Brazilian portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire

ABSTRACT Introduction: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. Materials and Methods: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. Results: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). Conclusion: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty.

Brazilian portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire.

INTRODUCTION: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. MATERIALS AND METHODS: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. RESULTS: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). CONCLUSION: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty.

Skeletal Muscle Discomfort and Lifestyle of Brazilian Military Police Officers of Administrative and Tactical Force.

Our aim was to evaluate musculoskeletal discomfort and the lifestyle of military police officers of administrative and tactical force departments. Military police officers were distributed into two groups: administrative (Adm, n = 15) and tactical force (TF, n = 16) departments. Their lifestyle was assessed using the Fantastic Lifestyle questionnaire. Moreover, physical activity quantification was assessed using the International Physical Activity questionnaire, and musculoskeletal discomfort was quantified using the Corlett diagram. The mean total time of physical activity was 546 ± 276 min per week. No differences (p = 0.0832) were found between the Adm (454 ± 217 min) and TF (623 ± 301 min) groups. Concerning lifestyle, in general the sample presented very good (42%) and good (42%) style classification. For this parameter, no significant differences were found, but only a tendency was discovered (x2: 7.437; p = 0.0592); indeed, the TF presented a better classification (63%) of very good, compared to the Adm (53%) of good. No differences (p > 0.05) were found in musculoskeletal perception of discomfort between the right and left sides (p > 0.05) for all police officers and between the Adm and FT groups (p > 0.05). Military police officers showed high and moderate risk for waist circumference and waist-to-hip ratio, respectively; however, lifestyle and total time of physical activity were considered adequate without differences between military administrative and tactical force sectors.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume

ABSTRACT Purpose: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. Material and Methods: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. Results: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. Conclusion: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Application of spatial environmental indicators in the assessment of degradation potential of water resources in water basins.

Changes in land use have been occurring in a continuous and disorderly way in recent decades due to rapid population growth and the growing demand for food. These constant changes result in a series of harmful effects to the environment, especially to water resources, significantly changing their availability and quality. This study aims to evaluate the degradation potential of watersheds through an evaluation of some environmental indicators using arithmetic means to construct an index called in this research "index of potential environmental degradation" (IPED). To form the IPED, the hydrographic sub-basins of the Sorocabuçu River, located in the central west of the State of São Paulo, Brazil, comprised the study area. The results showed that most hydrographic sub-basins, that is, eight units, present degradation values ranging from moderate to very high, resulting mainly from low conservation values of forests plus a use destined to the planting of temporary cultures depending on good physical conditions. On the other hand, only one sub-basin showed a low degradation value. The methodology used for the development of the IPED is easy to apply and an effective tool for environmental analyses. It may contribute to studies and forms of planning and land use management aiming the conservation of water resources and protected areas and reduction of degradation.

Influence of the Dose and Frequency of Administration of Tramadol on Analgesia, Hematological, Biochemical Parameters, and Oxidative Status of Cats Undergoing Ovariohysterectomy.

This study aimed to evaluate the effects of the repeated administration of tramadol subcutaneously on postoperative analgesia, liver, kidneys, and oxidative status in the postoperative period of cats undergoing ovariohysterectomy. Thirty-seven cats were randomly assigned to 5 groups, according to the postoperative analgesic treatment: NaCl 0.9%, GC; tramadol at 2 mg/kg, T2B (q12h) and T2T (q8h); or 4 mg/kg, T4B (q12h) and T4T (q8h). Oxidative status was assessed at baseline, 12 hours and 24 hours after the final administration of tramadol by the activity of superoxide dismutase (SOD), catalase (CAT), myeloperoxidase (MPO), butyrylcholinesterase (BuChE), and lipoperoxidation (MDA). Total blood count, serum biochemistry and urinalysis were compared between baseline and 12 hours posttramadol. Postoperative pain was evaluated by applying the Glasgow Feline Composite Measure Pain Scale at baseline, 3 (T3), 6 (T6), 8 (T8), 12 (T12), 24 (T24) e 36 (T36) hours after extubation. No side effects were observed. Tramadol increased SOD activity while CAT varied among groups in all time points but not over time. MDA levels increased from baseline to 12 hours in all groups but T4T. MPO activity decreased from baseline to 24 hours in some groups, including GC. Creatinine and phosphatase alkaline decreased in T2T, T4B, and T4T at 12 hours. Higher pain scores were observed from T3 to T8, except for GC. Rescue analgesia was administered only at T3. No difference in pain scores was observed from T8 onwards. Based on the findings, it is suggested that tramadol at 2 mg/kg every 8 hours is recommended for postoperative analgesia of cats undergoing ovariohysterectomy.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume.

