Políticas públicas de saúde: a realidade do estado de Roraima/ Public health policy: the reality of the state of Roraima

A política social surge no capitalismo em virtude das mobilizações operárias e a partir do século XIX. No Brasil, as primeiras leis sociais apareceram a partir do processo de industrialização. Diante de todo processo, o país questiona a Reforma Sanitária através da VIII Conferência Nacional de Saúde, considerada um marco para a saúde social no Brasil, respaldada na Constituição-Cidadã, que moldou as diretrizes do Sistema Único de Saúde. O SUS surge como forte esperança para a melhoria da saúde da população, através da Constituição Federativa de 1988 e da lei 8080/90, que especificam entre outros itens os objetivos, princípios e diretrizes que regem esse novo plano de atenção à saúde pública. No âmbito regional, verifica-se que apesar de o plano SUS estar bem estabelecido na teoria, a prática aponta dificuldades em sua implementação efetiva. No estado de Roraima, o SUS é organizado através da Resolução nº 051 de 22 de outubro de 2009 (DOE nº 1178 de 06/11/2009), da Comissão Intergestores Bipartite - CIB/RR. Abordaremos sobre a Política Nacional de Humanização (PNH), como se desenvolve no Estado de Roraima no que se refere ao serviço de Alta Complexidade em Oncologia (UNACON)

SOCIODEMOGRAPHIC AND CLINICAL PROFILE OF WOMEN WITH CANCER IN THE GENITAL TRACT WHO UNDERWENT RADIATION THERAPY

Objetivo: caracterizar el perfil social demográfico y clínico de mujeres con cáncer en el trato genital sometidas a la radioterapia en el Centro de Pesquisas oncológicas entre 2010 y 2014.Método: estudio ecológico que se realizó por medio de 880 archivos del Registro Hospitalario de Cáncer. El análisis se hizo por estadística descriptiva, con cálculo de taja de prevalencia.Resultados: la mayor incidencia, 204 casos (23,18%), ocurrió en la franja etaria de los 40-49 años; con mayor taja de prevalencia de los 60 a 69 años, 165 casos (82,28%) para cada 100.000 mujeres. Estadio III con 315 casos (35,8%), topografía de cuello del útero con 695 casos (78,97%) y respectivas tajas de prevalencias 12,97%, 28,61%. De los casos de cáncer del cuello de útero, 274 (39,77%) ocurrieron en la Grande Florianópolis (Santa Catarina, Brasil) y 99 (14,37%) en la macro región Sur.Conclusión: se reafirman la magnitud del cáncer de cuello del útero, la necesidad de las políticas públicas para prevención de la enfermedad y el diagnóstico precoz de las lesiones pre neoplásicas y/o neoplásicas.Objetivo: caracterizar o perfil sociodemográfico e clínico de mulheres com câncer no trato genital submetidas à radioterapia no Centro de Pesquisas Oncológicas entre 2010 e 2014.Método: estudo ecológico realizado em 880 arquivos do Registro Hospitalar de Câncer. A análise ocorreu por estatística descritiva, com cálculo de taxa de prevalência.Resultados: a maior incidência, 204 casos (23,18%) ocorreu na faixa etária dos 40-49 anos; com maior taxa de prevalência dos 60 a 69 anos, 165 casos (82,28%) para cada 100.000 mulheres. Estádio III com 315 casos (35,8%), topografia colo do útero com 695 casos (78,97%) e respectivas taxas de prevalências 12,97%, 28,61%. Dos casos de câncer do colo do útero, 274 (39,77%) foram procedentes da Grande Florianópolis e 99 (14,37%) da macrorregião Sul.Conclusão: reafirma-se a magnitude do câncer do colo do útero, a necessidade das políticas públicas para prevenção da doença e do diagnóstico precoce das lesões pré-neoplásicas e/ou neoplásicas.Objective: To characterize the sociodemographic and clinical profile of women with cancer in the genital tract who underwent radiation therapy at the Centro de Pesquisas Oncológicas between 2010 and 2014.Method: Ecological study of 880 files of the Hospital-based Cancer Registry. Descriptive statistics, with calculation of the prevalence rate was used in the analysis.Results: The higher incidence, 204 cases (23.18%) occurred in the age group of 40-49 years; with a higher prevalence rate from 60 to 69 years, 165 cases (82.28%) for every 100,000 women. Stage III with 315 cases (35.8%), cervical topography with 695 cases (78.97%) and respective prevalence rates 12.97%, 28.61%. Of the total cases of cervical cancer, 274 (39.77%) were from Grande Florianópolis (Santa Catarina, Brazil) and 99 (14.37%) from the southern macro-region. Conclusion: The importance of cervical cancer, the need for public policies for disease prevention and early diagnosis of pre-neoplastic and/or cancer lesions are reaffirmed here

