Health care for people with sickle cell disease in a medium-sized Brazilian city

The objective of the study was to evaluate the access, assistance and satisfaction of people with sickle cell disease in relation to the health care provided by the Unified Health System in the Uberlândia city, Minas Gerais, Brazil. Thirty-four people with sickle cell disease were recruited using the snowball sampling method and submitted to semi-structured interview, with collection of demographic, clinical and relationship data and satisfaction with health care. Forty-four percent were not included in the Primary Health Care network, which did not provide several procedures/actions recommended by the Ministry of Health. Ninety-four percent were unsatisfied/partially satisfied with the emergency care provided in the Integrated Care Units. The main reasons for this unsatisfied were ignorance of sickle cell disease by the health team (87.5%), delay in care (81.3%) and inadequate conduct by the health team (59.5%). In conclusion, the access and quality of care provided to people with sickle cell disease by the Primary Health Care network and the Urgency and Emergency Network need to be improved and this improvement is directly related to the training of health teams

Fenotipagem das populações celulares e detecção in situ de citocinas em biópsias de pacientes com paracoccidioidomicose

A paracoccidioidomicose (Pbmicose) é micose sistêmica na qual complexos eventos inflamatórios e imunológicos são desencadeados pela interação fungo-hospedeiro, resultando em duas características importantes da doença: freqüente instalação de distúrbios imunorregulatórios e reação inflamatória granulomatosa. Este trabalho teve por objetivo estudar em pacientes portadores da forma crônica multifocal da Pbmicose, na fase pré-tratamento, as características da resposta granulomatosa em lesões de pele e mucosa, considerando suas populações celulares e a presença in situ de citocinas de padrão Th1 e Th2. Estes achados foram correlacionados com a gravidade clínica, níveis de competência imunológica humoral e celular e níveis séricos dessas mesmas citocinas. Foram estudados 27 pacientes com gravidade clínica moderada (13 pacientes), moderada/grave (8 pacientes), grave (5 pacientes) e não avaliada (1 paciente). As biópsias foram realizadas por punch de lesões de pele ou mucosa. Os soros foram separados de sangue obtido por punção venosa, e o teste cutâneo realizado pela paracoccidioidina. Nas biópsias foram analisados o número e padrão de distribuição de neutrófilos, eosinófilos, células gigantes, plasmócitos, linfócitos T CD3+ e CD8+, linfócitos B e células NK (estes três últimos caracterizados pela imuno-histoquímica), contagem de fungos e a detecção imuno-histoquímica de IL-4, IFN- , IL-10, TNF- e TGF- . No soro dos pacientes foram realizadas dosagens de IL-2, IL-4, IL-10 e TGF- e de anticorpos específicos anti-Pb por ensaio imunoenzimático (ELISA)...Paracoccidioidomycosis (Pbmycosis) is a systemic mycosis in which a complex inflammatory and immunological events are unchained by the interaction of the fungus (Pb) with the host tissues, resulting in two important characteristics of the disease: frequent immunoregulatory disturbances and a granulomatous inflammation. The aim of this work was to study in patients with the chronic multifocal form of Pbmycosis, before treatment, the characteristics of the granulomatous response in skin and mucosal lesions, considering the cellular populations and the presence in situ of Th1 and Th2 cytokines patterns. These results were correlated with the clinical severity, the levels of humoral and cellular immune competence and serum levels of those cytokines. Twenty seven patients were studied, distributed accordingly to clinical severity: moderate (13 patients), moderate/severe (8 patients), severe (5 patients), and not evaluated (1 patient). Punch biopsies were collected from skin or mucosal lesions, the serum obtained from venous blood samples to measured antibodies levels, and the skin test accomplished by the paracoccidioidin. In biopsies the following parameters were evaluated: the number and distribution pattern of neutrophils, eosinophils, giant cells, plasma cells, T CD3+ and CD8+ cells, B cells and NK cells (the last three characterized by immunohistochemistry), number of fungi, and detection of IL-4, IFN- , IL-10, TNF- and TGF- by immunohistochemistry. It was also measured the serum levels of IL-2, IL-4, IL-10 and TGF- and the level of specific antibodies anti-Pb by ELISA test. Specific granulomatous lesions, composed with epithelioid, well organized granuloma together with epithelioid loose, ill organized granuloma were observed in the same lesion of the dermis and submucosa. Neutrophils... (Complete abstract, click electronic address below

Testicular histology after intestinal pedicle flap (cecum) apposition in rats Histologia testicular depois da aposição de um retalho intestinal (ceco) em ratos

PURPOSE: Histological study of vascularization between a cecal pedicle flap and the testicle of Wistar rats. METHODS: Fifty-three rats were studied. G1: submitted to celiotomy (a), mobilization of the right testicle (RT) to the abdomen (b), cecal flap suture to the RT (d) and cavity closure. G1: procedures a, b and d and fixation of RT into abdomen. G3: procedures a, b and d, exposition of RT to air and reposition into scrotum. G4: not operated. Euthanasia and histology was done after 20 days. Histometry and lesions score classification was done. Testicular vascularization was studied with comparison between G1 and G3. A p < .05 was considered significant. RESULTS: The G1 RT diameters were not different to G2 RT and all have decreased size in comparison with RT of G3 and G4. The lesions score in the RT was 5.83 in G1 and 3.3 in G2 without statistical difference. The vascularization's average in G1 was 16.9 vessels in 400X field in the RT. In the G3 this average was 0.96 to the RT and 0.92 to left testicles. The weight's average in G1 was similar with G2 but different of G3 and G4. CONCLUSION: A significant increase of vascularization was observed between the intestinal flap and the rat testicle.<br>OBJETIVOS: Estudar histologicamente a vascularização entre um retalho cecal e o testículo de ratos Wistar. MÉTODOS: Cinquenta e três ratos foram estudados. G1, submetidos a (a) celiotomia, (b) mobilização do testículo direito (TD) para o abdome, (c) sutura do retalho cecal ao TD, (d) fechamento da cavidade. G2, procedimentos (a, b e d), com o TD fixado no abdome. G3, procedimentos (a, b e d), com exposição do TD ao ar e retorno ao escroto. G4 não operados. Após 20 dias, eutanásia e histologia. Realizou-se histometria e classificação segundo escore de lesão. Avaliou-se a vascularização testicular, comparando-se os grupos 1 e 3. Considerou-se significativo um p < 0,05. RESULTADOS: Diâmetros dos TD no G1, iguais ao G2 e diferentes de G3 e G4. O escore de lesão nos TD foi de 5,83 pontos para o G1, de 3,3 pontos para o G2, não havendo diferença significativa, porém diferentes de G3 e G4 (sem lesão). A vascularização no G1 teve média de 16,9 vasos por campo de grande aumento no TD. No G3 a média foi de 0,96 no TD e 0,92 no TE, com diferença significativa. O peso médio do G1 foi igual ao G2 e diferente de G3 e G4. CONCLUSÃO: Houve aumento significativo da vascularização entre o retalho e o testículo do rato