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A Peste Suína Clássica é uma enfermidade viral, cuja gravidade pode impactar na comercialização internacional de animais e produtos de origem animal. O último foco desta doença no Rio Grande do Sul foi em 1991 e, desde 2015, o Estado é reconhecido como livre pela Organização Mundial de Saúde Animal. Por conseguinte, as ações de vigilância sanitária contemplam populações tanto de suínos domésticos quanto de asselvajados. A Secretaria da Agricultura, Pecuária e Desenvolvimento Rural possui registros de colheita de amostras para sorologia de Peste Suína Clássica na população asselvajada, no Estado, desde 2014. No período de 2014 a 2018, foram analisadas 623 amostras, obtidas através de agentes de manejo populacional, as quais resultaram negativas para a doença alvo, confirmando a ausência de circulação viral e ratificando o reconhecimento do Rio Grande do Sul como livre desta enfermidade.

NTx is a type I collagen metabolite previously shown to be increased in patients with bone metastasis. We evaluate NTx potential prognostic role in PCa at diagnosis, when most of the patients have no overt bone involvement.Men with histologic diagnosis of PCa were included at diagnosis. Serum NTx was measured serially every 3 months up to two years by ELISA. Fifty-five PCa patients with a median age of 67 y (51-83 y) were included. Most (86%) had stage I; 4% stage II; 2% stage III and 10% stage IV disease.At entry, median NTx was 14.65 nMBCE and it did not correlate with age, Gleason score or PSA, but we observed a significant direct correlation with stage (p=0.0094). With a median follow up of 23 months, serum NTx correlated significantly with biochemical recurrence (p=0.012), as did Gleason score (p=0.00056), stage (p=0.012) and PSA (p0.0001). By multivariate analysis the only 2 independent variables significantly correlated with biochemical recurrence were PSA (p=0.046) and NTx (p=0.021).NTx serum concentrations may have a prognostic value in patients with PCa at diagnosis. These results emphasize the importance of bone metabolism biomarkers in patients with PCa even without evident overt bone involvement.

A fixed-ratio combination of the basal insulin analogue insulin degludec and the glucagon-like peptide-1 (GLP-1) analogue liraglutide has been developed as a once-daily injection for the treatment of type 2 diabetes. We aimed to compare combined insulin degludec-liraglutide (IDegLira) with its components given alone in insulin-naive patients.In this phase 3, 26-week, open-label, randomised trial, adults with type 2 diabetes, HbA1c of 7-10% (inclusive), a BMI of 40 kg/m(2) or less, and treated with metformin with or without pioglitazone were randomly assigned (2:1:1) to daily injections of IDegLira, insulin degludec, or liraglutide (1·8 mg per day). IDegLira and insulin degludec were titrated to achieve a self-measured prebreakfast plasma glucose concentration of 4-5 mmol/L. The primary endpoint was change in HbA1c after 26 weeks of treatment, and the main objective was to assess the non-inferiority of IDegLira to insulin degludec (with an upper 95% CI margin of 0·3%), and the superiority of IDegLira to liraglutide (with a lower 95% CI margin of 0%). This study is registered with ClinicalTrials.gov, number NCT01336023.1663 adults (mean age 55 years [SD 10], HbA1c 8·3% [0·9], and BMI 31·2 kg/m(2) [4·8]) were randomly assigned, 834 to IDegLira, 414 to insulin degludec, and 415 to liraglutide. After 26 weeks, mean HbA1c had decreased by 1·9% (SD 1·1) to 6·4% (1·0) with IDegLira, by 1·4% (1·0) to 6·9% (1·1) with insulin degludec, and by 1·3% (1·1) to 7·0% (1·2) with liraglutide. IDegLira was non-inferior to insulin degludec (estimated treatment difference -0·47%, 95% CI -0·58 to -0·36, p0·0001) and superior to liraglutide (-0·64%, -0·75 to -0·53, p0·0001). IDegLira was generally well tolerated; fewer participants in the IDegLira group than in the liraglutide group reported gastrointestinal adverse events (nausea 8·8 vs 19·7%), although the insulin degludec group had the fewest participants with gastrointestinal adverse events (nausea 3·6%). We noted no clinically relevant differences between treatments with respect to standard safety assessments, and the safety profile of IDegLira reflected those of its component parts. The number of confirmed hypoglycaemic events per patient year was 1·8 for IDegLira, 0·2 for liraglutide, and 2·6 for insulin degludec. Serious adverse events occurred in 19 (2%) of 825 patients in the IDegLira group, eight (2%) of 412 in the insulin degludec group, and 14 (3%) of 412 in the liraglutide group.IDegLira combines the clinical advantages of basal insulin and GLP-1 receptor agonist treatment, resulting in improved glycaemic control compared with its components given alone.Novo Nordisk.

