Availability of pediatric and neonatal intensive care units in the city of São Paulo

OBJECTIVE: To describe the health care service provided in pediatric intensive care units in the city of São Paulo, by identifying and describing the units and analyzing their geographic distribution. METHODS: A descriptive cross-sectional study was carried out during a two-year period (August 2000 to July 2002). Data were collected through questionnaires answered by medical directors of each pediatric and neonatal intensive care unit. RESULTS: São Paulo is served by 107 pediatric and neonatal intensive care units, of which 85 (79.4%) completed and returned the questionnaire. We found a very unequal distribution of units as there were more units in places with the least pediatric population. Regarding to pediatric intensive care units specialization, 7% were pediatric, 41.2% were neonatal and 51.7% were mixed (pediatric and neonatal). Regarding hospital funds, 15.3% were associated with philanthropic institutions, 37.6% were private and 47% were public. A total of 1,067 beds were identified, of which 969 were active. The ratio bed/patient aged 0-14 was 1/2,728, varying from 1/604 at health districts - I to 1/6,812 at health districts - III. The units reported an average of 11.7 beds (2 to 60). The neonatal intensive care unit had a median of 16.9 beds per unit and pediatric intensive care units a median of 8.5 beds/unit. CONCLUSION: In São Paulo, we found an uneven distribution of pediatric and neonatal intensive care units among the health districts. There was also an uneven distribution between public and private units, and neonatal and pediatric ones. The current report is the first step in the effort to improve the quality of medical assistance in pediatric and neonatal intensive care units in São Paulo.OBJETIVO: Caracterizar a assistência de saúde prestada em tratamento intensivo pediátrico e neonatal no município de São Paulo através da identificação, descrição e distribuição geográfica das unidades. MÉTODOS: Estudo descritivo, tipo transversal, onde foram estudadas as unidades de terapia intensiva pediátrica e neonatal do município de São Paulo, no período de agosto de 2000 a julho de 2002. A coleta dos dados foi realizada por meio de questionário preenchido pelo coordenador médico de cada unidade. RESULTADOS: Foram listadas 107 unidades de terapia intensiva pediátricas e neonatais no município de São Paulo. Oitenta e cinco (79,4%) unidades forneceram os dados, constituindo a população de estudo. Observou-se maior número de unidades de terapia intensiva em Núcleos Regionais de Saúde com menor população pediátrica. Quanto à faixa etária, 7% eram exclusivamente pediátricas, 41,2% neonatais, e 51,7% mistas. Em relação ao mantenedor: 47% eram públicas, 37,6% privadas, e 15,3% filantrópicas. Identificamos 1.067 leitos, estando 969 em atividade. A razão leito/paciente de 0 a 14 anos foi de 1:2.728, variando de 1:604 (Núcleo Regional de Saúde - I) a 1:6.812 (Núcleo Regional de Saúde - III). O número de leitos por unidade variou de 2 a 60, com média de 11,7 (unidades de terapia intensiva neonatais: 16,9; mistas: 8,5). CONCLUSÃO: No município de São Paulo, observou-se uma distribuição desproporcional das unidades de terapia intensiva pediátrica e neonatal entre os cinco Núcleos Regionais de Saúde. Houve também uma distribuição desproporcional entre unidades de terapia intensiva públicas e privadas e entre neonatais e pediátricas. Esse estudo foi o primeiro esforço na busca por melhor qualidade na assistência intensiva pediátrica e neonatal no município de São Paulo.Universidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade de São Paulo Hospital Universitário Unidade de Terapia Intensiva PediátricaUNIFESP, Depto. de PediatriaSciEL

Changes in Epigaeic Ant Assemblage Structure in the Amazon during Successional Processes after Bauxite Mining

Environmental impact studies often involve monitoring and using bioindicators to evaluate the restoration stage of impacted areas. We aimed to assess ant assemblages’ response to the ecological succession of previously disturbed areas in the Brazilian Amazon. We sampled epigeic ant assemblages in five bauxite mining areas, representing different restoration stages, and compared them with two pristine areas. We also compared trends in species richness at the same mine site investigated 14 years earlier. Ten pitfall traps and four Winkler samples of litter were taken along a 100-m transect in each area. We expected that ant species richness would increase with the amelioration in habitat condition (i.e., environmental surrogates of ecological succession, including litter depth, soil penetrability, the circumference of trees, the distance of trees to adjacent trees, and percentage of ground cover). We also compared the efficacy of both sampling methods. Due to more significant sampling effort, pitfall traps captured more ant species than Winkler sacks. However, Winkler samples’ addition allowed the collection of more cryptic species than by pitfall traps alone. We sampled a total of 129 ant species, with increases in ant species richness in more mature rehabilitation. Nevertheless, similarity analysis indicated a significant difference between ant assemblages of rehabilitated areas and pristine ones. Assemblages differed mainly by the presence of specialist and rare species, found only in pristine plots. Rehabilitated areas exhibited a significant increase in tree circumference as they reached more ecologically advanced stages, which contributed to increasing ant species richness. These trends and comparison with the earlier study indicate that although there are favorable increases in ant species richness, in terms of species composition, rehabilitated areas were far from achieving an ant assemblage composition or environmental status that closely resembles pristine areas