PURPOSE: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Implementation of Escape Room as an Educational Strategy to Strengthen the Practice of Safe Surgery.

OBJECTIVE: Describe a safe surgery learning experience based on interactive escape room activities to engage and train nursing and physician teams. DESIGN: This paper is based on the authors' participatory and observational experiences creating the Escape Room activity. SETTING: Jundiai Regional Hospital, Surgical Department. PARTICIPANTS: Nurses, nurses assistant/technician and physicians and medical residents who work in the surgical center. RESULTS: Results identified were promising, which broadens the perspective for further studies using the Escape Room activity in the hospital environment through structured research that can assess its implications for teaching and learning. CONCLUSION: We see opportunities for using the escape room activity as a teaching tool to implement other learning objectives.

Simple lessons from complex learning: what a neural network model learns about cosmic structure formation.

We train a neural network model to predict the full phase space evolution of cosmological N-body simulations. Its success implies that the neural network model is accurately approximating the Green's function expansion that relates the initial conditions of the simulations to its outcome at later times in the deeply nonlinear regime. We test the accuracy of this approximation by assessing its performance on well-understood simple cases that have either known exact solutions or well-understood expansions. These scenarios include spherical configurations, isolated plane waves, and two interacting plane waves: initial conditions that are very different from the Gaussian random fields used for training. We find our model generalizes well to these well-understood scenarios, demonstrating that the networks have inferred general physical principles and learned the nonlinear mode couplings from the complex, random Gaussian training data. These tests also provide a useful diagnostic for finding the model's strengths and weaknesses, and identifying strategies for model improvement. We also test the model on initial conditions that contain only transverse modes, a family of modes that differ not only in their phases but also in their evolution from the longitudinal growing modes used in the training set. When the network encounters these initial conditions that are orthogonal to the training set, the model fails completely. In addition to these simple configurations, we evaluate the model's predictions for the density, displacement, and momentum power spectra with standard initial conditions for N-body simulations. We compare these summary statistics against N-body results and an approximate, fast simulation method called COLA (COmoving Lagrangian Acceleration). Our model achieves percent level accuracy at nonlinear scales of k ∼ 1 Mpc - 1 h , representing a significant improvement over COLA.

Effect of maternal true combined endodontic-periodontal lesion on insulin and inflammatory pathway in adult offspring.

BACKGROUND: Maternal periodontal disease (PED) and apical periodontitis (AP) are associated insulin resistance (IR), increased tumor necrosis factor-α (TNF-α) levels, and alterations in insulin signaling (IS) in the gastrocnemius muscle (GM) of adult offspring. TNF-α stimulates I kappa B kinase (IKK) and c-Jun N-terminal protein kinase (JNK), resulting in IS attenuation. However, studies that investigated the maternal true endodontic-periodontal lesion (EPL) in offspring are scarce, and in this case, the impact could be even higher. This study aimed to evaluate the effects of EPL on the IR, IS, and inflammatory pathways on the offspring GM. METHODS: Female Wistar rats were distributed into control, AP, PED, and EPL groups. After 30 days of oral inflammation induction, rats from all groups were allowed to mate with healthy rats. The body weight of the offspring was assessed from birth to 75 days of age. After 75 days, the following measurements were performed: glycemia, insulinemia, IR, TNF-α content, and IKKα/ß, JNK, pp185 (Tyr), and IRS-1 (Ser) phosphorylation status in the GM. RESULTS: Maternal PED and EPL were associated with low birth weights. All maternal oral inflammations promoted IR and IS impairment in the GM and only maternal PED and EPL caused an increase in TNF-α content and IKKα/ß phosphorylation status in the GM of offspring. The offspring of the rats with EPL group showed worsening of metabolic changes when compared with offspring of rats with AP or PED. CONCLUSION: Association of maternal AP and PED promoted a more pronounced worsening in the health of the adult offspring.

