Resumo: O objetivo deste estudo foi comparar os resultados obtidos para a coordenação do cuidado a partir do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), com os parâmetros adotados pelo Atlas de Medidas de Coordenação do Cuidado e pelo Observatório Europeu de Políticas e Sistemas de Saúde. Foi realizado estudo transversal, com base no banco de dados do 3º ciclo do PMAQ-AB. Foram criadas três tipologias de coordenação do cuidado: PMAQ-AB, Atlas e Observatório. O teste qui-quadrado foi aplicado para comparar as proporções; os testes de Kruskal-Wallis e de Nemenyi para verificar e identificar eventuais diferenças entre as tipologias. O nível de significância foi de 5%. Foram avaliadas 35.350 equipes que realizaram alguma atividade de coordenação do cuidado. Observou-se diferença significativa (p < 0,001), entre os níveis de coordenação, com maior percentual entre o nível alto e médio nos três instrumentos, PMAQ-AB (56,07% e 38,35%), Atlas (52,63% e 40,66%) e o Observatório (44,82% e 43,98%). Na comparação dos indicadores, houve diferença significativa (p < 0,001) entre as tipologias. Para o Brasil, na tipologia PMAQ-AB, todos os estratos exibiram maior percentual entre o nível alto e médio; no Atlas, o estrato 1 destacou-se no nível médio (43,81%) e, no Observatório, predominou o nível alto. Na comparação dos indicadores por estratos, pelo menos um estrato diferiu dos demais (p < 0,001). O 6 se distinguiu dos demais (p < 0,001), e o 1 diferiu de todos (p < 0,001), exceto do 2 (p > 0,05). Os níveis de coordenação do cuidado diferenciaram-se entre os instrumentos utilizados. Altos e médios níveis foram identificados, demonstrando a necessidade de estudos adicionais.

Abstract: This study aimed to compare the results obtained with the coordination of care through the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), with the parameters adopted by the Care Coordination Measures Atlas and the European Observatory on Health Systems and Policies. A cross-sectional study was performed using the dataset from the third cycle of the PMAQ-AB. Three typologies of coordination of care were created: PMAQ-AB, Atlas, and Observatory. Chi-square test was applied to compare proportions and Kruskal-Wallis and Nemenyi tests to verify and identify potential differences between the typologies. Significance was set at 5%. In all, 35,350 teams were assessed that performed some activity in care coordination. A significant difference was observed (p < 0.001) between levels of coordination, with a higher percentage between the high and medium levels in the three instruments, PMAQ-AB (56.07% and 38.35%), Atlas (52.63% and 40.66%), and Observatory (44.82% and 43.98%). In the comparison of the indicators, there was a significant difference (p < 0.001) between the typologies. For Brazil, in the PMAQ-AB typology, all the strata displayed a higher percentage between the high and medium levels; in the Atlas, stratum 1 stood out in the medium level (43.81%); the high level predominated in the Observatory. In the comparison of the indicators by strata, at least one stratum differed from the others (p < 0.001). Number 6 differed from the others (p < 0.001), and number 1 differed from all of them (p < 0.001) except number 2 (p > 0.05). The levels of coordination of care differed according to the instruments used. High and medium levels were identified, showing the need for additional studies.

