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Social policy has played a central role in developing countries over the last decade, contributing to a significant decline in poverty and inequality. The objective of this paper is to provide an overview of the evolution of social policy in Brazil, its effects on inequality and poverty, and the implications of the current political and economic scenario regarding the maintenance of its continuous progress. Analyses conducted over the past decade show that negative poverty indicators resulted from a combination of an increase in the value of the minimum wage, a renewed focus on income transfer programmes, and the expansion of assistance projects, old-age pensions and educational and health policies. However, despite these improvements, the current critical economic and political situation (with inflation rates rising in almost every country worldwide) could be quite destructive and demands a concerted strategy to preserve social policy benefits in Brazil. This paper provides a review of recent literature focused on social assistance, social security, health and education, and is divided into six sections. The introduction is followed by an overview of social policy in Brazil. The third section discusses the evolution of poverty and inequality in the country, while the fourth explores the current political and socio-economic situation. The fifth and sixth sections provide the final remarks and bibliographical references, respectively.

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Objective: To describe occurrences of mortality due to cervical cancer in Recife (PE), in northeastern Brazil. Method: This was a time-series ecological study using data from the Mortality Information System (SIM) regarding the total number of deaths due to cervical cancer (C53 ICD10) that occurred between 2000 and 2012. Results: It was observed that the risk of death due to this form of cancer was higher among women over 60 years of age, those of mixed skin color (53.24%), those who only worked at home (63.16%) and those who did not have a partner (44.32%). Conclusion: Additional efforts towards maintaining early detection and health education programs and towards using therapeutic strategies of greater efficiency are needed, given that mortality due to this form of cancer is considered avoidable when diagnosed early. RESUMO Objetivo: Descrever a ocorrência da mortalidade por câncer no colo uterino no Recife (PE), região nordeste do Brasil. Métodos: Estudo ecológico de série temporal com dados do Sistema de Informações sobre Mortalidade (SIM), referente ao total de óbitos por câncer no colo uterino (C53 - CID10), ocorridos no período de 2000 a 2012. Resultados: Observou-se que o risco de morte por esta neoplasia cresce em mulheres a partir dos 60 anos, pardas (53,24%), donas de casa (63,16%) e sem companheiros (44,32%). Conclusão: É necessário esforço adicional através da manutenção de programas de detecção precoce, educação em saúde e uso de estratégias terapêuticas mais eficientes, pois a mortalidade por essa neoplasia é considerada evitável quando diagnosticada precocemente. RESUMEN Objetivo: Describir la ocurrencia de mortalidad por cáncer cervical en Recife (PE), en el noreste de Brasil. Método: Este fue un estudio ecológico de series temporales que utilizó datos del Sistema de Información de Mortalidad (SIM) sobre el número total de muertes por cáncer cervical (C53 ICD10) ocurridas entre 2000 y 2012. Resultados: Se observó que el riesgo de muerte por esta forma de cáncer fue mayor entre las mujeres mayores de 60 años, las de color de piel mixto (53.24%), las que sólo trabajaban en casa (63.16%) y las que no tenían pareja (44.32%). Conclusión: Se requieren esfuerzos adicionales para mantener los programas de detección precoz y educación sanitaria y para utilizar estrategias terapéuticas de mayor eficacia, ya que la mortalidad por esta forma de cáncer se considera evitable cuando se diagnostica tempranamente.

Self-expanding metal stents (SEMS) are the treatment of choice for advanced esophageal cancers. Literature is scarce on risk factors predictors for adverse events after SEMS placement. Assess risk factors for adverse events after SEMS placement in advanced esophageal cancer and evaluate survival after SEMS placement. Cross-sectional study of patients with advanced esophageal cancer referred for SEMS placement, during a period of 3 years. Ninety-seven patients with advanced esophageal cancer placed SEMS. Adverse events were more common when tumors were located at the level of the distal esophagus/cardia (47% vs 23%, P = 0.011, OR 3.1), with statistical significance being kept in the multivariate analysis (OR 3.1, P = 0.018). Time until adverse events was lower in the tumors located at the level of the distal esophagus/cardia (P = 0.036). Survival was higher in patients who placed SEMS with curative intent (327 days [126-528] vs. 119 days [91-147], P = 0.002) and in patients submitted subsequently to surgery compared with those who did just chemo/radiotherapy or who did not do further treatment (563 days [378-748] vs. 154 days [133-175] vs. 46 days [20-72], P < 0.001). Subsequent treatment kept statistical significance in the multivariate analysis (HR 3.4, P < 0.001). SEMS allow palliation of dysphagia in advanced esophageal cancer and are associated with an increased out-of-hospital survival, as long as there are conditions for further treatments. Tumors located at the level of the distal esophagus/cardia are associated with a greater number of adverse events, which also occur earlier.

Background Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO2) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery. Methods Seventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO2/FiO2 ratio 0.05) were related. Conclusion Increased PEEP after cardiac surgery decreased ScvO2 and increased blood lactate, even with higher O2 delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.