The management model in municipal health departments (MHD) is influenced by a hegemonic managerial rationality, which undermines primary care management, complicates the transformation of the technical care model, and distances the management team from its object of study: care provision by Family Health Teams (Equipes de Saude da Familia – EqSF). One of the goals of the State Foundation for Family Health (Fundacao Estatal Saude da Familia – FESF-SUS), created in Bahia in 2009, is the development of municipal management through the shared management of contracted services. Strategies to achieve this goal include Management and Care Development Plans (MCDPs), which were developed between the institutional support team and the Monitoring and Assessment Committees (Comissoes de Acompanhamento e Avaliacao – CAA) and serve guides for monitoring the management contract. The MCDPs were developed in 22 municipalities, and they recommended the identification of priority needs of both the institutional support and the CAAs based on a shared management perspective. An important requirement that some of the CAAs identified was the reorganisation of the work process involved in coordinating primary care and implementing municipal institutional support. Institutional support as a “way of performing” primary care management can transform the teams’ work processes in ways that affect the provision of health care.

The management model in municipal health departments (MHD) is influenced by a hegemonic managerial rationality, which undermines primary care management, complicates the transformation of the technical care model, and distances the management team from its object of study: care provision by Family Health Teams (Equipes de Saude da Familia – EqSF). One of the goals of the State Foundation for Family Health (Fundacao Estatal Saude da Familia – FESF-SUS), created in Bahia in 2009, is the development of municipal management through the shared management of contracted services. Strategies to achieve this goal include Management and Care Development Plans (MCDPs), which were developed between the institutional support team and the Monitoring and Assessment Committees (Comissoes de Acompanhamento e Avaliacao – CAA) and serve guides for monitoring the management contract. The MCDPs were developed in 22 municipalities, and they recommended the identification of priority needs of both the institutional support and the CAAs based on a shared management perspective. An important requirement that some of the CAAs identified was the reorganisation of the work process involved in coordinating primary care and implementing municipal institutional support. Institutional support as a “way of performing” primary care management can transform the teams’ work processes in ways that affect the provision of health care.

e16030 Background: NTx is a metabolite of type I collagen, the main constituent of bone matrix, which has been previously shown to be increased in patients with bone metastasis. We wanted to evaluate NTx role in sample PCa patients at diagnosis when most of them have no overt bone involvement. Methods: Men with a histologic diagnosis of PCa at diagnosis were included. Serum Ntx was measured serially every 3 months up to two years by ELISA with the osteomark NTx Serum kit. Results: 55 PCa patients with a median age of 67 years (51 – 83), 86% with stage I, 4% with stage II, 2% with stage III and 10% with stage IV were included. At entry median NTx was of 14.65 nM and it did not correlate with age, Gleason score or PSA but we observed a significant direct correlation with stage (p = 0.0094). With a median follow up of 23 months, at diagnosis, Seum Ntx correlated significantly with biochemical recurrence (p = 0.012) as did Gleason score (p = 0.00056), Stage (p = 0.012) and PSA (p < 0.0001). By multivariate analysis the only 2 independent variables significantly correlated with biochemical recurrence were PSA (p = 0.046) and NTx (p = 0.021). Conclusions: We conclude that Serum Ntx has potential prognostic value in PCa patients at diagnosis and may improve current prognostic models. These data stress the potential prognostic importance of bone metabolism biomarkers for PCa patients even in the absence of overt bone involvement. Supported by: FAPESP.