Fractional Distillation of Bio-Oil Produced by Pyrolysis of Açaí (Euterpe oleracea) Seeds

In this work, the seeds of açaí (Euterpe oleracea, Mart), a rich lignin-cellulose residue, has been submitted to pyrolysis to produce a bio-oil-like fossil fuels. The pyrolysis carried out in a reactor of 143 L, 450°C, and 1.0 atm. The morphology of Açaí seeds in nature and after pyrolysis is characterized by SEM, EDX, and XRD. The experiments show that bio-oil, gas, and coke yields were 4.38, 30.56, and 35.67% (wt.), respectively. The bio-oil characterized by AOCS, ASTM, and ABNT/NBR methods for density, kinematic viscosity, and acid value. The bio-oil density, viscosity, and acid value were 1.0468 g/cm3, 68.34 mm2/s, and 70.26 KOH/g, respectively. The chemical composition and chemical functions of bio-oil are determined by GC-MS and FT-IR. The GC-MS identified in bio-oil 21.52% (wt.) hydrocarbons and 78.48% (wt.) oxygenates (4.06% esters, 8.52% carboxylic acids, 3.53% ketones, 35.16% phenols, 20.52% cresols, 5.75% furans, and 0.91% (wt.) aldehydes), making it possible to apply fractional distillation to obtain fossil fuel-like fractions rich in hydrocarbons. The distillation of bio-oil is carried out in a laboratory-scale column, according to the boiling temperature of fossil fuels. The distillation of bio-oil yielded fossil fuel-like fractions (gasoline, kerosene, and light diesel) of 4.70, 28.21, and 22.35% (wt.), respectively

Contemporary specificities of labour in the health care sector: introductory notes for discussion

BACKGROUND: This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. METHOD AND FRAMEWORK: The starting point is the investigation of the economic peculiarities of medical care. RESULTS AND DISCUSSIONS: This investigation leads to the identification of the prevalence of non-market forms of medical care in the countries of the Organisation for Economic Co-operation and Development (OECD). Furthermore, the health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. CONCLUSION: The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately. This process should take into account the rapid development of the health innovation system and one important consequence: the obsolescence of the acquired knowledge. One way to dignify labour is to implement continued education and training of health professions personnel

Alternative Complement Pathway Deregulation Is Correlated with Dengue Severity

BACKGROUND:The complement system, a key component that links the innate and adaptive immune responses, has three pathways: the classical, lectin, and alternative pathways. In the present study, we have analyzed the levels of various complement components in blood samples from dengue fever (DF) and dengue hemorrhagic fever (DHF) patients and found that the level of complement activation is associated with disease severity. METHODS AND RESULTS:Patients with DHF had lower levels of complement factor 3 (C3; p = 0.002) and increased levels of C3a, C4a and C5a (p<0.0001) when compared to those with the less severe form, DF. There were no significant differences between DF and DHF patients in the levels of C1q, immunocomplexes (CIC-CIq) and CRP. However, small but statistically significant differences were detected in the levels of MBL. In contrast, the levels of two regulatory proteins of the alternative pathway varied widely between DF and DHF patients: DHF patients had higher levels of factor D (p = 0.01), which cleaves factor B to yield the active (C3bBb) C3 convertase, and lower levels of factor H (p = 0.03), which inactivates the (C3bBb) C3 convertase, than did DF patients. When we considered the levels of factors D and H together as an indicator of (C3bBb) C3 convertase regulation, we found that the plasma levels of these regulatory proteins in DHF patients favored the formation of the (C3bBb) C3 convertase, whereas its formation was inhibited in DF patients (p<0.0001). CONCLUSION:The data suggest that an imbalance in the levels of regulatory factors D and H is associated with an abnormal regulation of complement activity in DHF patients

Gene Expression Profiling during Early Acute Febrile Stage of Dengue Infection Can Predict the Disease Outcome

Background: We report the detailed development of biomarkers to predict the clinical outcome under dengue infection. Transcriptional signatures from purified peripheral blood mononuclear cells were derived from whole-genome gene-expression microarray data, validated by quantitative PCR and tested in independent samples. Methodology/Principal Findings: The study was performed on patients of a well-characterized dengue cohort from Recife, Brazil. The samples analyzed were collected prospectively from acute febrile dengue patients who evolved with different degrees of disease severity: classic dengue fever or dengue hemorrhagic fever (DHF) samples were compared with similar samples from other non-dengue febrile illnesses. The DHF samples were collected 2-3 days before the presentation of the plasma leakage symptoms. Differentially-expressed genes were selected by univariate statistical tests as well as multivariate classification techniques. The results showed that at early stages of dengue infection, the genes involved in effector mechanisms of innate immune response presented a weaker activation on patients who later developed hemorrhagic fever, whereas the genes involved in apoptosis were expressed in higher levels. Conclusions/Significance: Some of the gene expression signatures displayed estimated accuracy rates of more than 95%, indicating that expression profiling with these signatures may provide a useful means of DHF prognosis at early stages of infection. © 2009 Nascimento et al