Successive applications of pig slurry and poultry manure can improve the soil structure, according to the land use conditions and amounts applied. This study evaluated the effect of manure fertilization on the physical properties and organic carbon of a Rhodic Kandiudox. Treatments included land use and management and time of pig slurry and poultry litter application, namely: native forest (NF); yerba mate after 20 years of animal waste application (YM20); pasture after 15 years of application (P15); grassland after 20 years of manuring (PP20); grassland after 3 years of manuring (P3); pasture without application (P0), maize after 20 years of application (M20); and maize after 7 years of application (M7). Soil samples were collected in the 0-5, 5-10 and 10-20cm layers, in which density, porosity, aggregate stability, flocculation, penetration resistance, available water, and total clay content, total and particulate organic carbon, and C:N ratio were analyzed. The total organic carbon is sensitive to management and was not related to waste application, except in the 10-20cm layer of ryegrass pasture after three years of manuring. Reponses to waste application and land use and management systems were observed in the variables soil density and penetration resistance.

O manejo adequado do solo é uma das bases para a sustentabilidade do sistema agrícola. O objetivo do estudo foi avaliar atributos químicos de um Cambissolo Húmico Alumínico após 12 anos em dois sistemas de preparo do solo, com rotação e sucessão de culturas. O experimento foi conduzido em Lages, SC, utilizando preparo convencional (PC) e semeadura direta (SD), sob rotação (r) e sucessão (s) de culturas. O delineamento experimental foi inteiramente casualizado com quatro repetições. As sequências de cultivo foram: feijão-pousio-milho-pousio-soja-pousio no PCr; milho-pousio no PCs; feijão-aveia-milho-nabo-soja-ervilhaca na SDr; e milho-ervilhaca na SDs. As amostras de solo foram coletadas nas camadas 0-2,5; 2,5-5; 5-10; e 10-20cm. Avaliou-se carbono orgânico total (COT), cálcio, magnésio, alumínio trocável, fósforo, potássio, nitrogênio total (NT) e pH em água. A SD aumentou os teores de COT e nutrientes em comparação ao PC, especialmente na camada superficial do solo. O cultivo de milho e ervilhaca em sucessão aumentou os teores de COT e NT na camada superficial do solo em comparação com a rotação sob semeadura direta.Suitable soil management is one of the bases for sustainability in agricultural systems. The study aimed to evaluate chemical properties of a Humic Dystrudept for 12 years under two tillage systems, with crops rotation and succession. The experiment was carried out in Lages, SC, under conventional tillage (CT) and no-till (NT), with rotation (r) and succession (s) cropping systems, using crop sequences of beans-fallow-maize-fallow-soybean in CTr; maize-fallow in CTs; beans-oats-maize-fodder radish-soybean-vetch in NTr; and maize-vetch in NTs. The experimental design was completely randomized with four replicates. The soil samples were collected in the layers 0-2.5, 2.5-5, 5-10 and 10-20cm. The variables assessed were total organic carbon (TOC), calcium, magnesium, exchangeable aluminum, phosphorus, potassium, total nitrogen (TN) and water pH. The no-tillage system increased TOC and nutrient levels in comparison with conventional tillage, especially in the surface soil layer. Maize and vetch crop succession had higher TOC and TN contents in the surface soil layer compared to crop rotation under no-tillage.

Alternativas tecnológicas podem minimizar os impactos negativos dos dejetos líquidos de suínos (DLS) sobre o ambiente, além de melhorar seu efeito como fertilizante. O objetivo deste trabalho foi comparar o efeito do modo de aplicação dos DLS e da ureia, com e sem o uso de inibidor de nitrificação dicianodiamida (DCD), sobre a evolução dos teores de N mineral no solo, nas cultura de milho e trigo, em plantio direto. O trabalho foi conduzido em Cambissolo Húmico Alumínico, utilizando o delineamento experimental de blocos ao acaso com quatro repetições, em esquema fatorial 2 x 5. Os tratamentos foram dois modos de aplicação ao solo de DLS e ureia (injeção x aplicação superficial) e cinco tratamentos com as fontes de N (ureia; ureia+DCD; DLS; DLS+DCD e testemunha sem N). Os tratamentos foram avaliados em cultivo de milho na safra 2012/2013 e de trigo na safra 2013. As amostras de solo foram coletadas nas profundidades de 0-5, 5-10 e 10-20 cm. A adição de DCD aos DLS e à ureia preserva por mais tempo na forma amoniacal o N dos fertilizantes. A injeção dos fertilizantes aumentou os teores de amônio em relação à aplicação superficial.

