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Este artigo apresenta a experiência de organização de um serviço de saúde em atenção primária, o Centro de Saúde-Escola Barra Funda na cidade de São Paulo, que privilegiou o acesso dentro dos princípios da eqüidade e da discriminação positiva, criando condições de incorporar alguns segmentos que vivem na área central da cidade de São Paulo. São eles, os moradores de rua, as trabalhadoras do sexo e a população que habita em favelas. Promove, desse modo, uma reflexão acerca das variadas formas de vida social encontradas em áreas centrais de centros urbanos, em particular aquelas que vivem à margem dos processos de inclusão e sofrem graus acentuados de vulnerabilidade e marginalidade no acesso a bens e serviços. Também aponta para a possibilidade de se implementar políticas de saúde que promovam intervenções eficazes junto a segmentos sociais normalmente excluídos dos serviços de saúde, efetivando dessa forma o princípio da universalização.

In tropical soils with intensive agriculture an increasing sulfur deficiency has been verified in several crops. The low available S in these soils is caused by the continuous use of concentrated NPK fertilizers. The objective of this work was to evaluate the utilization by rice (Oriza sativa L.) and crotalaria juncea (Crotalaria juncea L.) of sulfur applied to the soil, under greenhouse conditions. Pots with 3 kg of an Argisol (Paleudalf) were used to test the isotopic technique with the stable isotope 34S, adding a solution of sodium sulfate labeled with 34S (14.30 ± 0.05 atom % of 34S) to the soil (70 mg SO4-S per kg-1 of soil) 18 days after sowing both species. The shoots of the crotalaria and rice were harvested, respectively on the 72nd and 122nd days after S fertilization. The concentration and the amount of sulfur in the crotalaria were higher than in rice, due to the higher legume requirement for this nutrient. The sulfur requirement and the short time interval between fertilization and harvest of the crotalaria resulted in a small amount of native SO4-S mineralized in the soil and a small quantity of 34SO4 immobilized by soil microorganisms. Thus, the percentage of sulfur in the crotalaria derived from the fertilizer (Sdff) was higher than in the rice (%Sdff crotalaria = 91.3 ± 3.5%; %Sdff rice = 66.3 ± 0.8%). The expressive values of %Sdff indicate a low rate of mineralization of SO4-S probably as a consequence of the low available sulfur content in the soil.

Objective: To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). Methods: Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21–42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. Results: There was an increase in nasal width with an average of 1.3467 mm and an increase in the alar base with an average of 1.7333 mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. Conclusion: Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidence: Level 4.

O câncer representa hoje a primeira causa de morte por doença entre a população de faixa etária compreendida entre 1 e 21 anos nos Estados Unidos e em outros países economicamente desenvolvidos. No Brasil, esta doença figura como a terceira causa de morte por doença entre a população de faixa etária compreendida entre 1 e 14 anos, sendo já a primeira causa de óbito no município e no estado de São Paulo no grupo etário compreendido entre 5 e 14 anos, excluindo-se acidentes e causas externas. O objetivo deste artigo é informar a classe médica, principalmente a pediátrica, das particularidades do câncer infantil e de suas diferenças com as formas dos adultos, mais conhecidas e frequentes. Graças à moderna abordagem multidisciplinar, o câncer infantil pode atingir índices de cura de 60% a 70%, mas, para tal, é imprescindível o diagnóstico precoce. Portanto, é importante que toda a comunidade pediátrica mostre-se motivada e informada sobre os sinais e sintomas das neoplasias pediátricas, já que não dispomos de métodos de “screening” tão úteis e eficazes como para o controle do câncer do adulto.

