Ernesto Lima Gonçalves

Influence of medium-chain triglyceride-based lipid emulsion on rat polymorphonuclear cell functions

Intravenous lipid emulsions are used as energy and essential fatty acids sources. There are controversial reports postulating in vitro and in vivo inhibitory effects of long-chain triglycerides (LCT) upon the blood polymorphonuclear leukocytes (PMNL) functions. In the present study the in vivo and in vitro effects of LCT and a physical mixture of medium- and long-chain triglycerides (MCT/LCT) emulsions were investigated on select PMNL functions, i.e., chemotaxis, phagocytosis, and bacterial killing. Blood from 20 rats was incubated with LCT, MCT, MCT/LCT, and saline, respectively. MCT-containing emulsions exhibited an inhibitory effect on all PMNL functions investigated, whereas LCT exerted an effect on the phagocytic index only. The administration of a parenteral supply of LCT, MCT/LCT, and saline for 30 h followed by saline infusion for 14 h in discontinuous mode did not influence any of the investigated PMNL functions. Similarly, continuous infusion over 44 h at increasing infusion rates up to 1.5 mL/h did not affect the PMNL functions. The obvious difference between in vitro and in vivo response of the PMNL model emphasizes the necessity for continuous monitoring of in vivo conditions. Appropriate interpretation of the data requires continuous circumspection and consideration of trials in a clinical setting.

O hospital-empresa: do planejamento à conquista do mercado

Different steps of conception of a new hospital are analysed. Planning stage market research and economic-financial viability study are impositive, because they are essential in defining architectonic, organizational and functional projects. Even before hospital activity starts, intensive effort in marketing area must be done, in initial and posterior expansion of market development.

The influence of nutritional status on skin anergy in experimental cancer.

Malignant tumours as well as severe malnutrition can interfere with carcass weight, serum albumin and delayed hypersensitivity tests. In order to identify the separate effects of these two phenomena, Wistar rats were submitted to various nutritional manipulations prior to Walker-256 carcinosarcoma inoculation (TU). Six groups of well-nourished rats with positive response to the Keyhole Limpet Haemocyanin (KLH) test were studied. Three TU-bearing groups were established, [1] protein-deprived before and after TU (group DDT), [2] protein deprived before TU and later brought back to normal chow (group DNT), and [3] those receiving a complete diet throughout the experiment (group NNT). Identical control groups without TU, sham-injected, were called DDC, DNC and NNC. Tumour size and body weight were measured daily. KLH tests were done sequentially and serum albumin was determined at sacrifice. Results indicated that cancer produced marked changes in immune response. Malnutrition was responsible for anergy and weight loss, and further aberrations tended to occur when both conditions were present. Feeding was able to restore body weight and KLH response in tumour-bearing as well as in control rats, but subsequent deterioration occurred in cancer bearing rats after the first week of tumour development. It is concluded that cancer potentiates the effects of malnutrition, on body weight and immune response, but temporary recovery could be demonstrated after adequate refeeding.