Resumen: El objetivo de este estudio fue comparar los resultados obtenidos para la coordinación del cuidado, a partir del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB), con los parámetros adoptados por el Atlas de Medidas de Coordinación del Cuidado y por el Observatorio Europeo de Políticas y Sistemas de Salud. Se realizó un estudio transversal, basado en el banco de datos del 3er ciclo del PMAQ-AB. Se crearon tres tipologías de coordinación del cuidado: PMAQ-AB, Atlas y Observatorio. El test de chi-cuadrado se aplicó para comparar las proporciones, el test de Kruskal-Wallis y el de Nemenyi para verificar e identificar eventuales diferencias entre las tipologías. El nivel de significancia fue de 5%. Se evaluaron a 35.350 equipos que realizaron alguna actividad de coordinación del cuidado. Se observó una diferencia significativa (p < 0,001), entre los niveles de coordinación, con mayor porcentaje entre el nivel alto y medio en los tres instrumentos, PMAQ-AB (56,07% y 38,35%), Atlas (52,63% y 40,66%) y el Observatorio (44,82% y 43,98%). En la comparación de los indicadores, hubo una diferencia significativa (p < 0,001) entre las tipologías. Para Brasil, en la tipología PMAQ-AB todos los estratos expusieron un mayor porcentaje entre el nivel alto y medio; en el Atlas, el estrato 1 se destacó en el nivel medio (43,81%) y, en el Observatorio, predominó el nivel alto. En la comparación de los indicadores por estratos, por lo menos un estrato difirió de los demás (p < 0,001). El 6 se distinguió de los demás (p < 0,001), y el 1 difirió de todos (p < 0,001), excepto del 2 (p > 0,05). Los niveles de coordinación del cuidado se diferenciaron entre los instrumentos utilizados. Se identificaron niveles altos y medios, demostrando la necesidad de estudios adicionales.

Resumo: O objetivo deste estudo foi comparar os resultados obtidos para a coordenação do cuidado a partir do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), com os parâmetros adotados pelo Atlas de Medidas de Coordenação do Cuidado e pelo Observatório Europeu de Políticas e Sistemas de Saúde. Foi realizado estudo transversal, com base no banco de dados do 3º ciclo do PMAQ-AB. Foram criadas três tipologias de coordenação do cuidado: PMAQ-AB, Atlas e Observatório. O teste qui-quadrado foi aplicado para comparar as proporções; os testes de Kruskal-Wallis e de Nemenyi para verificar e identificar eventuais diferenças entre as tipologias. O nível de significância foi de 5%. Foram avaliadas 35.350 equipes que realizaram alguma atividade de coordenação do cuidado. Observou-se diferença significativa (p < 0,001), entre os níveis de coordenação, com maior percentual entre o nível alto e médio nos três instrumentos, PMAQ-AB (56,07% e 38,35%), Atlas (52,63% e 40,66%) e o Observatório (44,82% e 43,98%). Na comparação dos indicadores, houve diferença significativa (p < 0,001) entre as tipologias. Para o Brasil, na tipologia PMAQ-AB, todos os estratos exibiram maior percentual entre o nível alto e médio; no Atlas, o estrato 1 destacou-se no nível médio (43,81%) e, no Observatório, predominou o nível alto. Na comparação dos indicadores por estratos, pelo menos um estrato diferiu dos demais (p < 0,001). O 6 se distinguiu dos demais (p < 0,001), e o 1 diferiu de todos (p < 0,001), exceto do 2 (p > 0,05). Os níveis de coordenação do cuidado diferenciaram-se entre os instrumentos utilizados. Altos e médios níveis foram identificados, demonstrando a necessidade de estudos adicionais.

Abstract: This study aimed to compare the results obtained with the coordination of care through the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), with the parameters adopted by the Care Coordination Measures Atlas and the European Observatory on Health Systems and Policies. A cross-sectional study was performed using the dataset from the third cycle of the PMAQ-AB. Three typologies of coordination of care were created: PMAQ-AB, Atlas, and Observatory. Chi-square test was applied to compare proportions and Kruskal-Wallis and Nemenyi tests to verify and identify potential differences between the typologies. Significance was set at 5%. In all, 35,350 teams were assessed that performed some activity in care coordination. A significant difference was observed (p < 0.001) between levels of coordination, with a higher percentage between the high and medium levels in the three instruments, PMAQ-AB (56.07% and 38.35%), Atlas (52.63% and 40.66%), and Observatory (44.82% and 43.98%). In the comparison of the indicators, there was a significant difference (p < 0.001) between the typologies. For Brazil, in the PMAQ-AB typology, all the strata displayed a higher percentage between the high and medium levels; in the Atlas, stratum 1 stood out in the medium level (43.81%); the high level predominated in the Observatory. In the comparison of the indicators by strata, at least one stratum differed from the others (p < 0.001). Number 6 differed from the others (p < 0.001), and number 1 differed from all of them (p < 0.001) except number 2 (p > 0.05). The levels of coordination of care differed according to the instruments used. High and medium levels were identified, showing the need for additional studies.

