Os Sistemas Únicos como estratégia de coordenação federativa: reflexos da relação intergovernamental nas políticas públicas de saúde e educação do Estado de São Paulo

Recent studies on Brazilian federative model have led to a decrease in relevance of the state entity (in here, the concept of state is used as province). In the foreground, this feature is attributed to the federative architecture adopted since the Federal Constitution of 1988, which delegates to States an indistinct scope of action compared to the entities of the municipalities and the Union. In addition, there are coordination gaps in vertically implemented public policies, which does not support the necessary protagonism for states being effective in implementation of cooperative public policies at local level. Since the 1990s, public policy systems inaugurated a new arrangement for intergovernmental relationship, mainly in the formulation and implementation phases of social policies. In this context, this work aims, based on Federalism theory and on the experience of the State of São Paulo, to discuss the shared institutional aspects about cooperation in two distinct systems: the Unique Health System, certainly the most successful portrait of public policy system implemented in the country, and the National Education System, which, although not formally established, is a priority agenda of the educational sector for decades.Os estudos recentes sobre o modelo federativo brasileiro deflagram uma tendência de diminuição na relevância dos entes estaduais nesse espectro político-institucional. Em primeiro plano atribui-se esta propriedade à arquitetura federativa adotada desde a Constituição de 1988, que delega aos Estados um escopo de atuação menos claro que aos Municípios e à União. Adicionalmente, há lacunas de coordenação nas políticas públicas implementadas em sentido vertical, o que não favorece o protagonismo necessário aos Estados para a execução efetiva de políticas públicas, em regime de cooperação, no nível local. A partir dos anos 1990, os sistemas de políticas públicas inauguram novo arranjo de relações intergovernamentais, sobretudo, na formulação e implementação de políticas sociais. Neste contexto, este trabalho busca à luz do Federalismo e com base na experiência do ente subnacional Estado de São Paulo, discutir os aspectos institucionais comuns e que dão o caráter de cooperação a dois destes principais sistemas: o Sistema Único de Saúde, certamente o mais bem-sucedido retrato de sistema de política pública implementado no país, e o Sistema Nacional de Educação, que, embora não formalmente instituído, há algumas décadas é agenda prioritária do setor educacional.Dados abertos - Sucupira - Teses e dissertações (2020

Classification of intervertebral disc degeneration by magnetic resonance

The authors suggest an analysis of the degeneration of intervertebral disks on human cadavers using magnetic resonance imaging. Nine lumbar spines were collected from fresh human cadavers and resonance images were captured. The images were analyzed and classified according to the degeneration grades, with the authors proposing a subdivision of type IV into IV-a and IV-b. Forty-four intervertebral disks were analyzed and authors found the following distribution: 4,5% type I; 40,9% type II; 32% type III and 18% type IV-a. However, the investigators disagreed with the conclusions in 4,5% of the disks. The authors found that the progressive signal lost in the T2-weighted images may be correlated to disk degeneration. Changes found in the magnetic resonance images must be standardized and classified for providing a better understanding.Os autores propõem uma análise da degeneração dos discos intervertebrais de cadáveres através de exame de ressonância magnética. Foram coletadas nove peças de coluna lombar de cadáveres frescos as quais foram submetidas a exame de ressonância magnética. As imagens foram analisadas e classificadas de acordo com o grau de degeneração sendo proposta uma subdivisão no tipo IV em IV-a e IV -b. A análise de 44 discos intervertebrais encontrou uma distribuição de 4,5% do tipo I, 40,9% do tipo II, 32% do tipo III e 18% do tipo IV-a. Houve 4,5% em que não houve concenso entre os examinadores. Os autores concluíram que a perda do sinal do disco nas imagens ponderadas em T2 pode ser correlacionada com a progressiva degeneração do disco. A correlação das alterações encontradas nas imagens produzidas pela ressonância magnética devem ser padronizadas e classificadas para sua melhor compreensão.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemUNIFESP, Depto. de Ortopedia e TraumatologiaUNIFESP, Depto. de Diagnóstico por ImagemSciEL

AT1R Activating Autoantibodies in Hematopoietic Stem Cell Transplantation.