Endoscopic-assisted canal wall-up tympanomastoidectomy for reduction of residual cholesteatoma

Introduction The treatment of cholesteatoma is generally surgical, and the major obstacle is the high prevalence of recidivism. The endoscopic ear surgery technique is proposed to minimize this problem. Objectives To utilize endoscopes to visualize andmanipulate cholesteatoma residues after microscopic removal Methods Cross-sectional study. Thirty-two patients with cholesteatoma underwent microscopic wall-up mastoidectomy combined with the endoscopic approach. The subjects were assessed for the presence and location of covert disease. Results Of the 32 cases, 17 (53.12%) had residual cholesteatoma in the endoscopic phase.Minimal disease was found, usually fragments of the cholesteatomamatrix. Pars tensa cholesteatomas had more covert disease than pars flaccida cholesteatomas (62.50% vs 43.75%). Posterior recesses (47.05%) and tegmen tympani (41.17%) were the locations with more covert disease (p<0.05). Conclusion Cholesteatomas of the pars tensa presented more residual disease and were significantly more common in the posterior recesses and tegmen tympani

Diagnostic aspects of juvenile ossificant fibroma: A case study

Juvenile ossifying fibroma is an uncommon, fast-growing benign neoplasm classified within the group of fibro-osseous lesions that directly affect the face and the jaws. Although it is not followed by metastasis, it usually presents a highly aggressive nature. It is histopathologically divided into two patterns: trabecular and psammomatoid. It can be differentiated through the age of the patients, anatomic location and behavior of the lesion. In this context, this paper reports on the findings of a rare pathology case: juvenile ossifying fibroma, focusing primarily on its clinical, medical imaging and histopathological features characteristics, in order to familiarize the dentist, provide correct diagnosis and the most appropriate treatment

Perfil epidemiológico de um centro especializado em oftalmologia em Fortaleza-CE: Epidemiological profile of a specialized ophthalmology center in Fortaleza-CE

Objetivo: Contribuir para o arsenal literário oftalmológico, no que tange ao perfil ocular da população brasileira. Metodologia: Foi realizado um estudo descritivo e retrospectivo, através da análise de prontuários eletrônicos de pacientes atendidos em um hospital especializado em doenças oftalmológicas (Fundação Leiria de Andrade), abrangendo a população da região metropolitana de Fortaleza – Ceará – Brasil. A amostragem foi realizada de forma aleatória simples e estratificada por idade. Resultado: Dos 382 prontuários selecionados, foi obtido uma idade média de 36 anos e um desvio padrão de 19. Ademais, dentre as doenças mais prevalentes, estavam conjuntivite (51,2%), trauma (12,3%), calázio/hordéolo (7,9%), olho vermelho (6,8%) e blefarite (5,2%). Entre os casos de conjuntivite, a prevalência foi maior entre os meses de fevereiro e abril, que correspondem aos meses chuvosos no estado do Ceará. Conclusão: Os dados epidemiológicos obtidos mostraram uma busca elevada de atendimento oftalmológico pela população economicamente ativa e, principalmente, para doenças como a conjuntivite