Resumen: El objetivo de este estudio fue comparar los resultados obtenidos para la coordinación del cuidado, a partir del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB), con los parámetros adoptados por el Atlas de Medidas de Coordinación del Cuidado y por el Observatorio Europeo de Políticas y Sistemas de Salud. Se realizó un estudio transversal, basado en el banco de datos del 3er ciclo del PMAQ-AB. Se crearon tres tipologías de coordinación del cuidado: PMAQ-AB, Atlas y Observatorio. El test de chi-cuadrado se aplicó para comparar las proporciones, el test de Kruskal-Wallis y el de Nemenyi para verificar e identificar eventuales diferencias entre las tipologías. El nivel de significancia fue de 5%. Se evaluaron a 35.350 equipos que realizaron alguna actividad de coordinación del cuidado. Se observó una diferencia significativa (p < 0,001), entre los niveles de coordinación, con mayor porcentaje entre el nivel alto y medio en los tres instrumentos, PMAQ-AB (56,07% y 38,35%), Atlas (52,63% y 40,66%) y el Observatorio (44,82% y 43,98%). En la comparación de los indicadores, hubo una diferencia significativa (p < 0,001) entre las tipologías. Para Brasil, en la tipología PMAQ-AB todos los estratos expusieron un mayor porcentaje entre el nivel alto y medio; en el Atlas, el estrato 1 se destacó en el nivel medio (43,81%) y, en el Observatorio, predominó el nivel alto. En la comparación de los indicadores por estratos, por lo menos un estrato difirió de los demás (p < 0,001). El 6 se distinguió de los demás (p < 0,001), y el 1 difirió de todos (p < 0,001), excepto del 2 (p > 0,05). Los niveles de coordinación del cuidado se diferenciaron entre los instrumentos utilizados. Se identificaron niveles altos y medios, demostrando la necesidad de estudios adicionales.

O estudo buscou compreender a coordenação do cuidado pela Atenção Primária à Saúde para casos de gestação, câncer de mama e de colo uterino. O atributo foi entendido como a responsabilidade que os profissionais das equipes de Saúde da Família (eSF) têm em coordenar a atenção prestada aos usuários ao longo da rede de atenção, assumindo o acompanhamento continuado e a identificação de necessidades. De modo geral, foram identificadas ações de coordenação do cuidado mais bem estruturadas nas ações internas em nível primário, sobretudo aquelas de atenção às gestantes. Quando o trabalho de coordenação envolvia a rede, o destaque foi para a ausência da contrarreferência e para a informalidade nos processos de continuidade da atenção.

The aim of this study was to understand the coordination of primary health care for pregnant women and breast and cervical cancer patients. The attribute was understood as the responsibility family health care workers have for coordinating care delivery, including continuous follow-up and the identification of patient needs. Overall, the findings show that care coordination was better structured at internal primary care level, particularly pregnancy care. When coordination involved the care network, the findings highlight lack of counter-referral and informal processes for the continuity of care.

El objetivo del estudio fue entender la coordinación del cuidado por parte de la Atención Primaria de la Salud para casos de gestación, cáncer de mama y de cuello uterino. El atributo fue entendido como la responsabilidad que los profesionales de los equipos de salud de la familia tienen para coordinar la atención prestada a los usuarios en la red de atención, asumiendo el acompañamiento continuado y la identificación de necesidades. Por lo general, se identificaron acciones de coordinación del cuidado mejor estructuradas en las acciones internas en el nivel primario, principalmente para aquellas de atención a las gestantes. Cuando el trabajo de coordinación envolvía la red, el destaque fue para la ausencia de la contrarreferencia y para la informalidad en los procesos para la continuidad de la atención.

