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ResumoAssim como na maioria dos serviços de emergência do Brasil, a Unidade de Emergência Dr. Armando Lages, principal hospital com este perfil de Alagoas, tem seu potencial limitado pelas lacunas no planejamento e na execução da Atenção Básica. A rede básica de atenção à saúde deveria constituir a principal porta de entrada no sistema. Afirma-se que na Atenção Básica 80% dos problemas de saúde da população sejam resolvidos. O que se verifica, contudo, é o escamoteamento de suas atribuições e potencialidades. Define-se que a Saúde da Família (SF) deve constituir equipes de saúde formadas por médicos, enfermeiros, auxiliares de enfermagem e agentes comunitários, em trabalho interdisciplinar com a definição de um território de abrangência. O processo de referência e contra-referência é imprescindível para que haja uma continuidade das ações e compete ao serviço municipal definir, no âmbito municipal ou regional, os serviços disponíveis para os níveis de maior complexidade. A SF deverá, portanto, em condições especiais, indicar o encaminhamento para consultas especializadas, assim como para os serviços de diagnóstico e internações hospitalares. Na prática, porém, os serviços de atenção terciária acabam absorvendo a demanda proveniente de problemas na rede básica. É o caso da Unidade de Emergência Dr. Armando Lages, na qual, mensalmente, a taxa de ocupação dos leitos é de 109,34%, absorvendo pacientes que não encontram outra referência para solucionar seus problemas de saúde. Obedecendo às normas que regem a Pesquisa em Seres Humanos, foi desenvolvido um estudo descritivo retrospectivo e prospectivo, aplicando-se questionário de perguntas estruturadas a pacientes da clínica cirúrgica da Unidade de Emergência Dr. Armando Lages que tiveram diagnósticos histopatológicos das peças cirúrgicas efetuados no período de janeiro de 2004 a dezembro de 2006. A análise dos dados revelou que, na trajetória dos pacientes pelo Sistema Único de Saúde, princípios doutrinários e organizativos do SUS estão desordenados, confirmando a hipótese do estudo, de que o número evidente de diagnósticos histopatológicos de neoplasias malignas e doenças infecto-parasitárias sugere falhas no planejamento em saúde da rede de Atenção Primária á Saúde. Rev Bras Med Fam e Com

ObjectiveThis study aimed to ascertain the relationship between early diagnosis of giant-cell tumors (GCT) and their prognosis, by correlating the time of symptom onset with the staging of the injury (through the Campanacci classification at the time of diagnosis), and with the type of treatment. The secondary objective of the study was to outline the epidemiological profile of patients with GCT in the region where the data were gathered, and to compare them with data in the literature.MethodsThe authors present an evaluation on 61 patients diagnosed with bone GCT, with regard to the site of involvement, age, initial symptoms, time of symptom onset, classification and type of treatment, among patients attended between May 1994 and August 2009.ResultsThe threshold indicated as the limit for Campanacci stage I tumors to be the commonest diagnosis, with a 98.2% chance that the treatment would be non-aggressive, was 2 months after symptom onset. This finding was statistically significant (p = 0.017). Every additional month increased the chance that a patient would be diagnosed with an advanced-stage tumor by 10.94%, in relation to the chances of having the other two stages of the tumor.ConclusionThe study result not only suggests that the alternative hypothesis that the earlier the diagnosis of GCT is, the less severe the lesion will be, has been confirmed; but also especially predicts the relationship between the time of symptom appearance and the severity of the tumor.

Background: Since April 2009, human cases of respiratory infections originated by novel swine-origin influenza A virus, designated pandemic A(H1N1)v, have been detected worldwide, causing immediate international concern. In Brazil, as of 06 October 2009, there have been 14.229 confirmed cases of infection and 1.167 deaths. Mortality rates of 0.61/100.000 inhabitantes were observed.Methods: The virus samples were obtained from clinical specimens from patients who came from the states of São Paulo, Mato Grosso and Distrito Federal. Virus isolation was performed in MDCK cell cultures. Viral RNA was extracted from the infected cells and submitted to reverse transcription-amplification reactions with primers set designed to cover the complete segments of the HA, NA and MP genes. The amplified products were directed sequenced. The complete genes of hemagglutin (HA), neuraminidase (NA) and matrix (MP) were sequenced.Results: Comparative sequence analysis indicated the presence of point mutations in the HA gene of the Brazilian strains when compared to the reference strain A/California/04/H1N1 (2009). These alterations do not change the all five of the known antigenic sites of the HA protein. The canonical sites for N-linked glycosylation at NxS/T motifs were preserved among strains. Data of the MP sequence analysis revealed that the strains of this study carried the S31N mutation that confers cross-resistence to the adamantine class of anti-influenza drugs. Sequencing of the NA gene showed that the neuraminidase relative drug binding pocket represented by H275 was not altered, yielding the strains sensitive to oseltamivir. Conclusion:These results emphasize the contribution of molecular surveillance, in addition to antigenic characterization to monitor the evolutionary pattern of the pandemic A(H1N1)v, in order to vaccine development, and evaluation of antiviral drugs susceptibility.