El presente trabajo que tuvo el propósito de realizar el diagnóstico del bosque de Jacarón como parte de la ejecución del proyecto denominado Fenología de especies forestales nativas protectoras del ambiente andino de Jacarón, ubicado en la república del Ecuador, provincia de Chimborazo, cantón Colta, parroquia Juan de Velasco (Pangor), sitio San Antonio de Pollongo, a 58 kilómetros de Riobamba vía al sur a 6 kilómetros de la comunidad Hierba Buena. El bosque de Jacarón alberga 34 especies forestales nativas; y, 12 especies de fauna y avifauna, distribuidas en 123,22 ha., localizadas en un terreno con más del 70% de pendiente con una altura que fluctúa entre los 3160 y 3600 msnm, precipitaciones media promedio anual entre 1250 y 1500 mm, temperaturas medias promedio anual de 10°C, con una luminosidad anual promedio de 4 horas diarias y más del 90% de humedad relativa. Los suelos son francos frescos derivados de materiales piro clásticos, ligeramente ácidos, con condiciones medias de contenido de materia orgánica; dando según el mapa de uso del suelo y cobertura vegetal del MAE CHIMBORAZO una identificación ecológica de BOSQUE SIEMPRE VERDE MONTANO ALTO de la cordillera occidental de los Andes. Con esa información se construyó una línea base. Se elaboró la cartografía temática a una escala de 1:5000 y se identificó los impactos ambientales que afectan al bosque de páramo nuboso húmedo de Jacarón. Con sus resultados se propuso proyectos de desarrollo y de investigación que deben realizarse en torno al bosque.

Soil is the basis underlying the food production chain and it is fundamental to improve and conserve its productive capacity. Imbalanced exploitation can degrade agricultural areas physical, chemical and biologically. The objective of this study was to evaluate some soil physical properties and their relation with organic carbon contents of a Humic Dystrudept under conventional tillage (CT) and no-tillage (NT), for 12 years in rotation (r) and succession (s) cropping systems. The experiment was carried out in Lages, SC (latitude 27 º 49 ' S and longitude 50 º 20 ' W, 937 m asl), using crop sequences of bean-fallow-maize-fallow-soybean in conventional tillage rotation; maize-fallow in conventional tillage succession; bean-oat-maize-turnip-soybean-vetch in no-tillage rotation; and maize-vetch in no-tillage succession. The experimental design was completely randomized with four replications. The soil samples were collected in the layers 0-2.5, 2.5-5, 5-10, and 10-20 cm. The following properties were analyzed: soil density, porosity, aggregate stability, degree of flocculation, water retention, infiltration, mechanical strength, and total organic carbon. Soil aggregation in the surface layer (0-5 cm) was better in the no-tillage than the conventional system, related to higher microporosity, organic carbon contents and water retention capacity, indicating that a periodical tillage of this soil is unnecessary. Infiltration was highest in no-tillage with crop succession.O solo é a base da cadeia produtiva de alimentos, por isso tornam-se necessárias a conservação e manutenção de sua capacidade produtiva. Muitas áreas exploradas de forma incorreta podem apresentar degradação física, química e biológica. O objetivo deste estudo foi avaliar alguns atributos físicos e suas relações com os teores de carbono orgânico de um Cambissolo Húmico alumínico nos sistemas de preparo convencional (PC) e semeadura direta (SD), após 12 anos com rotação (r) e sucessão (s) de culturas. O experimento foi conduzido em Lages - SC, situado a 27 º 49 ' de latitude sul e 50 º 20 ' de longitude oeste, com altitude média de 937 m. As sequências de cultivo foram: feijão-pousio-milho-pousio-soja no preparo convencional rotação; milho-pousio no preparo convencional sucessão; feijão-aveia-milho-nabo-soja-ervilhaca na semeadura direta rotação; e milho-ervilhaca na semeadura direta sucessão. O delineamento experimental foi inteiramente casualizado, com quatro repetições. As amostras de solo foram coletadas nas camadas 0-2,5, 2,5-5, 5-10 e 10-20 cm. As variáveis avaliadas foram densidade do solo, porosidade, agregação, grau de floculação, retenção de água, infiltração, resistência mecânica à penetração e teor de carbono orgânico total. A semeadura direta apresentou melhor agregação do solo na camada surface (0-5 cm) em relação ao preparo convencional, o que está associado à maior microporosidade, teor de carbono orgânico total e retenção de água, não havendo necessidade de revolvimento do solo. A infiltração foi maior na semeadura direta com sucessão de culturas.