The aim of this study was to understand the coordination of primary health care for pregnant women and breast and cervical cancer patients. The attribute was understood as the responsibility family health care workers have for coordinating care delivery, including continuous follow-up and the identification of patient needs. Overall, the findings show that care coordination was better structured at internal primary care level, particularly pregnancy care. When coordination involved the care network, the findings highlight lack of counter-referral and informal processes for the continuity of care.

El objetivo del estudio fue entender la coordinación del cuidado por parte de la Atención Primaria de la Salud para casos de gestación, cáncer de mama y de cuello uterino. El atributo fue entendido como la responsabilidad que los profesionales de los equipos de salud de la familia tienen para coordinar la atención prestada a los usuarios en la red de atención, asumiendo el acompañamiento continuado y la identificación de necesidades. Por lo general, se identificaron acciones de coordinación del cuidado mejor estructuradas en las acciones internas en el nivel primario, principalmente para aquellas de atención a las gestantes. Cuando el trabajo de coordinación envolvía la red, el destaque fue para la ausencia de la contrarreferencia y para la informalidad en los procesos para la continuidad de la atención.

O estudo buscou compreender a coordenação do cuidado pela Atenção Primária à Saúde para casos de gestação, câncer de mama e de colo uterino. O atributo foi entendido como a responsabilidade que os profissionais das equipes de Saúde da Família (eSF) têm em coordenar a atenção prestada aos usuários ao longo da rede de atenção, assumindo o acompanhamento continuado e a identificação de necessidades. De modo geral, foram identificadas ações de coordenação do cuidado mais bem estruturadas nas ações internas em nível primário, sobretudo aquelas de atenção às gestantes. Quando o trabalho de coordenação envolvia a rede, o destaque foi para a ausência da contrarreferência e para a informalidade nos processos de continuidade da atenção.

ABSTRACT Background: the giant cell tumor of the tendon sheath occupies the second place in frequency in the neoplasms of the hand. The diagnosis is clinical and radiological, confirmed by anatomic-pathological studies. Objective: to describe the epidemiology, clinical and histological aspects of the giant cell tumor of the tendon sheath. Methods: a descriptive observational study was carried out for the report of six cases from the files of the Department of Pathology from 2016 and 2018, to identify the cases with a diagnosis of giant cell tumor of the tendon sheath. Results: a total of six cases of giant cell tumor of the tendon sheath were diagnosed, corresponding 50% to each sex; the majority were under 40 years old; and in all cases the site of presentation of the tumor was the hand; with a predominance in the palm region of the thumb. None of the cases manifested pain. In the morphological study, the characteristic histological elements of the giant cell tumor of the tendon sheath were observed microscopically. Conclusions: the six patients studied presented the typical symptoms of the Giant cell tumor of the tendon sheath, referring to an increase in volume that was corroborated with the physical examination by palpating a mass of subcutaneous, non-painful, smooth, soft tissue with well-defined borders. In the same way, histopathologically, the characteristic morphological elements were corroborated, for which it can be established that there was a clinical-pathological correlation of 100%.

Fundamento: el tumor de células gigantes de la vaina tendinosa ocupa el segundo lugar en frecuencia dentro de las neoplasias de la mano. El diagnóstico es clínico y radiológico y se confirma por medios de estudios anatomopatológicos. Objetivo: describir la epidemiología, aspectos clínicos e histológicos del tumor de células gigantes de la vaina tendinosa. Métodos: se realizó un estudio observacional descriptivo para el reporte de seis casos de los archivos del Departamento de Anatomía Patológica de 2016 y 2018, para identificar los casos con diagnóstico tumor de células gigantes de la vaina tendinosa. Resultados: se diagnosticaron un total de seis casos de tumor de células gigantes de la vaina tendinosa, los cuales se correspondieron a igual número de casos para cada sexo, en su mayoría eran pacientes menores de 40 años y en todos los casos el sitio de presentación del tumor fue la mano, con predominio de la región palmar del dedo pulgar. Ninguno de los casos manifestó dolor. En el estudio morfológico microscópico se observaron, los elementos histológicos característicos del tumor de células gigantes de la vaina tendinosa. Conclusiones: los seis pacientes estudiados presentaron la clínica típica del tumor de células gigantes de vaina tendinosa, es decir, refirieron aumento de volumen que se corroboró con el examen físico al palpar una tumoración de tejido subcutáneo, no dolorosa, lisa, blanda y de bordes bien definidos. De igual manera en el estudio histopatológico, se corroboraron los elementos morfológicos característicos, por lo cual se puede establecer que hubo una correlación clínico-patológica del 100 %.