Equipamento hospitalar no Brasil: presença, regionalização e tendências

E apresentada uma analise do equipamento hospitalar existente no Brasil, especificamente quanto a sua distribuicao geografica e as tendencias de seu desenvolvimento no periodo compreendido entre 1962 e 1971. Examinando o aspecto referente a participacao da iniciativa particular e estatal, foi demonstrado que houve um aumento percentual, durante o periodo referido, de 56% no numero de hospitais oficiais e de 43% no de hospitais particulares; em consequencia, a participacao dos hospitais particulares no total da rede hospitalar brasileira, que era de 84,9% passou para 83,8%. Analisando o fenomeno sob o ângulo do numero de leitos instalados, verificou-se um aumento de 31% para os hospitais oficiais, contra 71% dos particulares; em consequencia, a participacao dos leitos hospitalares particulares no total brasileiro, que era de 60% em 1962, passou para 66% em 1971. Abordando a distribuicao geografica dos hospitais instalados, dentro do periodo considerado, verificou-se que 42% deles foram instalados na regiao Sudeste, 27% na Nordeste e 17% na regiao Sul. Considerando-se o numero de leitos hospitalares instalados, esses percentuais foram de 62%, 19% e 12% respectivamente. Quanto ao indice de leitos hospitalares por 1.000 habitantes, houve um aumento de 15%, quando se examina a populacao total; nas capitais, houve ligeiro decrescimo, passando o indice de 7,2 para 7,1 leitos/1.000 habitantes, enquanto que, no interior, houve um aumento de 2,5 para 2,9 leitos/1.000 habitantes. Regionalmente, o maior indice de crescimento foi de 56%, na regiao Nordeste; houve aumento de 5,9 para 6,8 leitos/1.000 habitantes nas capitais e de 0,7 para 1,0 no interior.

Problemas de assistência médico-sanitária no Estado de São Paulo, Brasil

Apresenta-se uma analise dos principais problemas medico-sanitarios do Estado de Sao Paulo, Brasil. Verificou-se a possibilidade de definicao de 5 regioes, cujas caracteristicas sao apreciavelmente homogeneas: a primeira, representada pelas sub-regioes de Sao Jose do Rio Preto, Aracatuba e Presidente Prudente; a segunda, correspondente a Bauru e Marilia; a terceira, inclui as areas de Sorocaba, do Litoral e do Vale do Paraiba; a quarta, abrange Campinas e Ribeirao Preto; e a quinta, correspondente a Grande Sao Paulo. Para cada uma dessas regioes foram descritos os indicadores basicos de saude e alguns aspectos relativos ao equipamento de saude disponivel. Verificou-se a dificuldade de relacionar os dois tipos de indicadores. Foram examinados os problemas basicos relativos ao atendimento da populacao urbana e da que habita as regioes rurais do Estado de Sao Paulo.The authors analyse the main medical and sanitary problems in the Brazilian State of S. Paulo and the possibility of defining, within the State, five zones, whose characteristics are outstandingly homogeneous: a first zone, including the regions of S. Jose do Rio Preto, Aracatuba and Presidente Prudente; a second zone, including Bauru and Marilia; a third zone, including the regions of Sorocaba, the coastal areas and the Paraiba Valley; a fourth zone including Campinas and Ribeirao Preto and a fifth zone, represented by Greater S. Paulo. For each zone, the authors outline the basic health indices and some aspects of the available health facilities, concluding that it is difficult to establish a correlation between those two parameters. They also analyse the basic problems concerning the medical care of the S. Paulo State urban and rural populations.

Sistemas de organização de assistência médica: critérios e padrões de avaliação

Sao definidas as recomendacoes da Organizacao Mundial da Saude e pela Organizacao Panamericana da Saude para a estrutura dos sistemas de organizacao de assistencia medica. Sao analisados os dois grandes sistemas - o indireto e o direto, examinando as vantagens e desvantagens de cada um deles para a medicina geral e a especializada, a hospitalizacao, a assistencia farmaceutica e odontologica e as atividades preventivas.

Aspectos demográficos da realidade brasileira e problemas de assistência médica no Brasil

Sao apresentados dados demograficos basicos, que certamente interferem, com os niveis de saude da populacao brasileira. Enquanto 28% da populacao moram em municipios com menos de 20.000 habitantes, 34% habitam cidades de populacao superior a 100.000; trata-se de extremos alem dos quais ha dificuldades para atendimento sanitario satisfatorio da populacao. Foi observado que 35% da populacao brasileira permanece a descoberto dos esquemas previdenciarios, o que significa, na pratica, extrema dificuldade de atendimento medico, juntando-se a esse numero a populacao rural, muito deficientemente atendida, chegou-se a um resultado de cerca de 63% da populacao brasileira total, com assistencia que pode ser definida como precaria.