INTRODUÇÃO: A esclerose sistêmica (ES) é uma doença reumatológica caracterizada por inflamação autoimune, vasculopatia e fibrose da pele e de vários órgãos. Poucos tratamentos são considerados eficazes para a doença com intenso envolvimento de pele como a ES na forma difusa. Portanto, avaliamos a eficácia da ciclofosfamida no tratamento de pacientes com ES difusa grave. PACIENTES E MÉTODOS: Nove pacientes com ES difusa (Critérios do Colégio Americano de Reumatologia [ACR]) com escore de Rodnan de pele modificado (ERM) > 30 (0-51) foram submetidos ao tratamento com ciclofosfamida (CFM) EV na dose de 0,5 a 1,0 g/m² mensal por 18 meses, totalizando 18 pulsos. Além da realização do ERM a cada seis meses, exames laboratoriais e avaliação de efeitos adversos foram também analisados. Pacientes com doença pulmonar e envolvimento cardíaco foram excluídos. RESULTADOS: A maioria dos pacientes era do sexo feminino (77%), com média de idade de 41,7 anos e tempo de doença de 2,2 anos. Observou-se redução significativa do ERM de 37,7 ± 4,08 para 29,1 ± 8,13 após 12 meses de tratamento (P = 0,009). Sete pacientes completaram 18 meses de CFM e com redução persistente do ERM (média ERM = 26,4; P = 0,01). Houve também uma redução da proteína C-reativa (PCR) (média inicial PCR = 8,9 mg/dL) quando comparada com valores após 18 meses de tratamento (média PCR = 3,09 mg/dL; P = 0,04). Não foram observadas infecções, alterações urinárias e/ou quadro hematológico importante durante todo o tratamento. CONCLUSÃO: Nesta amostra de pacientes, o tratamento com a CFM foi eficaz e pode ser considerado como terapia alternativa para pacientes com ES e envolvimento cutâneo grave. INTRODUCTION: Systemic sclerosis (SSc) is a rheumatologic disease characterized by autoimmune inflammation, vasculopathy and tissue fibrosis of skin and various organs. There are few effective treatments available for a severe cutaneous involvement of diffuse SSc. Therefore, we evaluated the efficacy of cyclophosphamide in the treatment of severe diffuse SSc. PATIENTS AND METHODS: Nine diffuse SSc (American College of Rheumatology [ACR] criteria) patients with a modified Rodnan skin score (MRSS) > 30 (0-51) were submitted to treatment with cyclophosphamide (CPM), at a monthly dose of 0.5 to 1.0 g/m² IV for 18 months. MRSS was performed every six months during 18 months. Laboratory evidence of inflammatory activity and adverse events were also retrospectively assessed. Patients with severe pulmonary and cardiac involvement were excluded. RESULTS: Most patients were female (77%) with mean age of 41.7 years and duration of disease of 2.2 years. There was a significant reduction in the MRSS from 37.7 ± 4.08 to 29.1 ± 8.13 after 12 months of treatment (P = 0.009). Seven patients completed 18 months of CPM and had persistent reduction of the MRSS (mean MRSS = 26.4. P = 0.01). There was also a reduction of C-reactive protein (CRP) (initial mean CRP = 8.9 mg/dL) compared with values after 18 months of treatment (mean CRP = 3.09 mg/dL, P = 0.04). There were no infections, urinary disorders and/or important hematological problems throughout the treatment. CONCLUSION: The treatment with cyclophosphamide was effective and should be considered an alternative for the treatment of severe cutaneous involvement of SSc.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:07:25Z No. of bitstreams: 1 S1516-35982009000100014.pdf: 70400 bytes, checksum: d9c81989ed560fa3ad60491cbd548171 (MD5) Made available in DSpace on 2013-08-22T19:07:25Z (GMT). No. of bitstreams: 1 S1516-35982009000100014.pdf: 70400 bytes, checksum: d9c81989ed560fa3ad60491cbd548171 (MD5) Previous issue date: 2009-01-01 Made available in DSpace on 2013-09-30T20:11:52Z (GMT). No. of bitstreams: 2 S1516-35982009000100014.pdf: 70400 bytes, checksum: d9c81989ed560fa3ad60491cbd548171 (MD5) S1516-35982009000100014.pdf.txt: 20743 bytes, checksum: 1ca97404054c561cf49ecf828ab6b01d (MD5) Previous issue date: 2009-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:18:15Z No. of bitstreams: 2 S1516-35982009000100014.pdf: 70400 bytes, checksum: d9c81989ed560fa3ad60491cbd548171 (MD5) S1516-35982009000100014.pdf.txt: 20743 bytes, checksum: 1ca97404054c561cf49ecf828ab6b01d (MD5) Made available in DSpace on 2014-05-20T15:18:15Z (GMT). No. of bitstreams: 2 S1516-35982009000100014.pdf: 70400 bytes, checksum: d9c81989ed560fa3ad60491cbd548171 (MD5) S1516-35982009000100014.pdf.txt: 20743 bytes, checksum: 1ca97404054c561cf49ecf828ab6b01d (MD5) Previous issue date: 2009-01-01 Foram utilizados dez ovinos da raça Corriedale - cinco machos e cinco fêmeas com pesos entre 52,2 e 87,6 kg - com o objetivo de avaliar o efeito da combinação da movimentação do ar (0 e 5,0 m/s) com a temperatura do ar (25, 30 e 40ºC) sobre a temperatura retal (T R, ºC), da epiderme (T E, ºC), da superfície do velo (T V, ºC) e do interior do velo (T I, ºC) e a espessura do velo (E V, cm) e suas relações com o isolamento térmico do velo. A presença de vento não teve efeito sobre as variáveis estudadas, o que sugere que fluxo de ar (40ºC) o fluxo de calor sensível não foi significativa. Ten Corriedale sheep were evaluated, five males and five females with 52.2 to 87.6 kg of body weight, to evaluate the effect of air velocity (0 and 5 m/s) and temperature (25, 30 and 40ºC) on rectal temperature (T R, ºC), skin temperature (T E, ºC), fleece surface temperature (T V, ºC), temperature inside the fleece (T I, ºC), and fleece thickness (E V, cm) and their relationship with fleece thermal insulation. The results showed that air velocity did not affect the studied traits, suggesting that airflow 40°C), the sensible heat flow was not significant. Universidade Federal Rural do Semi-Árido (UFERSA) Departamento de Ciências Animais Laboratório de Biometeorologia e Bem-Estar Animal Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinária Departamento de Zootecnia Universidade Estadual Paulista Faculdade de Ciências Agrárias e Veterinária Departamento de Zootecnia