Kinetic, thermodynamic and physical-chemical study of the removal of copper from cachaça using coconut fibers.

The use of coconut fiber as a copper adsorbent in cachaça was optimised, and changes in the chemical quality of the beverage were observed by analytical techniques. The influence of the adsorbent mass and copper concentration parameters was investigated using the Central Composite Design, and the optimum condition was obtained through the use of Response Surface Methodology. The equilibrium of the adsorption reaction was obtained within 120 min. The kinetic data were better adjusted for the Elovich model (Elovich and Zhabrova 1939) and the isotherm data for the Sips model (Sips 1948). The maximum adsorption capacity was 1.38 mg g-1. Slight changes in the physicochemical quality of the beverage were observed, including a decrease in volatile acidity and alcohol content. Copper levels in cachaça decreased from 8.57 mg L-1 to 4.97 mg L-1 after adsorption. Therefore, the use of biomass as a metal ion adsorbent in beverages can be successfully employed.

Caeski: an assistive technology for the communication of persons with deafblindness.

PURPOSE: Caeski is a keyboard with 12 vibrating keys that connects to an application via smartphone. This assistive technology aims to facilitate the communication of persons with deafblindness in presential contexts or with people who can be anywhere in the world. The purpose is to present this assistive technology and analyse the viability of its use through tests with eleven persons with deafblindness. MATERIALS AND METHODS: The study design consisted of ten days of testing with eleven persons with deafblindness and five interpreters who had the function of passing the information about the content of the tests. RESULTS: The tests showed that most participants were able to communicate through Caeski. In addition, the tests showed the need to add the function of repeating the reception of information via vibration to confirm the understanding. The results demonstrated the need for more training time to improve the learning of accented words and long sentences. Therefore, training time and previous contact with technological devices are factors that influence the result of the tests. CONCLUSION: The use of Caeski is feasible and as future perspectives, this assistive technology can be used in association with similar assistive technologies such as Perkins Machine and Braille Line, preventing possible tactile overloads. In addition, can be applied in the educational context, from literacy to university. Studies with longer training time should be conducted to confirm the results. The implications for rehabilitation:Social interactions, presential and online, with deafblind and non-deafblind persons anywhere in the world.Literacy and cognitive development of persons with deafblindness.Digital inclusion for occupational, school or academic contexts.

Atividade física e comportamento sedentário em idosos de grupos sociais: existe diferença em razão do risco de sarcopenia? / Physical activity and sedentary behavior in elderly in social groups: is there a difference because of the risk of sarcopenia?

Este estudo teve o objetivo de analisar se a frequência e duração da prática de atividade física e o comportamento sedentário interferem no risco de sarcopenia em idosos frequentadores de grupos sociais. Estudo transversal, em que foram avaliados 207 idosos frequentadores de grupos sociais do município de Sarandi, estado do Paraná. Foi utilizado o Questionário Internacional de Atividade Física (IPAQ) e o SARC-F. Os dados foram analisados por meio da estatística inferencial (p<0,05). Notou-se a prevalência de idosos com nível ativo de atividade física (93,2%) e que não apresentaram risco de sarcopenia (75,8%). Os idosos com risco de sarcopenia ficam mais tempo sentados em dias de semana do que os idosos com ausência de risco de sarcopenia (p=0,043). A duração e frequência da prática de atividade física não interferem no risco de sarcopenia. No entanto, o risco de sarcopenia está associado ao comportamento sedentário do idoso.

This study aimed to analyze whether the frequency and duration of physical activity and sedentary behavior interfere with the risk of sarcopenia in elderly attending social groups. Cross-sectional study to evaluate 207 elderly people attending social groups in the municipality of Sarandi, state of Paraná. The International Physical Activity Questionnaire (IPAQ) and the SARC-F were used. Data were analyzed using inferential statistics (p<0.05). The prevalence of elderly people with active level of physical activity (93.2%) and no risk of sarcopenia (75.8%) was observed. Elderly people at risk of sarcopenia spend more time sitting on weekdays than elderly people with no risk of sarcopenia (p=0.043). Duration and frequency of physical activity do not affect the risk of sarcopenia. However, the risk of sarcopenia is associated with sedentary behavior of the elderly.

