Video-Assisted Surgery Implementation in the Public Health System of a Developing Country

Background

Over the last two decades, video-assisted surgery has become the preferential access route for many procedures. Despite cholecystectomy being the laparoscopic procedure most frequently performed in Brazilian public hospitals from 2008 to 2012, the lack of population-based studies led us to conduct a survey on the prevalence of video-assisted surgery in the treatment of patients using the Sistema Único de Saúde (SUS) (Unified Health System), which is the universal, free, and public healthcare system of Brazil.

Methods

By analyzing the DATASUS (national public health registry database), the prevalence of laparoscopic cholecystectomy and open cholecystectomy (OC) was calculated in the period from January to December in 2008, 2010 and 2012, taking into consideration their geographic distribution throughout Brazil.

Results

At the end of the study period, an increase in the number of laparoscopic cholecystectomies was observed, with a variation of 125.7 %. However, OC was more prevalent despite an increase in the use of video-assisted surgery over the 5-year study period, increasing from 12 to 25 % in 2012.

Conclusions

In spite of a trend toward increased use of video-assisted surgery for treating SUS patients during the period under study, the data from 2012 are still far from being ideal. For this population, OC via laparotomy is still the most prevalent option in all regions. This information must encourage the Brazilian surgical societies to push for an improvement in the supply of the treatment provided by the public health system.     

Long-term decrease in Na,K-ATPase activity after pilocarpine-induced status epilepticus is associated with nitration of its alpha subunit

Temporal lobe epilepsy (TLE) is the most common type of epilepsy with about one third of TLE patients being refractory to antiepileptic drugs. Knowledge about the mechanisms underlying seizure activity is fundamental to the discovery of new drug targets. Brain Na⁺,K⁺-ATPase activity contributes to the maintenance of the electrochemical gradients underlying neuronal resting and action potentials as well as the uptake and release of neurotransmitters. In the present study we tested the hypothesis that decreased Na⁺,K⁺-ATPase activity is associated with changes in the alpha subunit phosphorylation and/or redox state. Activity of Na⁺,K⁺-ATPase decreased in the hippocampus of C57BL/6 mice 60 days after pilocarpine-induced status epilepticus (SE). In addition, the Michaelis–Menten constant for ATP of α2/3 isoforms increased at the same time point. Nitration of the α subunit may underlie decreased Na⁺,K⁺-ATPase activity, however no changes in expression or phosphorylation state at Ser⁹⁴³ were found. Further studies are necessary define the potential of nitrated Na⁺,K⁺-ATPase as a new therapeutic target for seizure disorders.     

True Strength of Ceramic Fiber Bundles: Experiments and Simulations

A study on the strength of ceramic fiber bundles based on experimental and computational procedures is presented. Tests were performed on single filaments and bundles composed of two fibers with different nominal fiber counts. A method based on fiber rupture signals was developed to estimate the amount of filament rupture during the test. Through this method, the fiber bundle true strength was determined and its variation with the initial fiber count observed. By using different load-sharing models and the single filament data as input parameter, simulations were also developed to verify this behavior. Through different approaches between experiments and simulations, it was noted that the fiber bundle true strength increased with the fiber count. Moreover, a variation of the fibers’ final proportion in the bundles relative to the initial amount was verified in both approaches. Finally, discussions on the influence of different load-sharing models on the results are presented.     

Short-term treatment of gastric ulcer

Gastric ulcer is relatively infrequent, and clinical trials are often based on small-sized samples. The aim of this study was to define the gold standard therapy of active gastric ulcer. We included all single- or double-blind clinical trials on the short-term treatment of gastric ulcer. All the articles published over the period 1977–1994 were reviewed. Meta-analysis was done with both fixed and random effect models; results were shown using Galbraith's radial plot. Forty-eight papers comprising 52 studies were evaluated. Cimetidine, ranitidine, and famotidine proved significantly better than placebo [odds ratio (OR) and 95% confidence interval (CI 95%) at four to six weeks were: 2.67 (2.03–3.52), 3.94 (2.28–6.80), 1.76 (1.08–2.88), respectively]. Cimetidine and ranitidine had results comparable with the newer H₂ blockers [OR (CI 95%) at four weeks: 1.16 (0.91–1.47), 1.11 (0.80–1.55), respectively]. H₂ blockers were proved comparable with either sucralfate [OR (CI 95%) at eight weeks: 0.81 (0.37–1.79)] or bismuth [OR (CI 95%) at four to six weeks: 0.67 (0.37–1.20)]. Omeprazole is more effective than H₂ blockers [OR (CI 95%) at four weeks: 2.00 (1.57–2.55)]. It is concluded that H₂ blockers are preferred to either a placebo or sucralfate for short-term gastric ulcer treatment; the newer H₂ blockers do not have significant advantages over the older types; omeprazole can be regarded as the gold standard for active gastric ulcer treatment.The statistical analysis and computing with plot program was performed by G. Leandro, MD, Biostatistician. This work was performed under the auspices of the Roberto Farini Foundation for Gastroenterological Research.