Ana Carolina Proença da Fonseca,1,2 Gabriella de Medeiros Abreu,2 Lohanna Palhinha,1 Verônica Marques Zembrzuski,2 Mario Campos Junior,2 João Regis Ivar Carneiro,3 José Firmino Nogueira Neto,4 Fernanda Cristina C Mattos Magno,5 Eliane Lopes Rosado,5 Clarissa Menezes Maya-Monteiro,1 Giselda Maria Kalil de Cabello,2 Pedro Hernán Cabello,2,6 Patricia Torres Bozza1 1Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 2Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 3Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4Department of Pathology and Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil; 5Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 6Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, BrazilCorrespondence: Ana Carolina Proença da FonsecaHuman Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, 4365 Brasil Avenue, Leônidas Deane Building – Office 611/615, Rio de Janeiro, RJ 21040-360, BrazilTel +552138658192Fax +552138658239Email ana.proenca@ioc.fiocruz.brBackground: Brain-derived neurotrophic factor (BDNF) is a pro-survival factor in the brain that also regulates energy balance. BDNF loss-of-function point mutations are responsible for haploinsufficiency, causing severe early-onset obesity. Up to date, only a few studies have sequenced this gene to search for rare mutations related to obesity. In this study, we aimed to investigate the prevalence of BDNF variants in a cohort of adults with severe obesity from Brazil.Material and Methods: This study comprised 201 adults with severe obesity (BMI ≥ 35.0 kg/m2) with onset during childhood- or adolescence/youth. As controls, 73 subjects with normal weight (18.5 ≤ BMI ≤ 24.9 kg/m2) were selected. The exclusion criteria were pregnancy, lactation, the use of medication to lose or gain weight, and the presence of symptoms suggestive of syndromic obesity (only for the case group). The coding region of the BDNF gene was screened by Sanger sequencing. Demographic, anthropometric, and blood pressure parameters were obtained from the participants as well as serum hormone and cytokines concentrations and biochemical values.Results: As a result, three missense variants [p.(Thr2Ile), p.(Val66Met), and p.(Arg209Gln)] and four synonymous variants (p.Leu107=, p.Thr149=, p.Ala150=, and p.Ser213=) were identified. The p.(Arg209Gln) was predicted as pathogenic by all in silico algorithms used and was not observed in the control group. The individuals carrying the p.(Val66Met) mutated allele had higher waist circumference, HDL-cholesterol and MCP1 levels, and reduced risk of developing metabolic syndrome.Conclusion: We observed that the common BDNF p.(Val66Met) variant has influenced waist circumference, HDL-cholesterol, and MCP1 levels. This polymorphism has also a protective effect on metabolic syndrome susceptibility. Additionally, we described for the first time a rare potentially pathogenic BDNF variant in a Brazilian patient with severe obesity and childhood-onset.Keywords: BDNF, severe obesity, rare mutation, early-onset obesity, metabolic syndrome

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Despite the numerous prerogatives of the Exchequer, as regards fiscal execution, is the Executive title from tax debt or not, guaranteed by law n° 6.830, 22 September 1980, and its subsequent amendments, the runs, or debtor faced often in difficulty during his defense. Whether in the formal aspect of the summons, garnishment and exactly the resources used by the undo the procedure enforceable. In this context, more specifically, highlight the difficulty in establishing what the limits of the allegations made by the debtor in the new embargoes after the correction or replacement of the Active Debt Certificate. From divergent views, one realizes the importance of the topic. [ABSTRACT FROM AUTHOR]

Ana Carolina Proença da Fonseca,1 Gabriella Medeiros Abreu,1 Verônica Marques Zembrzuski,1 Mario Campos Junior,1 João Regis Ivar Carneiro,2 José Firmino Nogueira Neto,3 Giselda Maria Kalil Cabello,1 Pedro Hernán Cabello1,41Human Genetics Laboratory, Oswaldo Cruz Institute/FIOCRUZ, Rio de Janeiro, Brazil; 2Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 3Department of Pathology and Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil; 4Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, BrazilBackground: Obesity occurs due to the interaction between the genetic background and environmental factors, including an increased food intake and a sedentary lifestyle. Nowadays, it is clear that there is a specific circuit, called leptin-melanocortin pathway, which stimulates and suppresses food intake and energy expenditure. Therefore, the aim of this study was to evaluate the influence of genetic variants related to appetite regulation and energy expenditure on severe obesity susceptibility and metabolic phenotypes in a Brazilian cohort.Material and methods: A total of 490 participants were selected (298 severely obese subjects and 192 normal-weight individuals). Genomic DNA was extracted and polymorphisms in protein related to agouti (AGRP; rs5030980), ghrelin (GHRL; rs696217), neuropeptide Y (NPY; rs535870237), melanocortin 4 receptor (MC4R; rs17782313), brain-derived neurotrophic factor (BDNF; rs4074134) and fat mass and obesity-associated (FTO; rs9939609) genes were genotyped using TaqMan® probes. Demographic, anthropometric, biochemical and blood pressure parameters were obtained from the participants.Results: Our results showed that FTO rs9939609 was associated with severe obesity susceptibility. This polymorphism was also related to body weight, body mass index (BMI), waist to weight ratio (WWR) and inverted BMI. Individuals carrying the mutant allele (A) showed higher levels of BMI as well as lower values of WWR and inverted BMI.Conclusion: This study showed that FTO rs9939609 polymorphism plays a significant role in predisposing severe obesity in a Brazilian population.Keywords: leptin-melanocortin pathway, FTO, obesity, polymorphisms, hypothalamus