Abstract Brazilian Purpuric Fever (BPF) is a hemorrhagic pediatric illness caused by Haemophilus influenzae biogroup aegyptius (Hae), a bacterium that was formerly associated with self-limited purulent conjunctivitis. BPF is assumed to be eradicated. However, the virulence mechanisms inherent to Hae strains associated with BPF is still a mystery and deficient in studies. Here, we aim to analyze the role of the autotransporter genes related to adherence and colonization las, tabA1, and hadA genes through RT-qPCR expression profiling and knockout mutants. Relative quantification by real-time PCR after infection in human cells and infant rat model suggests that las was initially downregulated probably duo to immune evasion, tabA1, and hadA were overexpressed in general, suggesting an active role of TabA1 and HadA1 adhesins in Hae in vitro and in vivo. Transformation attempts were unsuccessful despite the use of multiple technical approaches and in silico analysis revealed that Hae lacks genes related to competence in Haemophilus, which could be part of the elucidation of the difficulty of genetically manipulating Hae strains.

Abstract S. pneumoniae, commonly known as pneumococcus, is a naturally competent Gram-positive bacterium and is the major cause of pneumonia in elderly and children in developing countries. This pathogen is associated with respiratory diseases affected by pollution. The objective of this work was determining the effect of ash and environmental dust from the burning of sugarcane on pneumococci bacterial transformation. The transformation capacity of the Pn360 pneumococci strain was performed using the assays of DNA donor of mutant for luxS gene. Thus, the transformation tests were performed in contact with dust collected in the southwestern region of Brazil (important region where burning of sugar cane is present in the agriculture). The use of degradative practices in the sugar cane agriculture in Brazil was involved in the transformation capacity of the S. pneumoniae. This phenomenon includes important consequences for public health concerning to resistance acquisition and new virulence factors of this important infection. In conclusion, we obtained important results concerning the action of environmental pollution in Streptococcus pneumoniae transformation, increasing the DNA acquisition for this pathogen.

ABSTRACT Introduction: Effective and long-term combined antiretroviral therapy (cART) has decreased morbidity and mortality in HIV-infected individuals. Despite treatment advances, HIV-infected children continue to develop noninfectious conditions, including liver fibrosis. Methods: Cross-sectional study designed to identify liver fibrosis in HIV-infected adolescents and young adults, in an outpatients clinic of Pediatric Infectious Diseases Division at Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), diagnosed by noninvasive methods (liver elastography–FibroScan®, APRI and FIB4). Variables examined included demographics, clinical, laboratories, HIV treatment. All participants underwent FibroScan® to measure liver parenchyma elasticity. Values equal to above 7.0 kPa were interpreted as the presence of significant liver fibrosis. Two different biomarkers of liver fibrosis were employed: the AST-to-Platelet Ratio Index (APRI) and the Fibrosis-4 score (FIB-4). APRI values above 1.5 have been considered as levels of clinically significant liver fibrosis and FIB-4 values above 3.25 suggested the presence of advanced fibrosis. Results: Between August 2014 and March 2017, the study enrolled 97 patients, age 10–27 years old, fourteen of 97 subjects (14.4%) presented liver stiffness (≥7 kPa) detected by the liver elastography. No patient had APRI> 1.5. No patient had FIB4 value > 3.25. The only isolated laboratory parameter that could be significantly associated with high liver stiffness was thrombocytopenia (p= 0.022, Fisher's exact test). Conclusion: Liver stiffness was identified in 14.4% (14/97) of this cohort by liver elastography. Liver disease in HIV-infected adolescents and young adults manifests itself silently, so should be routinely investigated.