Aim: The aim of this randomized, controlled, clinical study was to compare two surgical techniques with the acellular dermal matrix graft (ADMG) to evaluate which technique could provide better root coverage. Material and Methods: Fifteen patients with bilateral Miller Class I gingival recession areas were selected. In each patient, one recession area was randomly assigned to the control group, while the contra-lateral recession area was assigned to the test group. The ADMG was used in both groups. The control group was treated with a broader flap and vertical-releasing incisions, and the test group was treated with the proposed surgical technique, without releasing incisions. The clinical parameters evaluated before the surgeries and after 12 months were: gingival recession height, probing depth, relative clinical attachment level and the width and thickness of keratinized tissue. Results: There were no statistically significant differences between the groups for all parameters at baseline. After 12 months, there was a statistically significant reduction in recession height in both groups, and there was no statistically significant difference between the techniques with regard to root coverage. Conclusions: Both surgical techniques provided significant reduction in gingival recession height after 12 months, and similar results in relation to root coverage.

In the last decades, the increase of candidiasis has been accompanied by an intensification of infections caused by Candida tropicalis.Indeed, C. tropicalis has been described as able to colonize and infect several anatomically distinct sites, including the skin, gastrointestinal, genitourinary and respiratory tracts. Adaptation to diverse pH that exists in each human niche has been shown to be critical for virulence in many commensal pathogens, but there are no reports concerning C. tropicalis. Biofilm formation ability is one of the most important virulence factors that have important clinical repercussions due to its increased resistance to antifungal therapy. Thus, the aim of the current study was to characterize the influence of pH on C. tropicalis biofilm formation, structure and composition. The effect of pH (3, 4, 7 and 8) on C. tropicalis biofilms was evaluated by enumeration of culturable cells, total biomass quantification and matrix composition. Biofilm structure and the morphology of its cells were analysed through scanning electron microscopic and confocal laser microscopy. The resultsrevealed an intensification of C. tropicalis capacity to form biofilm at neutral and alkaline conditions, with an increased on number of culturable cells and total biomass and in its structural complexity, comparatively to acid conditions. For the first time, we have demonstrated that C. tropicalis biofilm formation is highly influenced by the environmental human pH, which has an important clinical impact, which may partly explain the increase incidence of candidiasis.

The present study demonstrates the antibacterial potential of a phage endolysin against Gram-negative pathogens, particularly against multidrug resistant strains of Acinetobacter baumannii. We have cloned, heterologously expressed and characterized a novel endolysin (ABgp46) from Acinetobacter phage vb_AbaP_CEB1 and tested its antibacterial activity against several multidrug-resistant A. baumannii strains. LC-MS revealed that ABgp46 is an N-acetylmuramidase, that is also active over a broad pH range (4.0-10.0) and temperatures up to 50°C. Interestingly, ABgp46 has intrinsic and specific anti-A. baumannii activity, reducing multidrug resistant strains by up to 2 logs within 2 hours. By combining ABgp46 with several organic acids that act as outer membrane permeabilizing agents, it is possible to increase and broaden antibacterial activity to include other Gram-negative bacterial pathogens. In the presence of citric and malic acid, ABgp46 reduces A. baumannii below the detection limit (> 5 log) and more than 4 logs P. aeruginosa and Salmonella Typhimurium strains. Overall, this globular endolysin exhibits a broad and high activity against Gram-negative pathogens, that can be enhanced in presence of citric and malic acid, and be used in human and veterinary medicine., Project “BioHealth – Biotechnology and Bioengineering approaches to improve health quality,” Ref. NORTE-07-0124-FEDER-000027, co-funded by the Programa Operacional Regional do Norte (ON.2 – O Novo Norte), QREN, FEDER. The authors also acknowledge the project “Consolidating Research Expertise and Resources on Cellular and Molecular Biotechnology at CEB/IBB,” Ref. FCOMP-01-0124-FEDER-027462 and the bilateral project CNR/FCT. Mass spectrometry analyses were carried out at the Faculty of Science Mass Spectrometry Centre, University of Sheffield

Glycogenic hepatopathy is a rare and under-recognized complication in long-standing poorly controlled type 1 diabetes mellitus patients. This is a distinct entity from other causes of hepatomegaly and elevated liver enzymes in diabetics, such as nonalcoholic fatty liver disease. Glycogenic hepatopathy is characterized by the combination of poorly controlled diabetes, acute liver injury with marked elevation in serum aminotransferases, and the characteristic histological features on liver biopsy. It is important to distinguish this entity as it has the potential for resolution following improved glycemic control. In this report, we describe four cases of adult patients presenting elevated serum transaminases and hepatomegaly with a history of poorly controlled type I diabetes mellitus. One of the patients had also elevated amylase and lipase in the serum, without clinical or imagiologic evidence of acute pancreatitis (AP). Liver biopsy was performed in all patients and revealed glycogenic hepatopathy. Clinician's awareness of glycogenic hepatopathy should prevent diagnostic delay or misdiagnosis and will provide better insight and management for this condition.

