Andréa Freitas

Mediastinitis after cardiac transplantation

OBJECTIVEnAssessment of incidence and behavior of mediastinitis after cardiac transplantation.nnnMETHODSnFrom 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6%) of the transplanted patients developed confirmed mediastinitis. Patients ages ranged from 42 to 66 years (mean of 52.3 +/- 10.0 years) and 10 (83.3%) patients were males. Seven (58.3%) patients showed sternal stability on palpation, 4 (33.3%) patients had pleural empyema, and 2 (16.7%) patients did not show purulent secretion draining through the wound.nnnRESULTSnStaphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7%) patients. Staphylococcus epidermidis was identified in 2 (16.7%) patients, Enterococcus faecalis in 1 (8.3%) patient, and the cause of mediastinitis could not be determined in 1 (8.3%) patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7%) patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3%) patient. Out of this series, 5 (41.7%) patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3%) patient.nnnCONCLUSIONnPromptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

A rotatividade dos servidores de confiança no governo federal brasileiro, 2010-2011

What are the determinants of turnover among political appointees in the Brazilian federal government? This article shows that a change in minister does not necessarily entail change among political appointees, although this is true for higher-level appointees with policymaking tasks. Contrary to initial expectations, we find that agencies affected by corruption scandals have lower turnover than other agencies. We argue that it is necessary to consider the policy expertise of appointees, measured as longevity in civil service, in order to understand bureaucratic turnover. Further research on political appointees and their relationships with political parties and ministers in Brazil will likely shedlight on important, yet neglected, aspects of the political system.

Migração partidária na Câmara dos Deputados de 1987 a 2009

This study analyzes the phenomenon of switching party affiliations in Brazil, taking a different approach from that traditionally adopted. Rather than inquiring into the intentions of the migrating legislators, I attempt to understand party-switching as a whole, seeking to grasp how the collective actors (in this case the political parties) use party switches to increase their power in the parliamentary and electoral arenas. By focusing on the moments in which party switches occur, it is possible to perceive the benefits derived by political parties whenever new members join their ranks.

Reforma política no Brasil: indagações sobre o impacto no sistema partidário e na representação

The effects produced by the method to convert votes into legislative seats have been at the center of the debate in Brazil since the 1988 Constitution, and since then political reform has never left the agenda of the political debate, both inside and outside of the university. The arguments are, in general, the strengthening of parties and the increase of electoral accountability. This article proposes to analyze the effects of changing the electoral districts. These issues are inscribed in a larger discussion about the impacts of the electoral system on the political system, as well as about the delicate balance between governability and representation. Consequently, they are directly related to the quality of the democratic system.