Development of an animated infographic on Permanent Health Education

Objetivo: desarrollar una infografía animada sobre el concepto de Educación Permanente en Salud de acuerdo con la Política Nacional y sus principales diferencias con respecto a la educación continua y a la educación en salud. Método: estudio metodológico que analizó el contexto y las brechas de conocimiento con revisión de la literatura y brainstorming, sintetizó el conocimiento en un mapa conceptual; creó y validó el guión; elaboró el diseño didáctico y produjo los medios infográficos. Participaron 18 interlocutores del Núcleo de Educación Permanente y Humanización en las etapas de análisis del contexto y síntesis de conocimientos y seis especialistas en la validación del guión. Resultados: mediante la asociación de textos, imágenes, audios, animaciones y transiciones, se presentaron los conceptos, los principios y trayectoria la jurídica de la política de Educación Permanente con ejemplos del trabajo cotidiano y, al final, se expone su diferencia en relación con la educación continua y la educación en salud. Los especialistas en la materia evaluaron positivamente la infografía por contener una información clara que satisface las necesidades del público objetivo: favoreciendo el aprendizaje y ser apta circular en el medio científico. Conclusión: la infografía contempla contenidos sobre la Educación Permanente en Salud al representar el escenario del trabajo diario; además, incentiva la reflexión de los trabajadores de la salud.Objective: to create an animated infographic on the concept of Permanent Health Education according to the National Policy and its main differences compared to continuing education and health education. Method: a methodological study that analyzed context and knowledge gaps with a literature review and brainstorming; synthesized knowledge into a concept map; built and validated a script; created a didactic design; and produced infographic media. 18 representatives from the Center for Permanent Education and Humanization participated in the stages of context analysis and synthesis of knowledge, and six specialists participated in the validation of the script. Results: through the combination of texts, images, audios, animations and transitions, the concepts, principles and legal journey of the Permanent Education policy were presented with examples from daily work and, at the end, the difference compared to continuing education and health education is presented. The specialist on the theme evaluated the infographic positively as it has clear information that meet the needs of the target audience; favors learning; and is able to circulate in the scientific environment. Conclusion: the infographic includes content on Permanent Health Education as it represents the daily work scenario and encourages reflection by the health care workers.Objetivo: desenvolver infográfico animado sobre o conceito de Educação Permanente em Saúde de acordo com a Política Nacional e suas principais diferenças com relação à educação continuada e educação em saúde. Método: estudo metodológico por via de análise de contexto e lacunas de conhecimento com revisão de literatura e brainstorming; síntese de conhecimentos em mapa conceitual; construção e validação de roteiro; elaboração de desenho didático e produção da mídia infográfica. Participaram 18 interlocutores de Núcleo de Educação Permanente e Humanização nas etapas de análise do contexto e síntese do conhecimento e seis especialistas na validação do roteiro. Resultados: por meio de associação de textos, imagens, áudios, animações e transições, foram apresentados os conceitos, princípios e a trajetória legal da política de Educação Permanente, com exemplos do cotidiano do trabalho, destacando-se as diferenças com relação à educação continuada e educação em saúde. Os especialistas no tema avaliaram positivamente o infográfico por possuir informações claras, que atendem as necessidades do público-alvo; favorecer o aprendizado e estar apto para circular no meio científico. Conclusão: o infográfico contempla conteúdos sobre a Educação Permanente em Saúde ao representar o cenário do cotidiano do trabalho e incentiva a reflexão pelos trabalhadores da saúde

Exploring the correlations between epi indicators of COVID-19 and the concentration of pharmaceutical compounds in Wastewater Treatment Plants in Northern Portugal

The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 g L1 in WWTP2 and 123. 506 g L1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.This study was supported by the Competitiveness and Internationalisation Operational Programme, Lisbon Regional Operational Programme and Algarve Regional Operational Programme with the support of FEDER, through the Incentive Scheme: research and development activities and investment in testing and optimisation (upscaling) infrastructures in the context of COVID-19, through the Project “SARS CONTROL: Evaluation of the impacts of SARS-CoV-2 on the urban water cycle and the downstream effects on Public Health" (Ref. 070076). Acknowledge is also due to the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit, and by LABBELS – Associate Laboratory in Biotechnology, Bioengineering and Microelectromechanical Systems, LA/P/0029/2020. Strategic funding from FCT to cE3c and BioISI Research Units (UIDB/00329/2020 and UIDB/04046/2020) and to the Associate Laboratory CHANGE (LA/P/0121/2020) is also gratefully acknowledged. ARS holds an FCT grant SFRH/BD/131905/2017 and COVID/BD/151951/2021.ARLR and MFRP acknowledge the financial support from LA/P/0045/2020 (ALiCE), UIDB/50020/2020 and UIDP/50020/2020 (LSRE-LCM), funded by national funds through FCT/MCTES (PIDDAC). ARLR acknowledges FCT funding under DL57/2016 Transitory Norm Programme.info:eu-repo/semantics/publishedVersio

INDICADORES ANTROPOMÉTRICOS EM CRIANÇAS COM CÂNCER EM UM HOSPITAL DE REFERÊNCIA / ANTHROPOMETRIC INDICATORS IN CHILDREN WITH CANCER IN REFERENCE HOSPITAL

