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To obtain an education of quality, a simple application of resources, is not enough, it is understood that is needed to dispose of efficacious, efficient and effective strategies. The Constitutional Amendment No. 19 of 1999 introduces the principle of efficiency to the list of constitutional principles of Public Administration. In this sense, the present study aims to analyze the efficiency of municipal spending on education in elementary school, in the context of the municipalities of the Serido Potiguar, RN. Therefore, and in accordance with the purpose defined, it can be characterized as quantitative and descriptive, making use of secondary data (educational indicators) in order to propose performance indicators of educational efficiency.The chosen study area includes 21 municipalities. The results highlighted three rankings in efficiency, having the municipality Carnauba dos Dantas achieved the best efficiency in all three and the municipalities Parelhas and Sao Joao do Sabugi alternating between the second and third place. The Total Spending on Education Efficiency Index (IETGE) revealed that the municipality with worse efficiency was Santana do Matos. It was noted that eight municipalities had IETGE low, meaning that most of the analyzed municipalities have not had a proportional performance to applied costs. Also was highlighted a considerable difference between the municipalities regarding the efficiency of spending on education. The work shows the possibility and the importance of measuring efficiency in the public sector, as well as provides the construction of efficiency rankings in the public sector as a driving tool to increase efficiency in the public area. It is suggested to perform an in-depth research in the municipalities that have the highest and lowest indicator to understand what dimensions/factors lead to success or failure in the indices, as well as replicate the model in other geographical regions. Keywords: Efficiency. Municipal Spending. Elementary School.

De acordo com a teoria da dívida, os entes subnacionais, estados e municípios, endividam-se para realizar investimentos que proporcionem alocar bens públicos aos seus jurisdicionados, contribuindo para o desenvolvimento humano. No entanto, problemas com a má gestão dos recursos públicos podem contribuir para que o endividamento público influencie negativamente o desenvolvimento humano. Nesse sentido, o presente artigo investigou a influência do endividamento público sobre o desenvolvimento humano dos grandes municípios brasileiros. Para tanto, foram coletadas informações referentes aos municípios brasileiros com mais de 500 mil habitantes ao longo de sete anos, de 2006 a 2012. Como técnica estatística, utilizou-se a regressão MQO com dados em painel. Os resultados revelaram que o endividamento e os gastos sociais públicos influenciam timidamente o desenvolvimento humano dos grandes municípios, ao passo que a variável com maior influência é o desenvolvimento humano já sedimentado localmente ao longo do tempo.

Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation. Resumo Introdução: O acesso vascular (AV) para hemodiálise (HD) é crucial para os pacientes portadores de doença renal crônica (DRC) estágio V. Infelizmente, com o passar dos anos, um percentual não desprezível desses enfermos evolui para falência de AV por diversos motivos, o que impossibilita a confecção de novas fístulas arteriovenosas (FAV) ou o implante de cateteres venosos centrais nos sítios de punções tradicionais. Nesse cenário, o implante de cateteres translombares para hemodiálise (CTLHD) em veia cava inferior ganha destaque como medida salvadora. Objetivos: Relatar uma série de 12 casos de implante de CTLHD, sua técnica de implante, patência e complicações. Métodos: Estudo retrospectivo que analisou 12 implantes de CTLHD por radiologista intervencionista no setor de hemodinâmica do Hospital Universitário da Universidade Federal do Rio Grande do Norte (UFRN), no período de janeiro/2016 a outubro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxa de sucesso, complicações observadas, sobrevida dos pacientes, patência do cateter e desfechos clínicos. Resultados: Todos os 12 CTLHD foram implantados e utilizados com sucesso; ocorreram apenas 2 complicações associadas ao procedimento (sangramento e falha na extubação); 41,6% dos pacientes apresentaram infecção relacionada ao cateter após 98 ± 72,1 dias (6-201 dias), mas não houve necessidade de remoção; e a patência foi de 315,5 cateteres-dia (65-631 dias). Conclusão: O CTLHD é uma opção para pacientes com falência de acesso vascular, prolongando a sobrevida dos pacientes e atuando como ponte para o transplante renal.

