Resumo: O estudo referente ao período de 2016 a 2019 trata das agendas empresariais na saúde brasileira e suas interseções com as do Banco Mundial, a governamental (Temer) e o programa eleitoral e ...propostas de ações relativas aos três primeiros meses do governo Bolsonaro. Houve uma aceleração da contrarreforma do Estado na saúde no governo Temer e uma continuidade das diretrizes da política de saúde entre Temer e Bolsonaro, ambas alinhadas com as agendas empresariais e as propostas do Banco Mundial.
Abstract: The study from 2016 to 2019 period deals with business agendas in Brazilian health, and their intersections with World Bank, Temer’s government and electoral program and related actions proposals of the first three months of government of Bolsonaro. There was an acceleration of the state’s counter-reform in health during Temer government and a continuity of health policy guidelines between Temer and Bolsonaro, and both are aligned with the business agendas and World Bank proposals.
Objective To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at ...NICU admission is associated with early neonatal death in preterm infants. Study design This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0°C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. Results Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25°C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0°C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25°C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). Conclusion Simple interventions, such as maintaining DR temperature >25°C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.
A partir de 2013, os Hospitais Universitários federais foram incentivados a aderir à Empresa Brasileira de Serviços Hospitalares (EBSERH). Ao final de 2017 apenas quatro Instituições Federais de ...Ensino Superior não aderiram a essa empresa. O artigo propõe identificar e discutir mudanças dos HUs, sejam eles contratualizados ou não com a EBSERH, com a finalidade de compreender e discutir o papel dos modelos de gestão sobre recursos físicos, humanos, produção e ocupação hospitalar no período entre 2012 e 2017, em que a maioria dos contratos foram estabelecidos. Trata-se de um estudo ecológico exploratório descritivo, analítico e retrospectivo, utilizando dados secundários de bancos oficiais públicos do Sistema Único de Saúde (SUS). Em ambos os modelos, verificou-se que houve um crescimento dos leitos complementares e número de trabalhadores e residentes junto a redução dos leitos hospitalares. Foi destacável o crescimento das internações e da taxa de ocupação em ambos os modelos de gestão. Não houve significância estatística nas médias de variação de todas as variáveis estudadas em ambos os modelos. Apenas foi verificada uma correlação negativa e significativa entre a variação da taxa de ocupação e os leitos hospitalares no conjunto dos hospitais contratualizados com a EBSERH, evidenciando que o crescimento das internações desses hospitais pode ser explicado por uma maior utilização de um menor número de leitos.
O presente artigo analisa a assistência à saúde em Barra do Rio Grande, no sertão do São Francisco, na Bahia, durante o século XIX, através do estudo do Hospital de Caridade de São Pedro que, por sua ...vez, era administrado pela Santa Casa da Misericórdia de Barra. As fontes consultadas foram corres-pondências da mesa administrativa da Santa Casa da Misericórdia com a presidência da província e os relatórios e falas dos presidentes da província na abertura dos trabalhos da Assembleia Provincial. Por estar localizado numa área de fronteira da Bahia, o hospital de caridade em questão possuía um alcance regional que extrapolava os limites provinciais que, por seu turno, tinha o rio São Francisco como principal meio de comunicação.
Primary brain tumors, both benign and malignant, pose a high risk of perioperative venous thromboembolism (VTE) due to the development of a prothrombotic state. Perioperative pharmacologic ...thromboprophylaxis with subcutaneous (SC) unfractionated heparin (UFH) has significantly reduced VTE associated morbidity. Recent reports suggest an association between prolonged activated partial thromboplastin time (aPTT) due to prophylactic SC UFH and increased bleeding risk. We present three patients with normal baseline coagulation parameters in whom pharmacologic thromboprophylaxis with SC UFH resulted in a marked prolongation of the aPTT, leading to adverse outcomes in two patients. These cases demonstrate the uncertain kinetics of SC UFH and effect on aPTT, suggesting the significance of routine aPTT monitoring in high-risk settings. Given the wide variation in presentations of therapeutic or supratherapeutic values of aPTT in the perioperative neurosurgical setting, we propose a practical standardized approach to the evaluation and management of aPTT prolongation following prophylactic SC UFH administration.
Maytenus guianensis is a member of the Celastraceae family that is used in traditional medicine, particularly for its anti-parasitic and anti-cancer effects. To explore the ethnopharmacological ...potential of this plant, the present study was designed to screen the in vitro antileishmanial activities of extracts and compounds isolated from M. guianensis.
Maytenus guianensis stems and leaves were extracted in acetone, followed by the preparation of eluates and isolation of secondary metabolites using chromatography on a glass column with silica gel as the fixed phase. The chemical components were identified using spectroscopic methods, including one- and two-dimensional nuclear magnetic resonance of hydrogen-1 and carbon-13, mass spectroscopy, and infrared spectroscopy. The anti-Leishmania amazonensis activities of these eluates and compounds were evaluated by direct promastigote counting and viability assays.