Ana Carolina Proença da Fonseca,1 Gabriella de Medeiros Abreu,1 Verônica Marques Zembrzuski,1 Mario Campos Junior,1 João Regis Ivar Carneiro,2 Fernanda Cristina C Mattos Magno,3 Eliane Lopes Rosado,3 José Firmino Nogueira Neto,4 Giselda Maria Kalil de Cabello,1 Pedro Hernán Cabello1,5 1Human Genetics Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil; 2Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 3Institute of Nutrition Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 4Department of Pathology and Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil; 5Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, Brazil Background: Melanocortin 4 receptor gene (MC4R) is an important regulator of food intake, body weight, and blood pressure. Mutations in MC4R are associated with the most common form of nonsyndromic monogenic obesity. MC4R variations have an autosomal co-/dominant model of inheritance. MC4R screening could reveal individuals previously unrecognized with Mendelian form of obesity for further clinical management and genetic counseling. However, there are limited data regarding MC4R variants in patients with obesity from Brazil. The aim of this study was to screen the coding region of the MC4R gene in a Brazilian cohort of severely obese adults and to investigate the phenotype–genotype correlation within MC4R variant carriers. Methods: This study comprised 157 adult participants, stratified according to the period of obesity onset. The first group included 97 patients with childhood-onset obesity (0–11 years) and the second group comprised 60 subjects with adolescence/youth-onset obesity (12–21 years). The entire coding region of MC4R gene was screened by Sanger sequencing. Results: As a result, five previously described variants (Met1?, Ser36Thr, Val103Ile, Ile98=, and Phe202Leu) were identified. Met1? is a start lost codon variant, which affects the translation of MC4R. It was found in a female patient with childhood-onset obesity. We also compared the anthropometric and metabolic parameters between patients with MC4R missense variants (Ser36Thr, Val103Ile, and Phe202Leu) and noncarriers. Patients carrying MC4R variants had higher median of waist–hip ratio when compared to noncarriers (P=0.048). These missense variants were also associated with hypertension (P=0.014). Additionally, Val103Ile carriers had lower diastolic blood pressure and lower systolic blood pressure compared to noncarriers (P=0.020 and P=0.065, respectively). Val103Ile was also associated with hypertension (P=0.003). Conclusion: This study showed the prevalence of MC4R variants in a cohort of Brazilian adults with severe obesity. We also identified significant phenotype differences between carriers and noncarriers of missense variants in our sample, suggesting an important role of MC4R on body fat distribution and blood pressure. Keywords: MC4R, severe obesity, mutation, start lost, blood pressure

Fernanda Cristina Carvalho Mattos Magno,1 Helena Chrispim Guaraná,1 Ana Carolina Proença Fonseca,2 Giselda Maria Kalil Cabello,2 João Régis Ivar Carneiro,3 Aline Pereira Pedrosa,1 Ana Carolina Ximenes,1 Eliane Lopes Rosado1 1Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Oswaldo Cruz Foundation (FIOCRUZ), Oswaldo Cruz Institute (IOC), Human Genetics Laboratory, Rio de Janeiro, RJ, Brazil; 3Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho, Service of Nutrology, Rio de Janeiro, RJ, Brazil Background: The fat mass and obesity-related (FTO) gene has a strong relationship with obesity, extreme obesity and inflammatory state, and may also be associated with food intake regulation.Objective: The aim of the present study was to evaluate the influence of the rs9939609 single-nucleotide polymorphism of the FTO gene on appetite, ghrelin, leptin, interleukin 6 (IL6), tumor necrosis factor α (TNFα) levels and food intake of morbidly obese women.Materials and methods: The study comprised 70 women, aged between 20 and 48 years, from Rio de Janeiro, Brazil. The participants were selected according to the body mass index between 40 and 60 kg/m2. Anthropometric and biochemical data were measured during fasting. Hormones and inflammatory data were measured before and after the participants ate an isocaloric meal. Dietary records were calculated and analyzed using a nutritional assessment program. Visual analog scales were used for behaviors of the sensations of appetite and food preferences. The FTO rs9939609 variant was genotyped using real-time polymerase chain reaction.Results: Participants with the AA genotype had lower values of ghrelin and IL6 and higher values of leptin than those with TT and TA in the postprandial period. Comparing the plasma concentrations of ghrelin, insulin, IL6 and TNFα intragenotypes, it was observed that those with TT had decreased leptin and increased IL6 at the postprandial period. Subjects with TA showed increased postprandial IL6, and those with AA had decreased postprandial ghrelin. There was no difference in TNFα intra- and intergenotypes. The postprandial sensations of hunger were lower in AA than those with TT. There were differences between genotypes regarding ingested grams of protein by weight, cholesterol, B3, B5, B6 and B12 vitamins, and selenium potassium and sodium minerals.Conclusion: These findings suggest that genetics may exert an influence on physiologic factors and might alter eating behavior. Keywords: obesity, rs9939609, hormones, inflammatory cytokines, food intake, binge eating