A study was carried out to evaluate the feasibility of autologous adipose derived stem cells (ADSC) transplantation into female rabbits' urethra walls as an alternative to intrinsic urethral regeneration.Inguinal fat pad of 12 New Zealand adult female rabbits were harvested and processed to obtain stromal vascular fraction (SVF). The SVF were platted to isolate ADSC. Before urethral injection, cells were labeled with DiI marker. The urethra wall was injected with 1 x 10(7) autologous cells or saline (sham). The urethra was harvested at 2, 4, and 8 weeks to identify DiI-labeled cells.At 2 and 4 weeks, the ADSCs create a nodule localized in the urethral sub-mucosa. At 8 weeks, the ADSCs spread and integrated with the urethra wall from the initial injection site.This is the first study to demonstrate a successful autologous ADSCs transplantation. It confirms that ADSCs can survive and integrate within the urethral wall.

Objective To study the factors that may influence the effectiveness of 0.2% betamethasone/hyaluronidase cream in the treatment of phimosis. Methods We treated 427 patients (3–10 years old, mean 6.33) in a prospective, randomized, blind study, with 214 patients on a 4-week and 213 patients on an 8-week course. All patients were seen once monthly at least for 6 months after the end of treatment. The penis was photographed to allow objective evaluation of treatment response. The therapeutic response was graded as total success when there was complete exposure of the glans; partial success when there was exposure of half of the glans, impeded by balanopreputial adherence or ring fibrosis at the prepuce; and therapeutic failure when patients had no or less than 50% glans exposure. Results After treatment 92.1% of patients showed total or partial success, but during follow up (mean 9.36 months, range 6–13) 29.5% failed to maintain this (22.6% and 37.6% for 8- and 4-week treatment, respectively). During treatment, 13.6% presented side effects or complications: prepuce ardor (6.1%), hyperemia (4.6%), paraphimosis (0.0098%). Intervention or interruption of treatment was unnecessary. The two groups were statistically similar in all parameters, but time of treatment = 8 weeks, previous urethral meatal exposure and no previous balanoposthitis increased the chance of total success. Surgery was indicated for failure or relapse in 181 patients (42.38%). Conclusion Treatment with topical 0.2% betamethasone/hyaluronidase cream for 8 weeks is effective and safe, especially if the urethral meatus is exposed and there is no previous balanoposthitis. Rescue treatment is not recommended, as the results were not encouraging.

Purpose The authors present here 5 cases of continent urinary diversion in rhabdomyosarcoma applying a recently described technique for the Mitrofanoff Principle devised by the authors. Methods Two previously irradiated rhabdomyosarcoma patients presenting with residual bladder disease and massive sensitive urinary urgency underwent a transverse colonic reservoir with catheterizable stoma. Two other patients presenting with a Bricker conduit underwent conversion into an ileal reservoir. One patient underwent reconstruction after a cystectomy. Results All patients were continent and able to perform continent intermittent catheterization. Conclusions The technique proved to be feasible for this group of patients. The authors believe that because of its simplicity, it should be an option of continent urinary diversion when the Mitrofanoff Principle is considered.

PURPOSE: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. MATERIALS AND METHODS: We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. RESULTS: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. CONCLUSIONS: Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

Purpose Congenital aphalia is a rare but complex male genital abnormality. The preferred approach in the past was female gender reassignment. However new concepts in ambiguous genitalia have questioned this strategy and opened the possibility for a cosmetic repair in childhood and future prosthesis implantation at puberty. We present a video describing a 12 year old boy with congenital aphalia whose posterior urethra emerged in distal rectum closed to the linea pectinea. Material and methods With the patient in the prone position an ASTRA approach enabled careful urethral isolation from the distal rectum. The patient was repositioned in the supine position and the urethral stump was left in the perineal area close to the scrotum. A skin flap was produced from the inferior abdominal wall keeping its vascularization in the suprapubic area. The flap was rotated caudally, partially defatted and prepared for tubularization in order to produce a phallic appearance. A 16cm buccal mucosa graft was obtained from the lower lip and cheek and tubularized over a urethral catheter. The neourethra was anastomosed to the posterior urethra and the distal part of the neourethra was anchored in the flap. The neophallus was completed by creating a “coronal-like” line. Results The patient had nice cosmetic healing of the penis but developed a perineal urethral fistula and stricture and awaits clinical revision. The psychological impact of the surgery for the patient was extremely favourable and successful. Conclusions The De Castro neophaloplasty is a feasible alternative for congenital aphalia and should be considered in these complex cases. Longer follow-up and larger experience with the technique is desired and therefore multi-institutional cooperative work should be encouraged.