It was found that the hexane bark eluate produced the strongest anti-L. amazonensis effect, with 90-100% inhibition of the promastigote form. The isolated metabolite that produced the best result was tingenone B, followed by a compound formed by the union of tingenone and tingenone B (80-90% inhibition).
Maytenus guianensis shows anti-parasite activity that warrants further investigation to determine the mechanisms underlying this antileishmanial effect and to evaluate the pharmacological potential of these eluates and isolated secondary metabolites, while minimizing any adverse effects.
Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with ...mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g-1 bryo. d-1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g-1 bryo. d-1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition.
A partir de 2013, os Hospitais Universitários federais foram incentivados a aderir à Empresa Brasileira de Serviços Hospitalares (EBSERH). Ao final de 2017 apenas quatro Instituições Federais de ...Ensino Superior não aderiram a essa empresa. O artigo propõe identificar e discutir mudanças dos HUs, sejam eles contratualizados ou não com a EBSERH, com a finalidade de compreender e discutir o papel dos modelos de gestão sobre recursos físicos, humanos, produção e ocupação hospitalar no período entre 2012 e 2017, em que a maioria dos contratos foram estabelecidos. Trata-se de um estudo ecológico exploratório descritivo, analítico e retrospectivo, utilizando dados secundários de bancos oficiais públicos do Sistema Único de Saúde (SUS). Em ambos os modelos, verificou-se que houve um crescimento dos leitos complementares e número de trabalhadores e residentes junto a redução dos leitos hospitalares. Foi destacável o crescimento das internações e da taxa de ocupação em ambos os modelos de gestão. Não houve significância estatística nas médias de variação de todas as variáveis estudadas em ambos os modelos. Apenas foi verificada uma correlação negativa e significativa entre a variação da taxa de ocupação e os leitos hospitalares no conjunto dos hospitais contratualizados com a EBSERH, evidenciando que o crescimento das internações desses hospitais pode ser explicado por uma maior utilização de um menor número de leitos. Palavras-chave: Hospitais. Universitários. Gestão hospitalar. Privatização. Starting from 2013, the federal University Hospitals (HUs) were induced to join the Brazilian Company of Hospital Services (EBSERH). At the end of 2017, only four Federal Higher Education Institutions (IFES) had not joined this company. The article intends to identify and discuss some changes in the Hus, whether having a contract with the EBSERH or not, in order to understand and compare the role of management models related to investments and use of resources, such as beds, people, equipment and production (hospitalizations) and occupancy rates in the period from 2012 to 2017 when most contracts were established. This is an exploratory, descriptive, analytical and retrospective ecological study that uses secondary data from the official public databases of the SUS. It was found that the average variation of the set of hospitals, in both management models, was positive for complementary beds, number of workers and residents and negative for hospital beds. The growth in hospitalizations and the occupancy rate in both management models was noteworthy, with no statistical significance in the means of variation of the two models in all the variables studied. There was only a negative and significant correlation between the variation in the occupancy rate and hospital beds in all hospitals with a contract with EBSERH, showing that the growth in hospital admissions from these hospitals were explained by a greater use of a smaller number of beds and not because of an increase in the number of workers or beds. Keywords: Hospitals. University. Hospital administration. Privatization.
Background and Aims
Bacterial infections are common and severe in cirrhosis, but their pathogenesis is poorly understood. Dysfunction of liver macrophages may play a role, but information about their ...function in cirrhosis is limited. Our aims were to investigate the specific profile and function of liver macrophages in cirrhosis and their contribution to infections. Macrophages from human cirrhotic livers were characterized phenotypically by transcriptome analysis and flow cytometry; function was assessed in vivo by single photon emission computerized tomography in patients with cirrhosis. Serum levels of specific proteins and expression in peripheral monocytes were determined by ELISA and flow cytometry. In vivo phagocytic activity of liver macrophages was measured by spinning disk intravital microscopy in a mouse model of chronic liver injury.
Approach and Results
Liver macrophages from patients with cirrhosis overexpressed proteins related to immune exhaustion, such as programmed death ligand 1 (PD‐L1), macrophage receptor with collagenous structure (MARCO), and CD163. In vivo phagocytic activity of liver macrophages in patients with cirrhosis was markedly impaired. Monocytes from patients with cirrhosis showed overexpression of PD‐L1 that paralleled disease severity, correlated with its serum levels, and was associated with increased risk of infections. Blockade of PD‐L1 with anti‐PD‐L1 antibody caused a shift in macrophage phenotype toward a less immunosuppressive profile, restored liver macrophage in vivo phagocytic activity, and reduced bacterial dissemination.
Conclusion
Liver cirrhosis is characterized by a remarkable impairment of phagocytic function of macrophages associated with an immunosuppressive transcriptome profile. The programmed cell death receptor 1/PD‐L1 axis plays a major role in the impaired activity of liver macrophages. PD‐L1 blockade reverses the immune suppressive profile and increases antimicrobial activity of liver macrophages in cirrhosis.
PDF