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare condition that occurs normally in the anterior maxilla of infants aged <1 year. The use of clinical and imaging tools for MNTI is extremely important to prevent problems with function as well as the aesthetic features in a breastfeeding child. Brazil is a multiethnic country with a poor epidemiological policy and little data to track the incidence of certain diseases, including MNTI. It is important to study this pathology with ethnicity as a factor to improve the current epidemiological programs and establish better post-treatment management. This paper describes a case of a 2-month-old male of African-indigenous descent and Brazilian Amazon residency, who presented to our unit in 2009 with a history of an expanding mass involving the anterior maxilla. Clinical and computerized tomography scans were used to diagnose the mass as MNTI, which was removed by total excision. A biopsy later confirmed the MNTI diagnosis. [ABSTRACT FROM AUTHOR]

This paper presents a heuristic constructive algorithm (HCA) for optimal capacitor placement on distribution systems. This is a nonlinear mixed integer optimization problem. In the proposed approach, the integer variables are represented using sigmoid function, thus interior point optimal power flow formulation can be applied to obtain sensitivity indexes based on Lagrange multipliers, reactive power, and bus voltage. The methodology is applied to two power distribution systems, and the results are compared with those obtained using. a genetic algorithm approach. [ABSTRACT FROM AUTHOR]

This work presents a new formulation for the power flow problem, with explicit representation of the neutral conductor and grounding. This methodology has been named the four-conductor current injection method (FCIM). The Newton-Raphson method is applied to solve the set of nonlinear current injection equations that are derived using phase coordinates, and the complex variables are written in rectangular form. The proposed algorithm can be used to analyze both balanced and unbalanced systems, meshed or radial, with controls and distributed generation, and is shown to be very efficient and robust for large scale systems. [ABSTRACT FROM AUTHOR]

It is well known that the accuracy of frequency-dependent line models in time-domain calculations relies on the equations that define the line propagation matrix H and characteristic admittance Yc. Therefore both modal-domain and phase-domain transmission line models are affected by the assumptions in the evaluation of the series impedance Z, namely, the formulation of the internal conductor and the ground return impedance. The complexities of the exact representation of these parameters have led investigators to propose approximate formulae, and several of these are available in the technical literature. This work examines the effects of these formulae on the calculation of matrices H and Yc on the time-domain responses of the line. Several possibilities have been tested. The results show that although the approximate methods can be used for overhead lines, caution is needed for underground cable systems. [ABSTRACT FROM AUTHOR]

This paper presents a new approach for distribution system reconfiguration (DSR) based on optimum power flow (OPF) in which the branch statuses (open/close) are represented by continuous functions. In the proposed approach, all branches are initially considered closed, and from the OPF results, a heuristic technique is used to determine the next loop to be broken by opening one switch. Then the list of switches that are candidates to be opened is updated, and the above process is repeated until all loops are broken, making the distribution system radial. This paper includes results and comparisons on test systems utilized in three classical papers published in the technical literature, as well as in a previous paper by the authors. Results obtained on a real large-scale distribution system are also presented. [ABSTRACT FROM AUTHOR]

This paper presents a reconfiguration algorithm that is specially suited to large-scale distribution systems. The algorithm uses a heuristic strategy that starts with the system in a meshed status, with all maneuverable switches closed. The choice of the switches to be opened is based on the calculation of the minimum total system losses, using a load-flow program. A refinement on this procedure, based on branch status exchange, is described. The paper includes results and comparisons on test systems utilized in three classical papers published in the technical literature. Results obtained on a real large-scale distribution system are also presented. [ABSTRACT FROM AUTHOR]