Polycyclic aromatic hydrocarbons in cachaças packed in bottles of polyethylene terephthalate.

Cachaça is a beverage of great cultural and economic importance for Brazil. It is made up of several substances that are responsible for the flavor of the beverage. Countless substances of a toxic nature can also be present, such as polycyclic aromatic hydrocarbons (PAHs). These contaminants are commonly found in beverages and food. They have been studied because their toxicity is related to their mutagenic and carcinogenic properties, and they pose a risk to human health. The PAHs can be formed in cachaça during different stages of processing. In this work, the presence of PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzo[a]anthracene, acephenylene, and benzo[a]pyrene) was investigated during the storage of the beverage in plastic containers. Thus, samples from five producers of cachaça in the state of Minas Gerais were stored for up to 8 months in polyethylene terephthalate (PET) packaging from three different manufacturers. Samples stored for 4 and 8 months were analyzed by high-performance liquid chromatography, and 10 PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzo[a]anthracene, acephenylene, and benzo[a]pyrene) were identified and quantified. An increase in PAH concentration in cachaça samples with the storage time in plastic containers was observed. The three different packages contributed to the contamination of the cachaça samples with different PAHs. The highest concentration (approximately 11.0 µg L-1 ) of fluorene was observed in sample A from the three packages and during the two storage times. Thus, it can be inferred that the storage of cachaça in bottles of PET is inadequate for maintaining the quality of the beverage. PRACTICAL APPLICATION: Therefore, it can be inferred from the results of the analysis that PET packages are sources of PAHs, and the storage time in these packages contributed to the increase in the concentration of these contaminants in the beverage. These results suggest that a review of the legislation regarding the use of PET packaging for beverage storage is necessary, as these compounds are carcinogenic.

Apical periodontitis promotes insulin resistance and alters adaptive immunity markers in rats.

OBJECTIVE: Apical periodontitis (AP) is a chronic or acute inflammatory disease usually developed from endodontic infections, predominantly due to gram-negative anaerobic bacteria invading the dental pulp. This study aimed to evaluate lymphocyte markers to assess the involvement of adaptive immunity in insulin resistance (IR) in a rat model of AP.Design.Forty-five male Wistar albino rats were divided into 3 groups (control, 1AP and 4AP). AP was induced in the upper right first molar (1AP), and in the first and second upper and lower right molars (4AP). The spleen was collected to evaluate the expression of transcription factors involved in lymphocyte polarization, including T-bet (Th1), GATA3 (Th2), and FOXP3 (Treg). Blood samples were assessed for serum cytokine levels transcribed by the respective lymphocyte polarizations, INF-γ (Th1), IL-4 (Th2) and TGF-ß (Treg). In addition, glucose and insulin levels were measured to evaluate IR by the HOMA-IR method. RESULTS: The results showed higher T-bet expression on AP groups, along with lower GATA3 and FOXP3 expression in the 1AP, in addition to increased GATA3 and decreased FOXP3 expression in the 4AP group compared to the CN group. There was no difference in the INF-γ levels, while IL-4 was decreased in the AP groups. Taken together, these results suggest that the adaptive immune system, with a predominance of the Th1 polarization, may be involved in the development of IR in rats with AP. CONCLUSIONS: AP promotes increase in the expression of T-bet (4AP) and decrease of FOXP3 expressions and IL-4 levels (1AP and 4AP). However, depending on the number of lesions (1 or 4 lesions), the expression of GATA3 appears differently. Thus, innate immunity and adaptive immunity may contribute to the IR observed in rats with AP.

Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID study.

INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.

