IDENTIFICAÇÃO DE CROMO III COMO CONTAMINANTE EM GELATINAS COMERCIALIZADAS EM PRESIDENTE PRUDENTE-SP

O cromo (Cr3+) é necessário na dieta humana, principalmente para o metabolismo dos carboidratos. Pode ser encontrado em água potável, levedo de cerveja e grãos integrais, ou através de gelatinas contaminadas, proveniente da extração do colágeno no tratamento industrial do couro bovino, podendo causar danos à saúde quando ingerido acima de 200µg/dia. O objetivo deste trabalho foi investigar a presença de Cr3+ em gelatinas comerciais de acordo com a legislação vigente. A metodologia utilizada foi espectrofotometria de absorção atômica (EAA) após a digestão de oito amostras de gelatina, em triplicata (marcas do tipo colorida em pó, incolor em pó e em folha incolor). Os resultados obtidos demonstraram que todas as amostras de gelatina apresentaram concentrações de Cr+3 acima do permitido pela legislação (0,1 ppm). Concluímos que o Cr+3 pode ter sido arrastado durante o processamento do colágeno para a fabricação de gelatina e/ou adicionado ao produto colorido como corante

SERVIÇOS DE ZOONOSES E O SEU PAPEL NA VIGILÂNCIA EM SAÚDE PARA LEISHMANIOSE VISCERAL

The visceral leishmaniasis (VL) is a zoonotic disease of great importance in public health and the actions performed by Zoonoses Services (ZS) can minimize their disorder. The objective was to evaluate the situation of zoonosis services of the counties in the health region of Presidente Prudente/SP and understand the role its play in health surveillance for VL. Was performed cartographic information on the epidemiological situation of the VL and the type ZS offered in the counties belonging of study. Of the 45 counties studied, 62.2% have fully structured ZS; 1.35% have no physical structure and partially function; 0.9% do not work and 5.4% do not possess. We conclude that, is of great relevance, the role played by ZSs in health surveillance and there is a high number of counties that do not have structured ZS, a fact that can make it difficult to control the VL, favoring the dissemination in the region.A leishmaniose visceral (LV) é uma doença zoonótica de grande importância em saúde pública e as ações realizadas pelos Serviços de Zoonoses (SZ) podem minimizar seu transtorno. O objetivo foi avaliar a situação dos Serviços de Zoonose dos municípios na região de saúde de Presidente Prudente/SP e compreender o papel que eles desempenham na vigilância em saúde para LV. Foi realizado tratamento cartográfico da informação sobre a situação epidemiológica da LV e o tipo de SZ ofertado nos municípios de estudo. Dos 45 municípios estudados, 62,2% possuem SZ totalmente estruturado; 1,35% não possuem estrutura física e funcionam parcialmente; 0,9% não funcionam e 5,4% não o possuem. Concluímos que é de grande relevância o papel que os SZs desempenham na vigilância em saúde e há uma elevada quantidade de municípios que não possuem SZ estruturado, fato que pode dificultar no controle da LV, favorecendo a disseminação na região

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

ASSENTAMENTOS DE REFORMA AGRÁRIA E A VIGILÂNCIA EM SAÚDE PARA LEISHMANIOSE VISCERAL NA REGIÃO DE PRESIDENTE PRUDENTE, SÃO PAULO, BRASIL

The Visceral Leishmaniasis (VL) has interdependence with modified remnant forest regions, and the rural spaces tend to store vectors and reservoirs. This study aimed to establish relationships among risk categories according to epidemiological classification and favoring the occurrence of LV in counties that shelter agrarian reform settlements belonging to the to the Region of Health of Presidente Prudente, São Paulo. The study regions were classified according to the category for zoonoses service and epidemiological situation, applying spatial analysis and cartographic treatment of the information. Of 45 counties, 19 (42.2%) have a total of 121 settlements, facing different scenery. There was a close relationship between the availability and performance of the zoonoses team and VL situation, especially in the silent study counties (receptive or not) and in research. The results contribute to health surveillance, decision support in priority areas and strengthening of the Unified Health System (SUS).A Leishmaniose Visceral (LV) possui interdependência com regiões de florestas remanescentes modificadas, e os espaços rurais tendem a armazenar vetores e reservatórios. Esse estudo objetivou dimensionar diferentes situações de risco epidemiológico conforme a classificação epidemiológica e o favorecimento da ocorrência de LV em municípios que abrigam assentamentos de reforma agrária, pertencentes à Região de Saúde de Presidente Prudente, São Paulo. As regiões de estudo foram classificadas segundo a estrutura do serviço de zoonoses e situação epidemiológica, aplicando-se análise espacial e tratamento cartográfico das informações. De 45 municípios, 19 (42,2%) abrigam um total de 121 assentamentos, enfrentando diferentes cenários. Houve estreita relação quanto à disponibilização e atuação da equipe de zoonoses e a situação da LV, especialmente nos municípios de estudo silenciosos (receptivos ou não) e em investigação. Os resultados contribuem para a vigilância em saúde, apoio a decisão em áreas prioritárias e fortalecimento do Sistema Único de Saúde (SUS)

ASSENTAMENTOS DE REFORMA AGRÁRIA E A VIGILÂNCIA EM SAÚDE PARA LEISHMANIOSE VISCERAL NA REGIÃO DE PRESIDENTE PRUDENTE, SÃO PAULO, BRASIL

The Visceral Leishmaniasis (VL) has interdependence with modified remnant forest regions, and the rural spaces tend to store vectors and reservoirs. This study aimed to establish relationships among risk categories according to epidemiological classification and favoring the occurrence of LV in counties that shelter agrarian reform settlements belonging to the to the Region of Health of Presidente Prudente, São Paulo. The study regions were classified according to the category for zoonoses service and epidemiological situation, applying spatial analysis and cartographic treatment of the information. Of 45 counties, 19 (42.2%) have a total of 121 settlements, facing different scenery. There was a close relationship between the availability and performance of the zoonoses team and VL situation, especially in the silent study counties (receptive or not) and in research. The results contribute to health surveillance, decision support in priority areas and strengthening of the Unified Health System (SUS).A Leishmaniose Visceral (LV) possui interdependência com regiões de florestas remanescentes modificadas, e os espaços rurais tendem a armazenar vetores e reservatórios. Esse estudo objetivou dimensionar diferentes situações de risco epidemiológico conforme a classificação epidemiológica e o favorecimento da ocorrência de LV em municípios que abrigam assentamentos de reforma agrária, pertencentes à Região de Saúde de Presidente Prudente, São Paulo. As regiões de estudo foram classificadas segundo a estrutura do serviço de zoonoses e situação epidemiológica, aplicando-se análise espacial e tratamento cartográfico das informações. De 45 municípios, 19 (42,2%) abrigam um total de 121 assentamentos, enfrentando diferentes cenários. Houve estreita relação quanto à disponibilização e atuação da equipe de zoonoses e a situação da LV, especialmente nos municípios de estudo silenciosos (receptivos ou não) e em investigação. Os resultados contribuem para a vigilância em saúde, apoio a decisão em áreas prioritárias e fortalecimento do Sistema Único de Saúde (SUS)

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially