Evolución de la demanda ambulatoria del sector público de la ciudad de Corrientes en el período 1991-2013 / Evolution of public sector demand ambulatory City Corrientes in the period 1991-2013

La estrategia de atención primaria de la salud (APS) promueve fuertemente el rol del primer nivel de atención (PNA) como puerta de entrada al sistema; siendo su utilización un indicador de importancia que tiene dentro del sistema. A fin de evaluar la tendencia y distribución de demanda ambulatoria del subsector público en la ciudad de Corrientes (CCtes.), se analizaron las consultas externas del período 1991-2013 según los Anuarios de Estadísticas de la Provincia. Se utilizaron datos censales y proyecciones de población. Se evaluó la tendencia de utilización mediante el número de consultas en ambos niveles y tasas poblacionales. En el período la población de la CCtes. creció un 81,20 %; en tanto, el incremento de las consultas fue del 51,66 %: un 99,27 % las hospitalarias y 21,55 % las del PNA. En el primer trienio del período las consultas fueron superiores en el PNA. Luego la relación se invirtió y sólo volvió a superar el PNA al hospital en dos oportunidades: en el año 1998 y el período 2004-2007. Finalmente, se observa una recuperación en los últimos cuatro años observados. Las tasas provinciales pasaron de 3,5 a 5,0 consultas/habitantes/año; en tanto en la CCtes. pasó de 5,0 a 5,2 consultas/habitantes/año. Se concluye que en la CCtes., según las tasas, la utilización no ha variado y que el PNA no ha ocupado un lugar de relevancia en la atención ambulatoria

The strategy of primary health care strongly promotes the rol of the first level of attention (FLA) as an entrance door to the system. In order to evaluate the ambulatory demand's tendencies and distribution of the public subsector in the city of Corrientes (CCtes), were analyzed the external consultations from the 1991-2013 period, according to the Anuary of Statistics of the Province. Were used the population's census data and projections. It was evaluated the use's tendency by the consulting number in both levels and population rate. In this period the population of Corrientes grew 81,20%, while the consultation increased a 51,66%: 99,27% in hospitals and 21,55% in FLA. Then the proportion reverts and only surpassed the FLA at hospitals in two periods: in 1998, and between 2004 and 2007. Finally, it was observed a recovery in the last four years considered. The province's rates went from 3,5 to 5,0 consultants/habitants/year, while in CCtes went from 5,0 to 5,2. In concludes that in CCtes, according to rates, the use haven't changed and FLA wasn't relevant in the ambulatory attention

La satisfacción de la atención. Una forma de integrar la comunidad a los servicios de salud / The satisfaction of attention. A way to integrate the community into health services

La integración entre servicios de salud del primer nivel de atención (PNA) y la comunidad es una de las características de la calidad de la atención; y para que ella se concrete es menester que exista satisfacción de la atención por parte de los usuarios. El solo hecho de indagar sobre la misma promueve la inclusión activa de los sujetos al sistema, condición necesaria para el desarrollo de Atención Primaria de la Salud como estrategia. El objetivo del trabajo, aquí reportado, fue explorar la satisfacción de usuarios del PNA de Salas de Atención Primaria de la Salud de la Ciudad de Corrientes (SAPS). Mediante una encuesta estructurada, se entrevistaron a usuarios de dichos servicios indagando sobre: razones de concurrencia a la SAPS y servicios requeridos, opinión sobre la atención recibida de los profesionales y administrativos, y opinión respecto al espacio físico y horarios de atención. El estudio abarcó al 10% de las SAPS, con una muestra de 105 usuarios. Como resultados, se pudo observar satisfacción con la atención recibida de los profesionales y administrativos, aunque con variaciones entre las SAPS. Es destacable el hecho que el 35% de los encuestados no pertenecían al área de referencia de las SAPS; sin embargo, adujeron su desplazamiento por la buena atención de los servicios. Respecto al espacio físico y horarios de atención, un 72% de los encuestados manifestó estar conforme. Un reclamo mayoritario fue que se aumentara la cantidad de profesionales. Las conclusiones de este trabajo fueron: 1) los encuestados están satisfechos con los servicios recibidos y en confianza con el personal (dos condiciones necesarias para el acercamiento de la comunidad a los servicios); 2) existen condiciones funcionales que facilitan la integración entre comunidad y servicios de salud; 3) se observa la necesidad de capacitar al personal en atención al usuario

The integration between first level of attention of health care service (FLA) and the community is one of the characteristics of the attention's quality, and in order for it to happen, the users of the service must be satisfied with it. Just inquiry about this promotes the active inclusion of the subjects to the system, necessary condition for the FLA development as a strategy. The objective of this work was explore the FLA user's satisfaction from the Rooms of Primary Health Care (RPHC) in the city of Corrientes (CCtes).The users were asked through a structured survey about: reasons of consultation to the RPHC and required services, opinion about the attention received from professionals and administrative personnel, opinion about the physical space and opening hours. The study included 10% of the RPHC, with a sample of 105 users. As a result, it was observed satisfaction with the attention received from professionals and administrative personnel, although with some variations between RPHC. It is remarkable the fact that 35% of the surveys didn't belong to the area of reference of the respective RPC, awarding this behavior to the nice attention perceived in those services. In reference to the physical space and opening hours, about 72% manifest agreement. A pronounced complain was the increase of professionals available. The conclusions of this work were: 1) the consulted were satisfied with the received services and with the relationship with the personnel (tow necessary conditions for the approach of the community to the services); 2) there are functional conditions that facilitates the integration between community and health care services; 3) it's observed the necessity to capacitate the personnel in customer care.Key words: satisfaction of attention, quality of attention, integration

Estudio comparativo entre dos técnicas comerciales para la cuantificación de carga viral plasmática en pacientes infectados por el virus de inmunodeficiencia humana tipo 1 / Comparative study of two comercial technical for quantification of viral load in patients infected with Human Immunodeficiency Virus Type 1

Los ensayos de cuantificación de ARN plasmáticos de VIH-1 son importantes para el control de pacientes infectados, así como el monitoreo de la respuesta a la terapia antirretroviral. Por lo tanto, los ensayos comerciales empleados para este propósito deben presentar buena correlación entre si, para dar lugar al manejo terapéutico apropiado. El objetivo del estudio consistió en correlacionar los resultados obtenidos mediante el ensayo de amplificación de señal (bDNA) y PCR en tiempo real (RT-PCR), ambas casas comerciales aprobadas por la FDA y con diferente diana de detección del VIH-1. La validación se realizó con 180 muestras clínicas de pacientes referidos al INHRR. Los resultados fueron comparados con la subpoblación de linfocitos TCD4+ determinados mediante citometría de flujo. El análisis estadístico se realizó empleando el coeficiente de regresión lineal de Pearson (R2) y el valor de contraste de hipótesis con una significancia del 95 %, usando el programa SPSS Statistics v10.0. Se observó una buena correlación entre los ensayos (R2=0.961, p<0.05), siendo la RTPCR más sensible. Las diferencias cuantitativas de carga viral entre las técnicas ensayadas fue menor de 0.5 log10 copias/ml para el 89% de las muestras, y >1 log10 copias/ml solo en dos pacientes, no indicando necesariamente cambio terapéutico. Adicionalmente, se encontró una correlación inversa entre los linfocitos TCD4+ y carga viral del VIH-1 medida por bDNA (R2= 0.20, p<0.05) y RT-PCR (R2= 0.15, p<0.05). Los ensayos evaluados mostraron que ambas técnicas puedes ser empleadas indistintamente para el control de los pacientes VIH positivo.

The assay for quantification of plasma HIV-1 RNA are important for the control of patients infected, as well as the monitoring of the response to antiretroviral therapy. Therefore, the commercial assays used for this purpose must submit good correlation between to give place to the appropriate therapeutic management. In this study, we correlate the results obtained through the testing of signal amplification (bDNA) and real-time PCR (RT-PCR), two comercial technical approved by the FDA and with different targets of detection HIV-1. The validation was carried out with 180 clinical samples of patients referred to the INHRR. The results were compared with the subpopulation of lymphocytes TCD4+ determined by flow cytometry. The statistical analysis was performed using the program SPSS Statistics v10. It was observed good correlation between the tests studied (R2=0.961, p<0.05), with RT-PCR more sensitive. The quantitative differences in viral load between the techniques tested was less than 0.5 log10 copies/ml for the 89% of the samples, and >1 log10 copies/ml in only two patients. Additionally, it was found an inverse correlation between lymphocytes TCD4+ and viral load of HIV-1, measured by bDNA (R2= 0.20, p<0.05) and RT-PCR (R2= 0.15, p<0.05). Therefore, these assays can be employed for the patient control HIV.

Impact of an international nosocomial infection control consortium multidimensional approach on catheter-associated urinary tract infections in adult intensive care units in the Philippines: international nosocomial infection control consortium [INICC] findings

To assess the impact of a multidimensional infection control approach on the reduction of catheter-associated urinary tract infection [CAUTI] rates in adult intensive care units [AICUs] in two hospitals in the Philippines that are members of the International Nosocomial Infection Control Consortium. This was a before-after prospective active surveillance study to determine the rates of CAUTI in 3183 patients hospitalized in 4 ICUS over 14,426 bed-days. The study was divided into baseline and intervention periods. During baseline, surveillance was performed using the definitions of the US Centers for Disease Control and Prevention and the National Healthcare Safety Network [CDC/NHSN]. During intervention, we implemented a multidimensional approach that included: [1] a bundle of infection control interventions, [2] education, [3] surveillance of CAUTI rates, [4] feedback on CAUTI rates, [5] process surveillance and [6] performance feedback. We used random effects Poisson regression to account for the clustering of CAUTI rates across time. We recorded 8720 urinary catheter [UC]-days: 819 at baseline and 7901 during intervention. The rate of CAUTI was 11.0 per 1000 UC-days at baseline and was decreased by 76% to 2.66 per 1000 UC-days during intervention [rate ratio [RR], 0.24; 95% confidence interval [CI], 0.11-0.53; P-value, 0.0001]. Our multidimensional approach was associated with a significant reduction in the CAUTI rates in the ICU setting of a limited-resource country

Avaliação da microdureza e rugosidade superficial de uma resina composta submetida ao clareamento com peróxido de hidrogênio a 35% / Evaluation of microhardness and surface roughness of a composite resin under 35% hydrogen peroxide bleaching

Objetivo - Avaliar a microdureza e rugosidade superficial de uma resina composta microhíbrida à base de silorano, submetida ao clareamento imediato com peróxido de hidrogênio a 35%, autocatalisado, contendo cálcio. Métodos - Foram confeccionados 30 corpos de prova, divididos em 3 grupos experimentais: Grupo 1 (n=10): resina composta sem tratamento clareador; Grupo 2 (n=10): resina composta submetida a duas sessões de clareamento imediato com peróxido de hidrogênio a 35%; Grupo 3 (n=10): resina composta submetida a duas sessões de clareamento imediato com peróxido de hidrogênio a 35% com cálcio e armazenadas por 7 dias em saliva artificial a 37ºC. Foram realizados testes de rugosidade e microdureza para todos os grupos. Resultados - Os dados foram avaliados por análises de variância ao nível de significância de 5%, complementadas pelo teste de Tukey. Não houve diferença significativa entre os grupos quanto à rugosidade (p=0,481), ainda que a média do controle tenha sido maior do que dos outros grupos. Por outro lado, houve diferença significativa entre grupos quanto à microdureza (p=0,007). Os grupos G1 e G2 apresentaram médias de microdureza equivalentes e significativamente maiores do que a média do grupo G3. Conclusão - Pode-se concluir que, após o clareamento com peróxido de hidrogênio a 35% contendo cálcio, a rugosidade superficial da resina não se alterou e a microdureza diminuiu após uma semana de armazenamento em saliva artificial.

Objective - To evaluate the microhardness and surface roughness of a resin-based microhybrid silorano, subjected to bleaching with hydrogen peroxide 35%, self-catalyzed, containing calcium. Methods - There was prepared 30 specimens, divided into three groups: Group 1 (n = 10): composite without bleaching treatment, Group 2 (n = 10): composite subjected to two sessions immediately bleaching with hydrogen peroxide 35%, Group 3 (n = 10): composite subjected to two sessions immediately bleaching with hydrogen peroxide to 35% with calcium and stored for 7 days at 37°C in artificial saliva. Tests of roughness and hardness were performed for all groups. Results - Data were evaluated by analysis of variance at a significance level of 5%, complemented by the Tukey test. There was no significant difference between groups in terms of roughness (p = 0.481), although the average of the control was higher than the other groups. On the other hand, significant differences between groups in terms of microhardness (p = 0.007) were observed. The groups G1 and G2 showed average microhardness equivalent and significantly higher than the average of the group G3. Conclusion - It can be concluded that, after bleaching with hydrogen peroxide containing 35% calcium, the surface roughness of the resin did not change and microhardness decreased after one week storage in artificial saliva.

Chumbo, ambiente e saúde: o desafio do controle da exposição humana / Lead, environment and health: the challenge of controlling human exposure

Esta publicação reúne estudos abrangentes sobre as fontes e distribuição do chumbo no ambiente, desafios ao controle da exposição humana, e resultados das investigações realizadas nas principais áreas contaminadas por chumbo no Brasil. Reúne textos de pesquisadores do Brasil, Uruguai e Portugal, abordando também aspectos sobre efeitos do chumbo no organismo humano, como danos ao sistema nervoso central e outros agravos à saúde

Composição química e atividade antioxidante do óleo volátil de Eupatorium polystachyum DC / Chemical composition and antioxidant activity of the volatile oil from Eupatorium polystachyum DC

Os óleos voláteis das folhas e inflorescências de Eupatorium polystachyum DC. (Asteraceae), coletado no Rio Grande do Sul, Brasil, foram caracterizados por CG-EM e sua atividade antioxidante foi avaliada utilizando-se o método de DPPH. Foram obtidos rendimentos de 1,6 e 0,9 por cento de óleo em relação às folhas e inflorescências frescas, sendo identificados 34 compostos, correspondendo a 99,1 e 99,5 por cento do óleo volátil, respectivamente. Os óleos apresentaram exclusivamente compostos terpênicos, sendo que as folhas contêm grande quantidade de monoterpenos (66,4 por cento) enquanto que as inflorescências apresentaram quantidades equivalentes de mono e sesquiterpenos (51,8 e 47,7 por cento, respectivamente). As amostras apresentaram-se qualitativamente muito semelhantes sendo constituídas majoritariamente por: beta-pineno (14,7 e 9,8 por cento), beta-mirceno (15,3 e 10,8 por cento) e limoneno (22,8 e 20,5 por cento) entre os monoterpenos e beta-cariofileno (10,4 e 15,4 por cento), germacreno D (7,2 e 9,4 por cento) e biciclogermacreno (12,0 e 19,2 por cento) entre os sesquiterpenos. As diferenças entre as amostras foram basicamente quantitativas. Os óleos apresentaram atividade antioxidante pelo ensaio com DPPH por bioautografia na diluição de 1:10 em éter etílico (v/v).

The essential oil obtained from leaves and flowers of Eupatorium polystachyum DC. (Asteraceae) collected in Rio Grande do Sul State, Brazil, was characterized by GC-MS and its antioxidant activity was assessed by DPPH assay. The yield of essential oil, relative to fresh material, was 1.6 and 0.9 percent for leaves and flowers, respectively. Both oils are constituted exclusively by terpenic compounds. Leaf oil contains great quantity of monoterpenes (66.4 percent); on the other hand, inflorescence oil contains comparable quantities of mono- and sesquiterpenes (51.8 and 47.7 percent, respectively). The same compounds are majority in both oils: beta-pinene (14.7 and 9.8 percent), beta-myrcene (15.3 and 10.8 percent) and limonene (22.8 and 20.5 percent) among monoterpenes and beta-caryophyllene (10.4 and 15.4 percent), germacrene D (7.2 and 9.4 percent) and bicyclogermacrene (12.0 and 19.2 percent) among sesquiterpenes. The oils had antioxidant activity by DPPH assay in 1:10 dilution in ethyl ether (v/v).

Avaliação in vitro das atividades antiinflamatória, antioxidante e antimicrobiana do alcalóide montanina / In vitro evaluation of the antioxidant, anti-inflammatory and antimicrobial activities of the montanine alkaloid

Diversas propriedades biológicas, dentre as quais atividade antiparasitária, antitumoral, antiviral e anticolinesterásica são associadas aos extratos e produtos isolados, incluindo alcalóides de espécies de Amarilidáceas. Neste trabalho verificou-se para o alcalóide montanina, isolado dos bulbos de Rhodophiala bifida (Herb.) Traub (Amaryllidaceae), atividade antioxidante e ação inibitória sobre o crescimento de culturas de Saccharomyces cerevisae (ATCC 2601), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 6538), Staphylococcus epidermides (ATCC 12228) e Escherichia coli (ATCC 25922). A atividade antiinflamatória avaliada através da determinação da capacidade antiquimiotáxica da amostra apresentou resultados não significativos na dose empregada.

Several biological properties, such as antiparasite, antitumor, antiviral and anticholinesterasic activities, are associated with extracts and isolated products, including alkaloids from Amaryllidaceae species. In this study, the antioxidant activity and inhibitory action on the growth of cell cultures of Saccharomyces cerevisae (ATCC 2601), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 6538), Staphylococcus epidermides (ATCC 12228) and Escherichia coli (ATCC 25922) were observed to the montanine alkaloid, isolated from the bulbs of Rhodophiala bifida (Herb.) Traub (Amaryllidaceae). The anti-inflammatory activity, which was evaluated through the sample antichemotaxis ability determination, was not significant in the used dose.