Introdução: A avaliação nutricional de crianças com câncer é de grande importância, e deve ser realizada no momento da internação,ou logo após o seu diagnóstico. Objetivo: Avaliar os indicadores antropométricos de crianças com câncer. Métodos:Estudo transversal analítico, realizado de janeiro a fevereiro de 2014, em um Hospital do Câncer no município de São Luís (MA).Foram coletados dados referentes ao gênero, idade, peso e altura e a partir desses foram realizados os indicadores antropométricos,peso por idade (P/I), Estatura por idade (E/I) e Índice de massa corporal por idade (IMC/I), cuja classificação obedeceu aoescore z. Resultados: Foram avaliadas 53 crianças e destas 81,1% meninos, 52,8% estavam na faixa etária de 7 a 8 anos e 54,7%com diagnóstico tumoral de leucemia. De acordo com o IMC/I houve uma predominância de crianças eutróficas (66,0%). O indicadorP/I, apresentou frequência de peso adequado para idade (67,9%) e 22,6% de risco nutricional (baixo peso P/I). Com relaçãoao indicador E/I, observou-se que 92,5% demonstraram estatura adequada para idade. Apresentaram risco nutricional,23,6% dos meninos e 20% das meninas (baixo P/I). Houve adequação da E/I em 90,7% dos meninos e em 100% das meninas.Conclusão: Em todos os indicadores antropométricos notou-se prevalência de eutrofia em relação à idade.Palavras-chave: Estado nutricional. Câncer. Pediatria.AbstractIntroduction: Nutritional assessment in childhood cancer is important, and should be performed at admission, or shortly aftertheir diagnosis. Objective: Assess anthropometric indicators of children with cancer. Methods: Analytical cross-sectionalstudy, conducted between January and February 2014 at a Cancer Hospital in São Luís, Maranhão, Brazil. Data regarding gender,age, weight and height were collected and from these the anthropometric indicators weight-for-age, height-for-age andbody mass index-for-age, these classifications the z- score. Results: Were evaluated 53 children, 81.1% were male, 52.8% in theage group 7-8 years old, 54.7% with primary tumor diagnosis of leukemia. According to the body mass index-for-age was apredominance of eutrophic children, with 66.0 %. The weight-for-age indicator, presented frequency appropriate weight for age(67.9%) and nutritional risk percentage (low weight for age), 22.6%. Regarding the indicator height-for-age, it was observed that92.5% demonstrated adequate height-for-age. They presented nutritional risk, with high percentage of appropriate weight forage, 23.6% of boys and 20% girls (Low weight-for-age). There was adequate height in relation to age for 90.7% of the boys and allthe girls (100%). Conclusion: In all anthropometric indicators was noted prevalence of normal weight in relation to age.Keywords: Nutritional Status. Cancer. Pediatrics

Modulation of the oscillatory mechanics of lung tissue and the oxidative stress response induced by arginase inhibition in a chronic allergic inflammation model

Abstract\ud \ud \ud \ud Background\ud The importance of the lung parenchyma in the pathophysiology of asthma has previously been demonstrated. Considering that nitric oxide synthases (NOS) and arginases compete for the same substrate, it is worthwhile to elucidate the effects of complex NOS-arginase dysfunction in the pathophysiology of asthma, particularly, related to distal lung tissue. We evaluated the effects of arginase and iNOS inhibition on distal lung mechanics and oxidative stress pathway activation in a model of chronic pulmonary allergic inflammation in guinea pigs.\ud \ud \ud \ud Methods\ud Guinea pigs were exposed to repeated ovalbumin inhalations (twice a week for 4 weeks). The animals received 1400 W (an iNOS-specific inhibitor) for 4 days beginning at the last inhalation. Afterwards, the animals were anesthetized and exsanguinated; then, a slice of the distal lung was evaluated by oscillatory mechanics, and an arginase inhibitor (nor-NOHA) or vehicle was infused in a Krebs solution bath. Tissue resistance (Rt) and elastance (Et) were assessed before and after ovalbumin challenge (0.1%), and lung strips were submitted to histopathological studies.\ud \ud \ud \ud Results\ud Ovalbumin-exposed animals presented an increase in the maximal Rt and Et responses after antigen challenge (p<0.001), in the number of iNOS positive cells (p<0.001) and in the expression of arginase 2, 8-isoprostane and NF-kB (p<0.001) in distal lung tissue. The 1400 W administration reduced all these responses (p<0.001) in alveolar septa. Ovalbumin-exposed animals that received nor-NOHA had a reduction of Rt, Et after antigen challenge, iNOS positive cells and 8-isoprostane and NF-kB (p<0.001) in lung tissue. The activity of arginase 2 was reduced only in the groups treated with nor-NOHA (p <0.05). There was a reduction of 8-isoprostane expression in OVA-NOR-W compared to OVA-NOR (p<0.001).\ud \ud \ud \ud Conclusions\ud In this experimental model, increased arginase content and iNOS-positive cells were associated with the constriction of distal lung parenchyma. This functional alteration may be due to a high expression of 8-isoprostane, which had a procontractile effect. The mechanism involved in this response is likely related to the modulation of NF-kB expression, which contributed to the activation of the arginase and iNOS pathways. The association of both inhibitors potentiated the reduction of 8-isoprostane expression in this animal model.FAPESP and LIM20HCFMUSP.FAPESP and LIM-20-HC-FMUSP