to their effects and highlights the existence of a plateau in the optimal region.

Trends in alkanes and PAHs in airborne particulate matter from Oporto and Vienna: identification and comparison.

A total of 56 weekly samples from Oporto and 40 from Vienna were collected and analysed, for 23 n-alkanes and 16 polycyclic aromatic hydrocarbons (PAH), by GC-MS after extraction with a toluene/methanol mixture. Total and elemental carbon were in the same range of values for both sampling sites. Although parts of the spectrum of species in both sampling sites were constant over the sampling period there is no evidence for suggesting a universal tracer for alkanes. For both Oporto and Vienna, Principal Component Analysis (PCA) identified two PCs and in both cases the first PC contained only PAHs while the second contained only alkanes. This separation between alkanes and PAHs and the observation of an alternating pattern with higher concentrations of odd carbon numbered from C27 to C30 (natural emissions from biological origin) is believed to result from a separation between anthropogenic and biological contributions associated with the first and second PC, respectively.

Prognostic factors in dogs with urinary bladder carcinoma.

Medical records and biopsy specimens were retrospectively reviewed from 25 dogs diagnosed with unresectable urinary bladder carcinoma and treated with chemotherapy. Our intention was to identify clinical, histologic, and immunohistochemical indicators of prognosis. Immunohistochemical stains for P-glycoprotein, glutathione-S-transferase pi, and factor VIII-related antigen were applied to archived tissue. There were more spayed female dogs than castrated male dogs (76% versus 24%). Transitional cell carcinoma was the most common tumor (88%, n = 22), followed by undifferentiated carcinoma (8%, n = 2) and squamous cell carcinoma (4%, n = 1). Overall median survival was 251 days. Histologic diagnosis and immunohistochemical characteristics did not correlate with prognosis. Spayed females survived significantly longer than castrated males (358 days versus 145 days, P = .042). Dogs that received either doxorubicin or mitoxantrone in addition to a platinum-based chemotherapeutic (either cisplatin or carboplatin) lived significantly longer than those that received only a platinum compound (358 days versus 132 days, P = .042).

Torsional comparative biomechanical test of modified tibial-plateau-leveling osteotomy plate and locking plate in canine synthetic tíbias / Teste de torção biomecânica comparative de placa de TPLO modificada e placa bloqueada em tibia sintética canina

The objective of this study was to develop a locked tibial-plateau-leveling osteotomy (TPLO) plate and to compare this implant with the conventional bone fixation method using a locked plate to determine bone stabilization against torsion forces. Maximum force, angle at peak torque, and stiffness values were determined. Ten synthetic tibias were used, divided into 2 groups. The results in Group 1 (modified TPLO plate) and Group 2 (locked plate) were assessed using analysis of variance and the means were compared using Tukey's test at 5% probability. There were significant differences in the angle at peak torque and stiffness. The group Modified TPLO plate had higher mean values of stiffness compared with Group locked plate. Group locked plate showed a greater angle at peak torque compared with Group modified TPLO plate. All constructs failed due to tibial fractures distal to the plate. The modified TPLO plate presented higher stiffness indexes than conventional locked plate in torsion. The locked plate presented greater elasticity than modified TPLO plate having greater angle at the peak of torque.(AU)

O objetivo do presente estudo foi desenvolver placa de TPLO bloqueada modificada e avaliar, em ensaio de torção, a estabilização óssea proporcionada pelo implante desenvolvido comparativamente a método de fixação óssea convencional com placa reta bloqueada. As variáveis obtidas foram força máxima, ângulo no pico de torque e rigidez. Foram utilizadas 10 tíbias sintéticas, dividas em dois grupos. Os resultados obtidos do grupo 1 (placa TPLO modificada) e do grupo 2 (placa bloqueada) foram submetidos à análise de variância, e as médias comparadas entre si pelo teste de Tukey a 5% de probabilidade. Houve diferença significativa em relação às variáveis, ângulo no pico de torque e rigidez. Na variável rigidez, a média do grupo placa de TPLO modificada foi maior que a do grupo placa reta bloqueada. Em relação à variável ângulo no pico de torque, o grupo placa reta bloqueada foi superior ao grupo placa de TPLO modificada. Todas as montagens falharam devido à quebra do corpo de prova distal à placa. Conclui-se que a placa de TPLO modificada apresentou maior índice de rigidez que a placa reta convencional sob força de torção. A placa reta bloqueada apresentou maior ângulo no pico de torque, sendo, portando, mais elástica.(AU)