The purpose of this study was to evaluate acellular dermal matrix (ADM) as a membrane for guided tissue regeneration (GTR) in the treatment of mandibular Class II furcation lesions and to compare it to a bioabsorbable membrane.Class II furcation lesions were created surgically and chronified in six mongrel dogs on the buccal surfaces of mandibular third and fourth premolars, bilaterally. After 1 month, GTR was performed. Each side was assigned randomly to the control group (CGr: bioabsorbable membrane made of polyglycolic acid: trimethylene carbonate) or the test group (TGr: ADM as a membrane). Clinical measurements of the width and thickness of the keratinized tissue (WKT and TKT, respectively) were made before GTR. The dogs were sacrificed 12 weeks following GTR, and histomorphometric analysis was performed. Area measurements were taken of new tissue, epithelium, connective tissue, and new bone; bone height and new cementum were measured.The formation of new bone, cementum, and periodontal ligament were similar in both groups. There were no statistically significant differences between the groups for any histomorphometric measurement. The TGr had a statistically significant increase in WKT and TKT after 3 months. The mean TKT gain was 1.03 mm for the TGr and 0.26 mm for the CGr (P0.05).The ADM demonstrated histomorphometric results similar to the bioabsorbable membrane and resulted in a greater increase in the thickness of the keratinized tissue.

A histological classification system (AHHS) has been recently proposed to predict 90-day mortality in patients with alcoholic hepatitis (AH). We analyzed the spectrum of histological features in patients with AH and assessed the ability of AHHS for predicting both response to steroids and 90-day mortality.Retrospective study of patients admitted to our tertiary centre between 2010 and 2014 with biopsy-proven AH. Histological features were analyzed and AHHS value was calculated. Kaplan-Meyer curves were calculated to assess the ability of AHHS to predict response to steroids and 90-day mortality.We included 34 patients (70.6% men, mean age 48.5±8.9 years). Transjugular liver biopsy was performed 3.5±2.9 days after admission. Presence of bilirubinostasis (p=0.049), degree of bilirubinostasis (p0.001), absence of megamitochondria (p0.001) and degree of polymorphonuclear infiltration (p=0.018) were significantly associated with higher mortality at 90 days. Patients who responded to steroids had a significantly lower AHHS value than non-responders (5.4±0.9 vs 8.1±1.1, p=0.003). AAHS value was significantly higher in patients who died compared to patients who survived at 90 days (9.0±0.7 vs 5.0±0.9, p0.001). AHHS predicted response to steroids [AUROC 0.90 (CI95% 0.742-1.000), p=0.004] and 90-day mortality [AUROC 1.0 (CI95% 1.0-1.0), p0.001] with high accuracy.In this cohort of patients, presence and degree of bilirubinostasis, absence of megamitochondria and degree of PMN infiltration were significantly associated with 90-day mortality. AHHS had a high accuracy for predicting response to steroids and 90-day mortality in this cohort of patients.