ABSTRACT Background: the indices of discrepancy and coincidence of the causes of death between the clinical and morphological diagnosis constitute, indirectly, an indicator of the quality of medical care. Objective: to determine the relationship between clinical and pathological diagnoses based on the results of necropsies of the dead patients in the 2015-2017 period; with emphasis on hospital care indicators. Methods: an observational, descriptive, longitudinal prospective study was conducted with a sample of 1 164 autopsies; 89.1 % of the population. Socio-demographic variables and others referred to the clinical and pathological diagnoses of the causes of death and their degree of agreement related to hospital stay, hospitalization service and diagnosed diseases were selected. Results: in the direct cause of death the coincidence was greater than the non-coincidence. In the basic cause of death the non-coincidence was similar to the coincidence. The coincidence for the direct cause of death according to sex was greater in men and the age group, with greater coincidence was that of 81-90. There was a predominance of coincidence in patients with incomes of less than 24 hours and 1 to 3 days; as well as those who died in the therapy service, followed by clinical specialties. Conclusions: there was a greater number of diagnostic matches for the direct cause of death; and in the basic cause of death the discrepancies predominate.

RESUMEN Fundamento: los índices de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y morfológico constituyen, de forma indirecta, un indicador de calidad de la atención médica. Objetivo: determinar la relación entre diagnósticos clínicos y patológicos con base en los resultados de necropsias de pacientes que resultaron fallecidos en el periodo 2015-2017; con énfasis en los indicadores de atención hospitalaria. Métodos: se realizó un estudio observacional, descriptivo, longitudinal prospectivo, con una muestra de 1 164 necropsias; 89,1 % de la población. Se seleccionaron variables sociodemográficas, otras referidas a los diagnósticos clínicos y anatomopatológicos de las causas de muerte y su grado de concordancia relacionado con estadía hospitalaria, servicio de hospitalización y enfermedades diagnosticadas. Resultados: en la causa directa de muerte la coincidencia fue mayor que la no coincidencia, en la causa básica de muerte la no coincidencia fue similar a la coincidencia. La coincidencia para la causa directa de muerte según el sexo fue mayor en hombres y el grupo de edad, con mayor coincidencia fue el de 81-90. Existió un predominio de la coincidencia en los pacientes con ingresos de menos de 24 horas y de uno a tres días; así como en los que fallecieron en el servicio de terapia, seguido de las especialidades clínicas. Conclusiones: existió mayor número de coincidencias diagnósticas para la causa directa de muerte y en la causa básica de muerte predominando las discrepancias.

ABSTRACT Background: the discrepancy indexes and the coincidence of the causes of death in clinical and morphological diagnosis are, in an indirect way, indicators of the quality of medical care. Objective: to describe the importance of the autopsy, as well as general aspects of the clinical-pathological correlation. Methods: a literature review in Spanish and English was carried out in PubMed, Hinari and SciELO databases from 2000 to 2019; 58 published documents were obtained, of which 27 were selected (10 original research articles, 12 reviews, 3 theses and 2 books). Results: autopsy allows the comparison of clinical and morphological findings; it is considered the final complement of the clinical investigation. As such, the autopsy is not simply a corrective measure of misdiagnosis with statistical purposes, but a monitoring of diagnosis procedures and techniques and knowledge refining. Conclusions: the systematic analysis of mistakes and successes is an inexhaustible source of possibilities to better treat every new patient.

RESUMEN Fundamento: los índices de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y morfológico constituyen de forma indirecta, un indicador de calidad de la atención médica. Objetivo: describir la importancia de la autopsia así como elementos generales de la correlación clínico patológica. Métodos: se realizó una revisión bibliográfica en idiomas español e inglés en las bases de datos PubMed, Hinari y SciELO desde el año 2000 a 2019 de las cuales se obtuvieron 58 documentos publicados, de ellos se seleccionaron 27 (10 trabajos originales, 12 revisiones, tres tesis y dos libros). Resultados: la autopsia permite la comparación de los hallazgos clínicos con los morfológicos, se considera que representa el complemento final de la investigación clínica. Visto así, la autopsia no es una medida simplemente correctiva de diagnósticos equivocados con fines estadísticos, sino una vigilante del procedimiento y de las técnicas de diagnóstico y de refinamiento del conocimiento. Conclusiones: el análisis sistemático de los errores y aciertos constituye un caudal inagotable de posibilidades para tratar mejor a cada nuevo paciente.

