Quality of Telehealth Services in Primary Care in the State of Minas Gerais.

Objective: Telemedicine is seen as an important tool to face contemporary health challenges. The factors that help improve quality in these services must be studied. The objective of this work was to assess the quality of telehealth primary care services offered in the State of Minas Gerais -Brazil, based on the ISO 13131 standard. Methods: This cross-sectional analytical study with a quantitative approach was conducted in the cities in the state of Minas Gerais that use telehealth services. A stratified sample composed of 385 cities was used. A questionnaire, based on ISO 13131 on the quality of telehealth services, was prepared, used, and verified for its consistency. Quality levels in telehealth were built from the data. To analyze the quality of care, data from the Ministry of Health's quality improvement program were used, involving 366 surveyed cities. Logistic regression was performed to verify the association between quality of telehealth and quality of care. Results: The research identified that 64% of the cities had records of telehealth activities, and 51% of cities had high quality telehealth services. There was no association between quality of telehealth and quality of care; only the dimensions of Quality and Risk Management were associated with quality of care. Conclusion: The developed instrument enabled the quality of telehealth actions to be verified. The State of Minas Gerais has high-quality telehealth services.

New endoperoxides highly active in vivo and in vitro against artemisinin-resistant Plasmodium falciparum.

BACKGROUND: The emergence and spread of Plasmodium falciparum resistance to artemisinin-based combination therapy in Southeast Asia prompted the need to develop new endoperoxide-type drugs. METHODS: A chemically diverse library of endoperoxides was designed and synthesized. The compounds were screened for in vitro and in vivo anti-malarial activity using, respectively, the SYBR Green I assay and a mouse model. Ring survival and mature stage survival assays were performed against artemisinin-resistant and artemisinin-sensitive P. falciparum strains. Cytotoxicity was evaluated against mammalian cell lines V79 and HepG2, using the MTT assay. RESULTS: The synthesis and anti-malarial activity of 21 new endoperoxide-derived compounds is reported, where the peroxide pharmacophore is part of a trioxolane (ozonide) or a tetraoxane moiety, flanked by adamantane and a substituted cyclohexyl ring. Eight compounds exhibited sub-micromolar anti-malarial activity (IC50 0.3-71.1 nM), no cross-resistance with artemisinin or quinolone derivatives and negligible cytotoxicity towards mammalian cells. From these, six produced ring stage survival < 1% against the resistant strain IPC5202 and three of them totally suppressed Plasmodium berghei parasitaemia in mice after oral administration. CONCLUSION: The investigated, trioxolane-tetrazole conjugates LC131 and LC136 emerged as potential anti-malarial candidates; they show negligible toxicity towards mammalian cells, ability to kill intra-erythrocytic asexual stages of artemisinin-resistant P. falciparum and capacity to totally suppress P. berghei parasitaemia in mice.