A partir da década de 1970, os impactos da sociedade de consumo industrial sobre o meio ambiente tornaram-se amplamente reconhecidos e debatidos em diversos setores da sociedade, inserindo-se nas agendas de lideranças mundiais. Central para o debate sobre meio ambiente e crescimento econômico tem sido o papel das empresas que, tendo sido historicamente parte do problema, passaram a incluir o meio ambiente em suas atividades e na gestão de seus negócios. Grandes acidentes envolvendo usinas nucleares e contaminações e outros de menor porte aumentaram a percepção pública quanto aos riscos decorrentes de um processo de produção predatório que ignora os limites da natureza. O objetivo do trabalho é discutir as estratégias de internalização da gestão ambiental à estrutura da empresa Suzano de Papel e Celulose nos últimos 30 anos, com enfoque na gestão hídrica da empresa. Para tanto, adotou-se uma metodologia baseada em análise documental e em um estudo de caso na empresa Suzano de Papel e Celulose. A revisão bibliográfica foi realizada em materiais obtidos na CETESB, na sede da Empresa Suzano e na Associação Brasileira de Papel e Celulose (ABTCPBRACELPA), além de teses e dissertações. Os dados para análise foram levantados em revistas setoriais com foco em gestão ambiental e em papel e celulose e nos relatórios de Sustentabilidade da empresa Suzano dos últimos 10 anos. Nesta etapa buscou-se avançar na compreensão das alternativas tecnológicas do setor de papel e celulose com foco na gestão da água, conhecer os participantes no mercado de papel e celulose e suas iniciativas voltadas ao tema da sustentabilidade. Foram ainda realizadas visitas à fábrica e à sede da empresa Suzano, com realização de entrevistas com a gerência de meio ambiente e qualidade. Os resultados alcançados revelam que três fatores têm sido determinantes para as mudanças na gestão hídrica na empresa, a saber: a legislação, que estabelece padrões de emissão de efluentes hídricos em corpos dágua; a pressão da opinião pública, notadamente a partir de meados da década de 1980 com relação à presença de compostos organoclorados (dioxinas) em efluentes de papel e celulose; e as exigências dos mercados importadores, como, por exemplo, quanto à certificação ambiental dos processos produtivos. Os resultados dessa pesquisa indicam que a empresa Suzano de Papel e Celulose nos últimos 30 anos passou de uma estratégia passiva com relação ao meio ambiente para uma estratégia proativa incorporando as exigências ambientais da legislação e de seus mercados no exterior. Conclui-se, portanto, que o meio ambiente tornou-se elemento-chave de competitividade e permanência no mercado para a empresa Suzano de Papel e Celulose. Since the 1970s, the impacts of the industrial production on the environment have become highly recognized and debated by ample sectors of society and taken over the agendas of leaders all over the world. Central to the debate between environmental protection and economic growth has been the role played by the business sector in the search for solutions to the environmental crisis by internalizing environmental demands. The aim of this paper is to discuss the strategies adopted by the Companhia Suzano de Papel e Celulose when interiorizing environmental concerns. Emphasis will be given to the industrial management of water resources in the last 30 years. To this effect, a case study method has been adopted. The bibliographic research was carried out through the use of materials, obtained at The State of São Paulo Environmental Agency), at ABTCP-BRACELPA (The Brazilian official Pulp and Paper Organization), and other studies on the pulp and paper sector. The data used in the analysis in environmental management magazines focused on the pulp and paper sector and the companys annual sustainability reports of the last 10 years. The aim was to acquire deeper understanding of the pulp and paper sector technological alternatives for cleaner production. In addition, interviews with the company´s Environment and Quality manager of the Suzano plant were also carried out. The results suggest that the company´s water management strategies have been determined by three key factors: the regulation, which sets the standards for effluent discharges; the pressure of public opinion, in the mid 1980s, particularly public demands for the elimination of the use of chlorine compounds (the dioxins); and the environmental demands of external markets such as those related to the environmental certification of production processes. The results reveal that, in the last 30 years, Companhia Suzano de Papel e Celulose has shifted from a passive strategy towards its environmental impacts to a proactive by interiorizing both the demands of the regulation and the demands of its overseas markets. In conclusion, the environment has become a key element both for the companys competitiveness and survival.

Background and Aims: Most international guidelines recommend performing a routine colonoscopy after the conservative management of acute diverticulitis, mainly to rule out a colorectal malignancy; however, data to support these recommendations are scarce and conflicting. This study is aimed at determining the rate of advanced colonic neoplasia (ACN) found by colonoscopy, and hence the need for routine colonoscopy after CT-diagnosed acute diverticulitis. Methods: We retrospectively analyzed all patients hospitalized for acute diverticulitis between July 2008 and June 2013. Patients who underwent colonoscopy more than 1 year after the acute episode were excluded. Advanced adenoma (AA) was defined as an adenoma with: (i) ≥10 mm, (ii) ≥25% villous features, or (iii) high-grade dysplasia. ACN included cases of colorectal cancer (CRC) and AA. Results: Of the 364 selected patients, 252 (69%) underwent colonoscopy (51% women, median age 55 ± 11 years). Adenomatous polyps were evident in 14.7% patients; 5.1% had AA and 3.2% had CRC. Patients with complicated diverticulitis had a higher number of ACN compared to those with uncomplicated diverticulitis (20.9 vs. 5.7%, p = 0.003). On multivariate analysis, age ≥50 years (OR 8.12, 95% CI 2.463-45.112; p = 0.017) and abscess on CT (OR 3.15, 95% CI 1.586-11.586; p = 0.036) were identified as significant risk factors for ACN. Conclusions: Patients with diverticulitis complicated with abscess have a higher risk of ACN on follow-up colonoscopy. The prevalence of ACN in patients with uncomplicated diverticulitis is quite similar to the average-risk population, and therefore an episode of CT-diagnosed uncomplicated diverticulitis, per se, does not seem to be a recommendation for colonoscopy.