Torsional comparative biomechanical test of modified tibial-plateau-leveling osteotomy plate and locking plate in canine synthetic tíbias / Teste de torção biomecânica comparative de placa de TPLO modificada e placa bloqueada em tibia sintética canina

The objective of this study was to develop a locked tibial-plateau-leveling osteotomy (TPLO) plate and to compare this implant with the conventional bone fixation method using a locked plate to determine bone stabilization against torsion forces. Maximum force, angle at peak torque, and stiffness values were determined. Ten synthetic tibias were used, divided into 2 groups. The results in Group 1 (modified TPLO plate) and Group 2 (locked plate) were assessed using analysis of variance and the means were compared using Tukey's test at 5% probability. There were significant differences in the angle at peak torque and stiffness. The group Modified TPLO plate had higher mean values of stiffness compared with Group locked plate. Group locked plate showed a greater angle at peak torque compared with Group modified TPLO plate. All constructs failed due to tibial fractures distal to the plate. The modified TPLO plate presented higher stiffness indexes than conventional locked plate in torsion. The locked plate presented greater elasticity than modified TPLO plate having greater angle at the peak of torque.(AU)

O objetivo do presente estudo foi desenvolver placa de TPLO bloqueada modificada e avaliar, em ensaio de torção, a estabilização óssea proporcionada pelo implante desenvolvido comparativamente a método de fixação óssea convencional com placa reta bloqueada. As variáveis obtidas foram força máxima, ângulo no pico de torque e rigidez. Foram utilizadas 10 tíbias sintéticas, dividas em dois grupos. Os resultados obtidos do grupo 1 (placa TPLO modificada) e do grupo 2 (placa bloqueada) foram submetidos à análise de variância, e as médias comparadas entre si pelo teste de Tukey a 5% de probabilidade. Houve diferença significativa em relação às variáveis, ângulo no pico de torque e rigidez. Na variável rigidez, a média do grupo placa de TPLO modificada foi maior que a do grupo placa reta bloqueada. Em relação à variável ângulo no pico de torque, o grupo placa reta bloqueada foi superior ao grupo placa de TPLO modificada. Todas as montagens falharam devido à quebra do corpo de prova distal à placa. Conclui-se que a placa de TPLO modificada apresentou maior índice de rigidez que a placa reta convencional sob força de torção. A placa reta bloqueada apresentou maior ângulo no pico de torque, sendo, portando, mais elástica.(AU)

Nefrectomia direita em cão parasitado por Dioctophyme renale: relato de caso / Right nephrectomy in dog parasited by Dioctophyme renale: case report

A dioctofimose, causada pelo nematódeo Dioctophyme renale, acomete frequentemente cães errantes e de hábitos alimentares pouco seletivos, podendo afetar também o homem. O parasita é grande, pode medir até cem centímetros de comprimento e se aloja geralmente no rim direito. O diagnóstico é obtido pela visualização dos ovos do D. renale durante o exame do sedimento urinário ou pelo achado do parasita à necropsia. O presente trabalho descreve um caso de parasitismo por este nematoide em cão atendido no Hospital Veterinário "Governador Laudo Natel" da Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, no qual a conduta terapêutica foi a realização de nefrectomia do rim acometido, devido à destruição do parênquima renal. A nefrectomia unilateral foi eficiente para a cura do paciente e eliminação do parasita.