El cáncer de vesícula biliar es una enfermedad poco frecuente en el mundo y altamente letal. Objetivo: caracterizar histopatológicamente el cáncer de vesícula biliar en el Hospital Clínico Quirúrgico Docente “Joaquín Albarrán” de La Habana-Cuba, en el periodo 2010 al 2019. Método: se realizó un estudio retrospectivo, descriptivo y observacional, en el cual se revisaron los registros de biopsias y necropsias para identificar los casos con diagnóstico histológico de cáncer de vesícula biliar, se revisaron además tejidos fijados en parafina del archivo. Resultados: fueron diagnosticados 10 casos de cáncer de vesícula, 9 femenino y 1 masculino, todos mayores de 60 años. Histológicamente la variedad predominante fue el adenocarcinoma moderadamente diferenciado, siendo 2 de ellos mucoproductores, de los cuales 1 infiltrante y con permeación linfática. Conclusión: el cáncer de vesícula biliar es una enfermedad con muy baja frecuencia y su diagnóstico, continua siendo un hecho incidental, es decir, que el diagnóstico se establece en el examen histopatológico luego de la colecistectomía o en la necropsia. La variedad más frecuente es el adenocarcinoma moderadamente diferenciado.

Gallbladder cancer is a rare and highly lethal disease in the world. Objective: To characterize histopathologically gallbladder cancer at the “Joaquín Albarrán” Clinical Teaching Surgical Hospital of Havana-Cuba, in the period 2010 to 2019. Methods: A retrospective, descriptive and observational study was conducted, in which biopsy and necropsy records were reviewed to identify cases with a histological diagnosis of gallbladder cancer. Paraffin-embedded tissues from the archive were also reviewed. Results: Ten cases of gallbladder cancer were diagnosed, nine female and one male, all over 60 years old. Histologically the predominant variety was moderately differentiated adenocarcinoma, being 2 of them mucoproducers, of which 1 was infiltrating and with lymphatic permeation. Conclusion: Gallbladder cancer is a very low frequency disease and its diagnosis continues to be an incidental fact, that is, the diagnosis is established in the histopathological examination after cholecystectomy or in the necropsy. The most frequent variety is moderately differentiated adenocarcinoma.

ABSTRACT OBJECTIVE To associate the strength of community health workers interventions with primary health care strategies for women’s and children’s health, diabetes, and hypertension. METHODS This is a cross-sectional study assessing 29,778 family health teams working in primary health care in Brazil in 2014. The association between community health workers activity levels and primary health care facilities was analyzed using multiple logistic regression. RESULTS We found higher levels of community health workers activities strongly associated with primary health care practices (OR = 6.88) for those activities targeting hypertension management, followed by children’s health (OR = 6.56), and women’s health (OR = 6.21). CONCLUSIONS At a time when Brazil discusses whether community health workers should or should not remain in the same scale-up and skill level as they currently are, our results reinforce the importance of these workers for the care model advocated by the Brazilian Unified Health System.

ABSTRACT OBJECTIVE To associate the strength of community health workers interventions with primary health care strategies for women’s and children’s health, diabetes, and hypertension. METHODS This is a cross-sectional study assessing 29,778 family health teams working in primary health care in Brazil in 2014. The association between community health workers activity levels and primary health care facilities was analyzed using multiple logistic regression. RESULTS We found higher levels of community health workers activities strongly associated with primary health care practices (OR = 6.88) for those activities targeting hypertension management, followed by children’s health (OR = 6.56), and women’s health (OR = 6.21). CONCLUSIONS At a time when Brazil discusses whether community health workers should or should not remain in the same scale-up and skill level as they currently are, our results reinforce the importance of these workers for the care model advocated by the Brazilian Unified Health System.