Angiotensin II type 1 receptor activating autoantibodies (AT1R-AAs) have gained attention in solid organ transplant as non-HLA antibodies associated with rejection, vasculopathy, and graft dysfunction. These antibodies have also been reported in the context of pre-eclampsia, scleroderma, and isolated hypertension. Here, we present 3 post-hematopoietic stem cell transplant (HSCT) cases with patients demonstrating elevated levels of AT1R-AAs detected within the first year post-HSCT. All patients had hypertension, and 2 patients exhibited profound diarrhea and hypokalemia. The hypertension, in all cases, was refractory to multiple classes of antihypertensives. Upon autoantibody identification, an angiotensin receptor blocker, losartan, was promptly initiated, and all patients showed blood pressure improvement. The 2 patients with electrolyte disturbances had rapid normalization of these levels and resolution of the diarrhea. These cases demonstrate a previously unreported association of elevated AT1R-AA levels in post-HSCT patients with a rapid response to angiotensin receptor blockade initiation

Antimicrobial Activity of Indigofera suffruticosa

Various organic and aqueous extracts of leaves of Indigofera suffruticosa Mill (Fabaceae) obtained by infusion and maceration were screened for their antibacterial and antifungal activities. The extracts were tested against 5 different species of human pathogenic bacteria and 17 fungal strains by the agar-solid diffusion method. Most of the extracts were devoid of antifungal and antibacterial activities, except the aqueous extract of leaves of I. suffruticosa obtained by infusion, which showed strong inhibitory activity against the Gram-positive bacteria Staphylococcus aureus with a minimal inhibitory concentration (MIC) of 5000 µg ml(−1). The MIC values to dermatophyte strains were 2500 µg ml(−1) against Trichophyton rubrum (LM-09, LM-13) and Microsporum canis. This study suggests that aqueous extracts of leaves of I. suffruticosa obtained by infusion can be used in the treatment of skin diseases caused by dermatophytes

Antimicrobial activity and bioautographic study of antistaphylococcal components from Caesalpinia pyramidalis Tull.

A determinação da atividade antimicrobiana dos extratos metanólicos e em acetato de etila da folha, casca do caule, casca da raiz, flor, fruto e semente de Caesalpinia pyramidalis Tull. foi realizada frente a dezessete isolados de Staphylococcus aureus MRSA multirresistentes, dois isolados de S. aureus MSSA e duas cepas padrão, pelas técnicas de poço/difusão em ágar e determinação das CMI pelo método de diluição em agar/multiinoculador de Stears. O extrato metanólico de casca da raiz indicou uma boa atividade, com CMI inferior a 0.5 mg.mL-1. Os extratos secos por extração em acetato de etila apresentaram menor atividade que se poderia explicar por problemas de solubilidade e menor difusão no meio de cultura em ágar. Resultados das bioautografias confirmaram zonas de inibição correspondente às substâncias ativas presente na folha, como também na flor da C. pyramidalis. No estudo fitoquímico das folhas, casca da caule, casca da raiz, flor e fruto dos extratos de C. pyramidalis evidenciou-se a presença de vários constituintes com reconhecida atividade antimicrobiana, entre estes o ácido ursólico, quercetina, catequina, ácido elágico, sitosterol, flavonóides, proantocianidinas e ácido gálico. Entre todos os metabólitos citados, somente o ultimo não observamos, por CCD, na casca da raiz de C. pyramidalis.The antimicrobial activity of dry methanol and ethyl acetate extracts for the leaves, bark of the stem, peel of the root, flower, fruit and seed of Caesalpinia pyramidalis Tull. (catingueira) was performed against seventeen isolates of Staphylococcus aureus MRSA multiresistant strains, which included two isolates of S. aureus MSSA and two ATCC strains. The antimicrobial activity was tested by the agar diffusion method and the Minimum Inhibitory Concentration (MIC) was determined. The dry methanol extract of the root showed good antimicrobial activity with a MIC of less than 0.5 mg.mL-1. The dry ethyl acetate extracts exhibited lower antimicrobial activity, which might be explained by solubility problems and less diffusion in the agar medium. Results of the bioautographies also confirmed inhibition halos corresponding to the active substances present in the leaves, as well as in the flower of C. pyramidalis. The phytochemical study of the leaves, bark of the stem, peel of the root, flower and fruit of extracts from C. pyramidalis confirmed the presence of a number of known antimicrobial agents including ursolic acid, quercetin, catechin, ellagic acid, sitosterol, flavonoids, proanthocyanidins and gallic acid

The retrocondylar retinaculum (Osborne’s ligament) and Struther's ligament

Many of the musculofascial and osteofibrous structures of the upper limbs, and which are of the normal human structural constituent (pattern), are notably neglected in general anatomical descriptions. Their complex structures, and sometimes controversial or incomplete descriptions, have significant implications in important neurovascular conditions, such as compressive trauma, and those of orthopedic reconstructions. Thus, we objective a detailed study, structural and historical, of the literature, on two of the most important osteofibrous formations - the retrocondylar retinaculum (Osborne's ligament), together with the aponeurosis of the flexor carpi ulnar muscle (Osborne's fascia), and the Struther's ligament in association with the supracondylar process and foramen homonym

Site-Specific Gene Editing of Human Hematopoietic Stem Cells for X-Linked Hyper-IgM Syndrome