Dioctophimosis, caused by the nematode Dioctophyme renale, frequently attacks erratic dogs and have poorly selective eating habits and, may also affects the man. The parasite is large, can be up to one meter long and usually is lodged to the right kidney. The diagnosis is obtained by the preview of D. renale eggs during the examination of the urinary sediment or by finding the parasite at necropsy. The present study describes a case of parasitism by this nematode in a dog attended at the "Governador Laudo Natel" Veterinary Hospital of the Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, in which the therapeutic management was the nephrectomy of the affected kidney, due to the destruction of the renal parenchyma. Unilateral nephrectomy was efficient for the cure of the patient and elimination of the parasite.

Nefrectomia direita em cão parasitado por Dioctophyme renale: relato de caso / Right nephrectomy in dog parasited by Dioctophyme renale: case report

A dioctofimose, causada pelo nematódeo Dioctophyme renale, acomete frequentemente cães errantes e de hábitos alimentares pouco seletivos, podendo afetar também o homem. O parasita é grande, pode medir até cem centímetros de comprimento e se aloja geralmente no rim direito. O diagnóstico é obtido pela visualização dos ovos do D. renale durante o exame do sedimento urinário ou pelo achado do parasita à necropsia. O presente trabalho descreve um caso de parasitismo por este nematoide em cão atendido no Hospital Veterinário "Governador Laudo Natel" da Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, no qual a conduta terapêutica foi a realização de nefrectomia do rim acometido, devido à destruição do parênquima renal. A nefrectomia unilateral foi eficiente para a cura do paciente e eliminação do parasita.(AU)

Dioctophimosis, caused by the nematode Dioctophyme renale, frequently attacks erratic dogs and have poorly selective eating habits and, may also affects the man. The parasite is large, can be up to one meter long and usually is lodged to the right kidney. The diagnosis is obtained by the preview of D. renale eggs during the examination of the urinary sediment or by finding the parasite at necropsy. The present study describes a case of parasitism by this nematode in a dog attended at the "Governador Laudo Natel" Veterinary Hospital of the Faculdade de Ciências Agrárias e Veterinárias, Jaboticabal, in which the therapeutic management was the nephrectomy of the affected kidney, due to the destruction of the renal parenchyma. Unilateral nephrectomy was efficient for the cure of the patient and elimination of the parasite.(AU)

Toxicity of organic and inorganic nanoparticles to four species of white-rot fungi.

The rapid development of nanoparticles (NP) for industrial applications and large-volume manufacturing, with its subsequent release into the environment, raised the need to understand and characterize the potential effects of NP to biota. Accordingly, this work aimed to assess sublethal effects of five NP to the white-rot fungi species Trametes versicolor, Lentinus sajor caju, Pleurotus ostreatus, and Phanerochaete chrysosporium. Each species was exposed to serial dilutions of the following NP: organic-vesicles of SDS/DDAB and of Mo/NaO; gold-NP, quantum dot CdSe/ZnS, and Fe/Co. Fungi growth rate was monitored every day, and at the end of assay the mycelium from each replicate was collected to evaluate possible changes in its chemical composition. For all NP-suspensions the following parameters were characterized: hydrodynamic diameter, surface charge, aggregation index, zeta potential, and conductivity. All tested NP tended to aggregate when suspended in aqueous media. The obtained results showed that gold-NP, CdSe/ZnS, Mo/NaO, and SDS/DDAB significantly inhibited the growth of fungi with effects on the mycelium chemical composition. Among the tested NP, gold-NP and CdSe/ZnS were the ones exerting a higher effect on the four fungi. Finally to our knowledge, this is the first study reporting that different types of NP induce changes in the chemical composition of fungi mycelium.

Determination of sulfur dioxide in wine using a quartz crystal microbalance.

A new method for the analysis of both total and bound SO(2) in wine is proposed, based on a quartz crystal microbalance (QCM), and it is compared with the widely used Ripper method. The proposed method is faster than the Ripper's, and the instrumentation is either home-made or widely available. When both methods are applied to the same sample, the results obtained using the QCM method are bracketed in an interval less than one-tenth the size of that obtained using the Ripper method. Although the SO(2) concentrations found using the QCM method correlate well with the ones obtained with the Ripper method, the results are systematically higher, which can be explained as due to the absence of interferences known to affect the Ripper method.