Identification of Continuous Human B-Cell Epitopes in the Envelope Glycoprotein of Dengue Virus Type 3 (DENV-3)

BACKGROUND:Dengue virus infection is a growing global public health concern in tropical and subtropical regions of the world. Dengue vaccine development has been hampered by concerns that cross-reactive immunological memory elicited by a candidate vaccine could increase the risk of development of more severe clinical forms. One possible strategy to reduce risks associated with a dengue vaccine is the development of a vaccine composed of selected critical epitopes of each of the serotypes. METHODOLOGY/PRINCIPAL FINDINGS:Synthetic peptides were used to identify B-cell epitopes in the envelope (E) glycoprotein of dengue virus type 3 (DENV-3). Eleven linear, immunodominant epitopes distributed in five regions at amino acid (aa) positions: 51-65, 71-90, 131-170, 196-210 and 246-260 were identified by employing an enzyme- linked immunosorbent assay (ELISA), using a pool of human sera from dengue type 3 infected individuals. Peptides 11 (aa51-65), 27 and 28 (aa131-150) also reacted with dengue 1 (DENV-1) and dengue 2 (DENV-2) patient sera as analyzed through the ROC curves generated for each peptide by ELISA and might have serotype specific diagnostic potential. Mice immunized against each one of the five immunogenic regions showed epitopes 51-65, 131-170, 196-210 and 246-260 elicited the highest antibody response and epitopes131-170, 196-210 and 246-260, elicited IFN-gamma production and T CD4+ cell response, as evaluated by ELISA and ELISPOT assays respectively. CONCLUSIONS/SIGNIFICANCE:Our study identified several useful immunodominant IgG-specific epitopes on the envelope of DENV-3. They are important tools for understanding the mechanisms involved in antibody dependent enhancement and immunity. If proven protective and safe, in conjunction with others well-documented epitopes, they might be included into a candidate epitope-based vaccine

Low-frequency physical variations in the coastal zone of Ubatuba, northern coast of São Paulo State, Brazil

Sea level (SL), wind, air temperature (AT) and sea surface temperature (SST) variations in the coastal region of Ubatuba, northern coast of São Paulo, are assessed. A Lanczos-square cosine filter, with a 40-hour window, was applied over the SL time series between 1978 and 2000, except for the period comprising 1984 to 1986. In order to study subtidal effects on mean sea level (MSL), SL numerical filtering indicated that there was a virtually complete removal of semidiurnal and diurnal astronomical tidal components over the period of study. Results indicated an average raw SL rise of 2.3 mm/year, whereas average filtered MSL was of the order of 0.7 mm/year. Despite the overall positive MSL trend, the lunar nodal cycle of 18.6 years seemed to be the explanation for the SL series pattern. Correlations between MSL and parallel wind had a maximum correlation coefficient around 0.6, with 99% statistical confidence, while MSL and perpendicular wind correlations were not statistically significant. These results may be explained by Ekman dynamics. Data records of AT and SST between 1990 and 2003 showed positive trends for both variables. During this period, AT rose about 0.087 ºC /year for the raw series and 0.085 ºC /year for the monthly time series, and SST showed a rise of 0.047 ºC /year and 0.046 ºC/year, for the raw and monthly time series, respectively. The monthly climatology for both AT and SST showed higher values in February with 27.79 ºC and 28.59 ºC for AT and SST, respectively, and the lowest in July with 21.12 ºC for AT and 21.91 ºC for SST

Beyond Genetic Factors in Familial Amyloidotic Polyneuropathy: Protein Glycation and the Loss of Fibrinogen's Chaperone Activity

Familial amyloidotic polyneuropathy (FAP) is a systemic conformational disease characterized by extracellular amyloid fibril formation from plasma transthyretin (TTR). This is a crippling, fatal disease for which liver transplantation is the only effective therapy. More than 80 TTR point mutations are associated with amyloidotic diseases and the most widely accepted disease model relates TTR tetramer instability with TTR point mutations. However, this model fails to explain two observations. First, native TTR also forms amyloid in systemic senile amyloidosis, a geriatric disease. Second, age at disease onset varies by decades for patients bearing the same mutation and some mutation carrier individuals are asymptomatic throughout their lives. Hence, mutations only accelerate the process and non-genetic factors must play a key role in the molecular mechanisms of disease. One of these factors is protein glycation, previously associated with conformational diseases like Alzheimer's and Parkinson's. The glycation hypothesis in FAP is supported by our previous discovery of methylglyoxal-derived glycation of amyloid fibrils in FAP patients. Here we show that plasma proteins are differentially glycated by methylglyoxal in FAP patients and that fibrinogen is the main glycation target. Moreover, we also found that fibrinogen interacts with TTR in plasma. Fibrinogen has chaperone activity which is compromised upon glycation by methylglyoxal. Hence, we propose that methylglyoxal glycation hampers the chaperone activity of fibrinogen, rendering TTR more prone to aggregation, amyloid formation and ultimately, disease