Dispensação de medicamentos na atenção primária do Sistema Único de Saúde / The dispensation of drugs in the primary health care of the Single Health System

Objetivo:analisar a dispensação de medicamentos na atenção primária do Sistema Único de Saúde em um município do Estado de São Paulo. Metodologia:realizou-se análise documental dos boletins de movimentação de medicamentos das farmácias das 19 Unidades Básicas de Saúde do município de Araçatuba-SP, sede do Departamento Regional de Saúde II-SP, durante 12 meses. Os medicamentos foram agregados segundo o sistema de classificação Anatomical Therapeutic Chemicale ação farmacológica. Analisou-se o total de medicamentos dispensados e o saldo final dos principais tipos de fármacos. Resultados:foram dispensados 60.479.959 medicamentos, sendo 53,10% antibióticos, 15,42% anti-hipertensivos, 5,09% antidepressivos, 4,81% hipoglicemiantes, 3,16% ansiolíticos, 2,82% complexos vitamínicos e minerais, 2,17% antipsicóticos, 1,99% analgésicos, dentre outros tipos (11,45%). Permaneceram disponíveis 8.778.863medicamentos, sendo os anti-hipertensivos, antidepressivos e ansiolíticos os que representam a maior proporção entre estes. Os antibióticos apresentaram a menor proporção de unidades disponíveis, com aproximadamente 2%. Os hipoglicemiantes apresentaram maior diversidade de fármacos sem unidades disponíveis para dispensação. Conclusão:os principais tipos de medicamentos dispensados foram antibióticos, anti-hipertensivos, antidepressivos e hipoglicemiantes. A dispensação de medicamentos foi satisfatória, considerando que mesmo os medicamentos que não apresentaram saldo residual positivo foram substituídos por outros de propriedades farmacológicas similares

Objective: to analyze the dispensation of drugs in the primary health care of the Single Health System in a city in the State of São Paulo.Methodology: a document analysis was carried out in the reports of how the movement of drugs took place in the 19 Primary Health Care Units in the city of Araçatuba-SP, head office of the Regional Health Department II-SP, for 12 months. The medications were classified according with the Anatomical Therapeutic Chemical system and with their pharmacological action. The total number of drugs dispensed and the remaining amount of the main types of drugs were analyzed.Results: 60,479,959 medications were dispensed, among which 53.10% were antibiotics, 15.42% antihypertensive, 5.09% antidepressant, 4.81% hypoglycemic, 3.16% anxiolytic, 2.82% vitamin and mineral complexes, 2.17% antipsychotics, 1.99% analgesics, among others (11.45%). 8,778,863 drugs were still available, among which the most numerous were hypertensive, antidepressants, and anxiolytics. Antibiotics represented the lowest percentage of available units, with approximately 2%. Hypoglycemic drugs were the ones that showed that highest diversity of unavailable medications.Conclusion: the main types of medications dispensed were antibiotics, antihypertensives, antidepressants, and hypoglycemic drugs. Drug dispensation was satisfactory,considering that even medications that did not have a positive residual supply were replaced by drugs with similar pharmacological properties

Comparative Study on Lead and Copper Biosorption Using Three Bioproducts from Edible Mushrooms Residues.

Agricultural waste products can be used as biosorbents for bioremediation once they are low-cost and high-efficient in pollutants removal. Thus, waste products from mushroom farming such as cutting and substrate of Lentinula edodes (popularly known as shiitake) and Agaricus bisporus (also known as champignon) were evaluated as biosorbents for metallic contaminants copper (Cu) and lead (Pb). Shiitake and champignon stalks, and shiitake substrate (medium in which shiitake was cultivated) were dried, grounded, characterized and experimented to remove Cu and Pb from contaminated water. The Sips model was used to establish the adsorption isotherms. Regarding Cu, champignon stalks have the best removal efficiency (43%), followed by substrate and stalks of shiitake (37 and 30%, respectively). Pb removals were similar among three residues (from 72 to 83%), with the champignon stalks standing out. The maximum adsorption capacities (qmax) for Cu in shiitake and champignon stalks were 22.7 and 31.4 mg/g-1, respectively. For Pb, qmax for shiitake and champignon stalks, and shiitake substrate were 130.0, 87.0 and 84.0 mg/g-1, respectively. The surface morphology of the champignon stalks revealed an organized and continuous structure. After an interaction with metals, the stalk of champignon accumulated the metal ions into interstices. Mushroom residues showed a relevant adsorption efficiency, especially for Pb. Mushroom farming waste are a very low-cost and promising alternative for removing toxic heavy metals from aquatic environment.