ABSTRACT Background: myocardial rupture is a rare complication of acute myocardial infarction with an overall incidence of around 6.2 %. Objective: to characterize the deaths due to acute myocardial infarction with the rupture of the left ventricle wall. Methods: a retrospective, descriptive and observational study was carried out in which the deceased were analyzed with a diagnosis of direct cause of death: cardiac tamponade due to hemopericardium, myocardial rupture and acute myocardial infarction. Results: of 877 acute myocardial infarcts diagnosed between 2010 and 2018, 16 of them had myocardial wall rupture of which 68.8% were male. The habit of smoking was the predominant risk factor. Only in 35.7 % the correct clinical diagnosis of AMI was made and in none of the cases was the diagnosis of myocardial rupture or cardiac tamponade due to hemopericardium. The anatomical region of the heart where myocardial ruptures were most frequently located was in the posterior wall. Conclusions: rupture of the myocardial wall is a rare but catastrophic complication of infarction with a high mortality, however, this can be reduced if the clinical picture is suspected, and an early diagnosis is made with the introduction of support measures to maintain hemodynamic stability.

RESUMEN Fundamento: la rotura miocárdica es una complicación rara del infarto agudo de miocardio con una incidencia global de alrededor del 6,2 %. Objetivo: caracterizar los fallecidos por infarto agudo de miocardio con la rotura de pared de ventrículo izquierdo. Métodos: se realizó un estudio retrospectivo, descriptivo y observacional, en el cual se analizaron los fallecidos con diagnóstico de causa directa de muerte: taponamiento cardíaco por hemopericardio, rotura de miocardio e infarto agudo de miocardio. Resultados: de 877 infartos agudos de miocardio diagnosticados entre 2010 a 2018, 16 de ellos presentaron rotura de pared miocárdica de los cuales 68,8 % eran del masculino. El hábito de fumar fue el factor de riesgo predominante. Solo en un 35,7 % se realizó el diagnóstico clínico correcto de IAM y en ninguno de los casos fue planteado el diagnóstico de rotura de miocardio o taponamiento cardíaco por hemopericardio. La región anatómica del corazón donde con mayor frecuencia se localizaron las roturas de miocardio fue en la pared posterior. Conclusiones: la rotura de la pared de miocardio es una complicación del infarto poco frecuente pero catastrófica con una mortalidad elevada, sin embargo, esta puede reducirse si el cuadro clínico es sospechado, y se realiza un diagnóstico precoz con instauración de medidas de apoyo para mantener la estabilidad hemodinámica.

ABSTRACT The objective of the present study is directed to exhibit ethical peculiarities of the anatomical-pathological work in view of the historical-social reality. Theoretical and empirical methods are used and from the documentary analysis it occurs with modality in the contemporary approaches. The study of general aspects referred to the morality and to the ethics allowed to gain access to definitions, legal bases and historical evolution, simultaneously that deepens in its aftereffect in the sector health and the peculiarities of the anatomical-pathological work develop from its declarations in the welfare, teaching and investigative activity. One concludes that the general ethical beginning of the professional and medical conduct is applicable to the anatomical-pathological work in all its spheres; as those of the bioethics.

RESUMEN El objetivo del presente estudio está dirigido a exponer particularidades éticas del trabajo anatomopatológico a la luz de la realidad histórico social. Se emplean métodos teóricos y empíricos y a partir del análisis documental se opera con referentes en los enfoques contemporáneos. El estudio de aspectos generales referidos a la moral y a la ética permitió acceder a definiciones, bases legales y evolución histórica, a la vez que se profundiza en su repercusión en el sector salud y se desarrollan las peculiaridades del trabajo anatomopatológico desde sus manifestaciones en la actividad asistencial, docente e investigativa. Se concluye que los principios éticos generales de la conducta profesional y médica son aplicables al trabajo anatomopatológico en todas sus esferas; al igual que los de la bioética.