Post-necrotic left ventricular dysfunction in Diabetes Mellitus: effects of trimetazidine

The Index of Myocardial Performance [IMP] in 149 non-diabetic [group I] and 151 diabetic [group II] subjects who were treated for acute myocardial infarction was evaluated using two-dimensional Doppler echocardiography. Isovolumetric Contraction Time [ICT], Isovolumetric Relaxation Time [IRT] and Ejection Time [ET] were also measured. All patients in both groups received conventional, anti-ischaemic therapy [nitrates, ACE-inhibitors, and antiplatelet drug]. In addition, 74 patients in group II [subgroup IIa] received an oral dose of 20 mg of trimetazidine, three times daily. The remaining 77 diabetics in group II were treated with conventional drugs alone [subgroup IIb]. All diabetic patients [group II] also received an anti-diabetic [oral drug or insulin] treatment to keep their diabetes under control. Twelve months after the experiment, IMP was significantly [p<0.001] higher in diabetic patients [0.55 +/- 0.05] compared to non-diabetic controls [0.49 +/- 0.04]. IRT was similar in both groups [81 +/- 15 ms vs 83 +/- 12 ms] and ET [275 +/- 27 ms vs 295 +/- 29 ms] was decreased in diabetics compared to the control group. The one-year follow-up showed a significant decrease in IMP in patients treated with trimetazidine [subgroup IIa] compared to those treated with conventional drugs [subgroup IIb alone]. IRT values were lower in sub-group IIa compared to that of subgroup IIb. ICT returned towards the normal limits in both subgroups. Finally, ET decreased in subgroup IIa but increased in subgroup IIb compared to values obtained at the onset of treatment. In conclusion, trimetazidine when added to the conventional, anti-ischaemic therapy, seems to induce a more evident attenuation of post-AMI left ventricular dysfunction compared to those not given the drug

Pilocarpine accumulation on Pilocarpus pennatifolius tissue culture

Callus and cell suspension cultures were established from young leaves of Pilocarpus pennatifolius on Murashige & Skoog (MS) medium supplemented with 5.0 mg/L 2,4-dichlorophenoxyacetic acid (2,4-D) and 1.0 mg/L kinetine. The pilocarpine contents of callus and cell suspension cultures were quantitatively compared by HPLC

Epifisiolise proximal do fêmur: relato de um caso / Slipping capital femoral epiphysis: report of a case

Os autores apresentam um caso de epifisiolise proximal do fêmur, bilateral, onde a fase aguda se deu aos 21 anos no lado esquerdo e aos 24 anos no lado direito, portanto bastante acima da idade habitual. No lado direito o desvio da cabeça femoral foi em valgo (lateral em relaçäo ao colo), ou seja, o contrário do habitual. A etiologia é comentada valorizando-se a causa endócrina; a idade óssea de acometimento é valorizada sobre a idade cronológica

Coxa vara: tecnica simplificada de correcao. / Coxa vara: a simplified correction technique

Os autores apresentam uma tecnica operatoria simplificada de correcao da coxa vara de qualquer etiologia, utilizando a placa de Jewett como fixacao; apresentam sete casos operados com a referida tecnica, demonstrando o excelente resultado obtido

Estudo sobre o comportamento do enxerto osseo em ratos. / The behaviour of bone grafts in rats

Os autores pesquisaram o comportamento do enxerto osseo em peronio de ratos albinos durante um periodo de seis semanas apos a enxertia. Os animais foram divididos em 3 grupos, sendo o primeiro com enxerto autogeno sem periosteo, o segundo com enxerto homologo sem periosteo e o terceiro com enxerto autogeno com periosteo. Foram sacrificados dois ratos de cada grupo, semanalmente, sendo o enxerto retirado e preparado em cortes histologicos para exame.Concluiu-se que por volta de uma semana o enxerto morre quase completamente, sendo reabitado por tecido osseo neoformado, num processo que parte quase inteiramente do endosteo quando o periosteo e retirado; quando esse ultimo e mantido, a reabitacao do enxerto e quase completamente de origem periostal. O comportamento do enxerto autogeno comparado ao do homologo, desprovidos de periosteo, nao apresentou diferenca significativa