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An 80-year-old man with a past medical history of hypertension and stage 3 chronic renal failure was referred for capsule enteroscopy because of iron deficiency anemia without overt bleeding. Previous upper gastrointestinal endoscopy and colonoscopy had revealed no significant changes. He had been on oral therapy with ferrous sulfate, in addition to candesartan cilexitil/hydrochlorothiazide. Capsule enteroscopy (●" Video1) showed brown hyperpigmentation with a speckled, continuous pattern affecting the jejunum (●" Fig.1a,b), but no hemorrhagic lesions were detected. Single-balloon enteroscopy revealed normal morphology of the villi with the same speckled brown pigmentation throughout the jejunum (●" Fig.2a,b). Histology revealed the deposition of brown pigment within macrophages in the lamina propria of normal villi (●" Fig.3a). A positive result with Prussian blue stain indicated hemosiderin deposition (●" Fig.3b). The term melanosis, derived from the Greek, means “state of blackness” and is appropriately used to describe conditions associated with excessive pigmentation. A variety of elements and compounds may cause dark pigmentation of the bowel, including melanin, lipofuscin, bismuth, iron, hemosiderin, and charcoal. The mechanisms of pigment deposition are unknown, and the consequences are thought to be benign [1]. Regardless of the chemical composition, deposits are typically found within macrophages in the lamina propria of normal villi. Pseudomelanosis of the small intestine is very rare, with only a few cases reported. It may be associated with chronic renal failure, gastrointestinal bleeding, drugs (hydralazine, propranolol, hydrochlorothiazide, furosemide, ferrous sulfate), or folic acid deficiency [2]. Although pseudomelanosis is a rare entity, physicians should be aware of it to facilitate a prompt diagnosis and avoid unnecessary testing. This case report underscores the association of pseudomelanosis of the small bowel with oral iron therapy and chronic renal failure. It has been hypothesized that the coupling of absorbed iron with a sulfur moiety in antihypertensive medications is the underlying mechanism for pigment accumulation in macrophages in the small-bowel mucosa [3].

Immunization against hepatitis B virus (HBV) infection is recommended in patients with inflammatory bowel disease (IBD), particularly in those under immunosuppressive therapy. Limited data are available about IBD patient's response to HBV vaccination. We assessed the response rate to HBV vaccination in IBD patients and evaluated the impact of different factors on the efficacy of HBV vaccination.Anti-HBs titers were measured in a cohort of IBD patients under treatment with infliximab and/or azathioprine. Vaccination was considered efficient when anti-HBs titers were higher than 10 IU/L.We have identified 217 patients with IBD under infliximab who were vaccinated for hepatitis B, 172 (79%) with Crohn's Disease and the remaining with ulcerative colitis; 114 patients (53%) were male and mean age was 33 ± 11 years. Overall, HBV vaccine was successful in 164 (76%) patients. Only 14 patients were vaccinated after infliximab was initiated, and only two of them had antibody levels above 10 IU/L. Among the patients that received vaccination before the beginning of infliximab, 88% of those who were vaccinated before starting azathioprine developed antibodies in contrast to 55% who already were under azathioprine. In multivariable analysis, treatment with infliximab (adjusted OR [95% CI]: 17.642 [8.514-33.937]) and with azathioprine (adjusted OR [95% CI]: 3.344 [1.653-9.145]) were the only factors associated with weaker response to HBV vaccination.The response rate to the standard HBV vaccination in IBD patients is low mainly in those treated with infliximab and/or azathioprine.

Vertigo and dizziness are among the most common medical complaints in the emergency room, and are associated with a considerable personal and health care burden. Scarce and conflicting reports indicate those symptoms may present a seasonal distribution. This study aimed at investigating the existence of a seasonal distribution of vertigo/dizziness in a tropical region, and the correlations of these findings with climatic variables. The charts of all patients consecutively admitted between 2009 and 2012 in the emergency room of a Brazilian general hospital were reviewed. A total of 4920 cases containing these terms were sorted from a sample of 276,076 emergency records. Seasonality was assessed using Cosinor Analysis. Pearson's correlations were performed between the incidence of consultations, considering separately dizziness and vertigo and each of the predictor climatic variables of that index month. Significant seasonal patterns were observed for dizziness and vertigo in the emergency room. Vertigo was more frequent in late winter-spring, negatively correlating to humidity (r = -0.374; p = 0.013) and rainfall (r = -0.334; p = 0.020). Dizziness peaked on summer months, and positively correlated to average temperatures (r = 0.520; p 0.001) and rainfall (r = 0.297; p = 0.040), but negatively to atmospheric pressure (r = -0.424; p = 0.003). The different seasonal patterns evidenced for dizziness and vertigo indicate possible distinct underlying mechanisms of how seasons may influence the occurrence of those symptoms.

The efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in the treatment of Inflammatory Bowel Disease (IBD) is well established. Many cutaneous and mucosal lesions have been described under anti-TNF-α therapy, some of them being considered as paradoxical. In this series we aimed to review the cases of oral lichen planus (OLP) in IBD patients under treatment with anti-TNF-α agents. Histologic findings from oral lesions of IBD patients treated with anti-TNF were revised. Three female patients with IBD developed oral lichen planus (OLP) after starting anti-TNF-α therapy. Other etiologies were excluded. In light of the increasing use of TNF-α inhibitors the occurrence of OLP is a potentially emerging side effect, thus we recommend a careful monitoring for oral manifestations in IBD patients treated with anti-TNF-α agents.