This paper presents an optimum power flow (OPF) modeling algorithm that uses the primal-dual interior point technique to determine the best investment strategy in the transmission line expansion problem. In the proposed method, the expansion decision (0 or 1) is mitigated by using a sigmoid function, which is incorporated in the OPF problem through the modified dc power flow equations. The investment decision is taken using a new heuristic model based on good sensitivity produced by the OPF results. Additionally, the transmission power losses are considered in the network model. The proposed methodology has been compared with methods available in the literature, using both a test system and an equivalent of the southeastern Brazilian system. [ABSTRACT FROM AUTHOR]

Presents the development of mathematical models for thyristor controlled series compensator for voltage regulator devices and for remote bus voltage control that are suitable to be used with the three-phase current injection method for power flow calculation. Methods of the study; Results and discussion; Conclusion.

Describes a thermal model designed to determine the ampacity derating of electric cables in wrapped trays. Heat transfer coefficient of natural convection; Effective thermal conductivity of the cable mass; Insulated conductors; Thermophysical properties; Sensitivity analysis; Thermal influences.

This letter describes a new voltage controlled bus (PV bus) representation in connection with the three-phase current injection method-TCIM of power flow analysis. This representation requires an augmented system of linearized equations to incorporate the reactive power as a dependent variable. Tests and comparisons between the former and the new approach are described and the improved stiffness of this new proposition is demonstrated. [ABSTRACT FROM AUTHOR]

Este artigo apresenta a experiência de organização de um serviço de saúde em atenção primária, o Centro de Saúde-Escola Barra Funda na cidade de São Paulo, que privilegiou o acesso dentro dos princípios da eqüidade e da discriminação positiva, criando condições de incorporar alguns segmentos que vivem na área central da cidade de São Paulo. São eles, os moradores de rua, as trabalhadoras do sexo e a população que habita em favelas. Promove, desse modo, uma reflexão acerca das variadas formas de vida social encontradas em áreas centrais de centros urbanos, em particular aquelas que vivem à margem dos processos de inclusão e sofrem graus acentuados de vulnerabilidade e marginalidade no acesso a bens e serviços. Também aponta para a possibilidade de se implementar políticas de saúde que promovam intervenções eficazes junto a segmentos sociais normalmente excluídos dos serviços de saúde, efetivando dessa forma o princípio da universalização.This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access.

Este artigo apresenta a experiência de organização de um serviço de saúde em atenção primária, o Centro de Saúde-Escola Barra Funda na cidade de São Paulo, que privilegiou o acesso dentro dos princípios da eqüidade e da discriminação positiva, criando condições de incorporar alguns segmentos que vivem na área central da cidade de São Paulo. São eles, os moradores de rua, as trabalhadoras do sexo e a população que habita em favelas. Promove, desse modo, uma reflexão acerca das variadas formas de vida social encontradas em áreas centrais de centros urbanos, em particular aquelas que vivem à margem dos processos de inclusão e sofrem graus acentuados de vulnerabilidade e marginalidade no acesso a bens e serviços. Também aponta para a possibilidade de se implementar políticas de saúde que promovam intervenções eficazes junto a segmentos sociais normalmente excluídos dos serviços de saúde, efetivando dessa forma o princípio da universalização.

With the urbanisation of the population in developing countries and the process of globalisation, Chagas has become an emerging disease in the urban areas of endemic and non-endemic countries. In 2006, it was estimated that the prevalence of Chagas disease among the general Bolivian population was 6.8%. The aim of the present study was to determine the prevalence of Trypanosoma cruzi infection among Bolivian immigrants living in São Paulo, Brazil. This study had a sample of 633 volunteers who were randomly selected from the clientele of primary care units located in the central districts of São Paulo, Brazil. Infection was detected by two different ELISA assays with epimastigote antigens, followed by an immunoblot with trypomastigote antigens as a confirmatory test. The prevalence of the infection was 4.4%. Risk factors independently associated with the infection were: a history of rural jobs in Bolivia, knowledge of the vector involved in transmission, and having relatives with Chagas disease. Brazil has successfully eliminated household vector transmission of T. cruzi, as well as its transmission by blood transfusion. The arrival of infected immigrants represents an additional challenge to primary care clinics to manage chronic Chagas disease, its vertical transmission, and the blood derivatives and organ transplant programs.