X-linked hyper-immunoglobulin M (hyper-IgM) syndrome (XHIM) is a primary immunodeficiency due to mutations in CD40 ligand that affect immunoglobulin class-switch recombination and somatic hypermutation. The disease is amenable to gene therapy using retroviral vectors, but dysregulated gene expression results in abnormal lymphoproliferation in mouse models, highlighting the need for alternative strategies. Here, we demonstrate the ability of both the transcription activator-like effector nuclease (TALEN) and clustered regularly interspaced short palindromic repeats-associated protein 9 (CRISPR/Cas9) platforms to efficiently drive integration of a normal copy of the CD40L cDNA delivered by Adeno-Associated Virus. Site-specific insertion of the donor sequence downstream of the endogenous CD40L promoter maintained physiologic expression of CD40L while overriding all reported downstream mutations. High levels of gene modification were achieved in primary human hematopoietic stem cells (HSCs), as well as in cell lines and XHIM-patient-derived T cells. Notably, gene-corrected HSCs engrafted in immunodeficient mice at clinically relevant frequencies. These studies provide the foundation for a permanent curative therapy in XHIM

O PERFIL EPIDEMIOLÓGICO DAS ARBOVIROSES NO BRASIL DE 2017 A 2022: UMA ANÁLISE DO IMPACTO DA PANDEMIA DE COVID-19

Introduction: The COVID-19 pandemic has changed the landscape of Brazilian public health, which was marked by arboviral diseases such as Dengue, Zika, Chikungunya, and Yellow Fever. The sudden need for a reorganization of the healthcare system and the fear of contracting COVID-19 contributed to the modification of the epidemiological profile of various diseases, potentially impacting the distribution of arboviruses. Objectives: This study aims to conduct an analysis of the epidemiological profile of arboviral diseases between the years 2017 and 2022, seeking to understand how the distribution of these diseases occurred before and during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional, analytical, descriptive, and quantitative study that aims to conduct a retrospective epidemiological investigation. It used data made available by the Department of Informatics of the Unified Health System (DATASUS) of the Ministry of Health. The data used pertained to the main arboviral diseases affecting Brazil, covering the years 2017 to 2022. Results: According to the present study, in Brazil, between 2017 and 2022, the year with the highest notification of arboviral diseases was 2019. Meanwhile, the years 2017 and 2018 had the lowest notification of cases of these diseases. Additionally, the notification of arboviral diseases was concentrated in the Southeast region, the most affected age group was 20 to 39 years, and there was a prevalence of cases in female individuals. Conclusions: The reduction in cases in 2020 and 2021, compared to 2019 and 2022, is noteworthy. As several studies suggest, this reduction may be due to possible underreporting. However, new studies should be conducted to develop and subsequently test the most plausible hypotheses regarding the transmission of arboviral diseases during the pandemic period to arrive at a plausible conclusion on this topic.  Introdução: A pandemia da COVID-19 mudou o cenário da saúde pública brasileira, que era marcado pelas arboviroses Dengue, Zika, Chikungunya e Febre Amarela. A necessidade de uma reorganização repentina do sistema de saúde e o medo de contrair a COVID-19 contribuíram para a modificação do perfil epidemiológico de diversas doenças, tendo um possível impacto na distribuição dos arbovírus. Objetivos: Esse estudo busca realizar uma análise do perfil epidemiológico das arboviroses entre os anos de 2017 e 2022, visando entender como ocorreu a distribuição dessas doenças antes e durante a pandemia de Covid-19. Materiais e métodos: Trata-se de um estudo de caráter transversal, analítico, descritivo e quantitativo, que almeja realizar uma investigação epidemiológica retrospectiva, o qual utilizou dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS) do Ministério da Saúde. Os dados utilizados foram acerca das principais arboviroses que acometem o Brasil. A pesquisa abrange os anos de 2017 a 2022. Resultados: Segundo o presente estudo, no Brasil, entre 2017 e 2022, o ano com maior notificação das arboviroses foi o de 2019. Enquanto isso, os anos de 2017 e 2018 apresentaram a menor notificação de casos dessas doenças. Além disso, a notificação das arboviroses concentrou-se na região Sudeste, a faixa etária mais afetada foi relativa a 20 a 39 anos e houve prevalência de casos em indivíduos do sexo feminino. Conclusões: Destaca-se a redução dos casos nos anos de 2020 e 2021, quando comparados com 2019 e 2022. Essa redução, como diversos estudos apontam, deve-se a uma possível subnotificação. Porém, novos estudos devem ser realizados para elaboração e, consequentemente, teste das hipóteses mais plausíveis acerca da transmissão das arboviroses no período pandêmico para que se efetive uma conclusão plausível a respeito deste tópico