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Uma das maiores deficiências da Análise de Política Externa é escassez de estudos sobre os resultados. Soma-se, ainda, o entendimento, no Brasil, de que a política externa, ainda que seja uma política pública, conservaria características de política de Estado. Essa noção não aporta benefícios heurísticos, por não representar a dinâmica política, e obstaculiza a produção da política externa a partir de evidência. Este artigo, via revisões bibliográficas, contribui para o campo em duas frentes: apresentando um conceito de política pública que abarca integralmente a política externa, e debatendo os principais modelos e a validade da avaliação como abordagem de pesquisa.

Common bile duct stones (CBDS) can spontaneously migrate through the duodenal papilla. In this case, ERCP could be unnecessary and a significant rate of complications could be avoided. In this study, we aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS and at analysing the factors associated to spontaneous stone migration.We conducted a retrospective multi-centre analysis of patients undergoing ERCP for CBDS in a 12-month period. 1016 patients with CBDS were analysed. In all patients CBDS was diagnosed with adequate imaging methods performed prior to ERCP. ERCPs with failed biliary cannulation were excluded. Data regarding patients' characteristics, imaging findings and ERCP procedure were analysed.1016 patients with CBDS undergoing ERCP were analysed (male sex 43.3%; mean age 69.9 ± 16.5 years). Diagnosis of CBDS was obtained by EUS in 415 patients (40.8%), MR in 343 (33.8%), CT in 220 (21.7%), and US in 38 (3.7%). No stones were found at ERCP in 179 patients (17.6%), in 14 (6.2%) when ERCP was performed within 6 h from imaging study, in 114 (18.5%) between 7 h and 7 days, in 32 (24.6%) between 8 and 29 days, and in 19 (43.2%) after 30 days. The rate of unnecessary ERCP occurred significantly more frequently in patients in whom imaging methods demonstrated either sludge or ≤ 5 mm CBDS (29.9 vs. 8.3%; p 0.001).Spontaneous migration of small CBDS is a frequent event, and ≤ 5 mm size and a delay in ERCP 7 days represent predictive factors for it. We suggest that CBDS ≤ 5 mm should not undergo immediate removal and this fact would allow reducing the rate of unnecessary ERCP with their related complications. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.

Background Endoscopy plays a fundamental role in the management of patients with inflammatory bowel disease (IBD). The aim of this study was to prospectively evaluate the tolerability and efficacy of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn’s disease (CD) patients compared to subjects participating in a colorectal cancer population screening program. Methods Consecutive enrolment of CD and UC patients and screening subjects (SS) undergoing colonoscopy. Bowel preparation was done by split dose of 2 L PEG-ELS + simethicone. We recorded endoscopic, clinical, and demographic features; cleanliness rating using the Boston Bowel Preparation Scale (BBPS); and sedation doses. Bowel-preparation tolerability, discomfort, and pain during colonoscopy were assessed using a Visual Analogue Scale from 0 to 100 mm. Results Sixty-three UC (mean age 49.9 ± 14.9 years), 63 CD (mean age 44.0 ± 14.0 years), and 63 SS (mean age 59.9 ± 6.3 years) patients were enrolled. Bowel preparation was similarly tolerated in UC, CD, and SS (P = 0.397). A complete colonoscopy was similarly performed in UC (59/63, 93.7%), CD (58/63, 92.1%), and SS (60/63, 95.2%) (P = 0.364). The BBPS did not show significant differences between UC (6.2 ± 1.6), CD (6.1 ± 1.3), and SS (6.2 ± 1.4) (P = 0.824). The need to increase sedation doses was significantly higher in CD (24/63, 38.1%) and UC (16/63, 25.4%) than in SS (4/63, 6.3%) (P < 0.0001). Conclusions Bowel preparation is equally tolerated and efficacious in IBD patients and in healthy SS. In IBD, higher sedation doses are needed to guarantee an equally tolerated colonoscopy.

Background During the COVID-19 outbreak in Italy, only fast-track endoscopic procedures have been performed; nevertheless, a significant drop in their number has been reported. We evaluated whether the pandemic has impacted the appropriateness and diagnostic yield of fast-track endoscopic procedures compared with those performed in 2019. Methods This retrospective study involved endoscopy services in Northern Italy. We compared data regarding endoscopic procedures performed in March and April 2020 with those performed during the same period in 2019. Results In 2020, there was a 53.6 % reduction in the number of fast-track endoscopic procedures compared with 2019. Patients undergoing endoscopy in 2020 were younger than in 2019. Both appropriate referral and diagnostic yield increased in 2020 for both upper and lower endoscopy. A higher rate of cancer was diagnosed in 2020 by upper endoscopy (3.6 % vs. 6.6 %; P = 0.04). Conclusions The high level of inappropriate endoscopy referrals registered in 2019 significantly improved during the COVID-19 outbreak of 2020, with an increase in the diagnostic yield.

At present, the time-frame used for the quarantine of individuals with coronavirus disease 2019 (COVID-19) is the entire duration of symptoms plus 14 days after symptom recovery; however, no data have been reported specifically for healthcare workers (HCWs). In the study population of 142 HCWs with COVID-19, the mean time for viral clearance was 31.8 days. Asymptomatic subjects cleared the virus more quickly than symptomatic subjects (22 vs 34.2 days; P

Background Inflammatory bowel disease (IBD) is usually diagnosed in subjects with gastrointestinal symptoms, but may also be asymptomatic and diagnosed incidentally. Aims to determine the prevalence of IBD in asymptomatic adults. Methods we identified subjects who underwent colonoscopy between 1 September 2013 and 31 August 2019 in a regional colorectal cancer screening program with endoscopic findings suggestive of IBD, and retrieved their clinical, histological and therapeutic information. Results 5116 subjects underwent colonoscopy, and 4640 persons were considered assessable. Of these, 54 (1.16%) had endoscopic findings suggestive of IBD, including 40 of Crohn's disease (CD) and 14 of ulcerative colitis (UC). A definite diagnosis of IBD was made in 19 patients, for an overall IBD prevalence of 0.41%, with 13 cases of CD (0.28%) and 6 of UC (0.13%). The mean follow-up was 26.8 months after the first colonoscopy. Therapy was started in 5 of 13 CD patients and all UC patients. Conclusion Endoscopic findings suggestive of IBD are not infrequent in an asymptomatic colorectal cancer screening population. Visualization of the terminal ileum is recommended in this setting. A definite diagnosis of IBD was made in about 1 out of 3 subjects with endoscopic lesions. Most IBD patients had a mild form of disease, but some needed biologic therapy.

Introduction The most typical presentation of COVID-19 is an acute respiratory syndrome whose most common symptoms include fever, cough, and dyspnea. However, gastrointestinal symptoms, such as diarrhea and nausea/vomiting, are increasingly reported in patients affected by COVID-19. This study aimed to describe the prevalence and time of onset of gastrointestinal symptoms in patients affected by COVID-19 and to find potential associations between gastrointestinal symptoms and clinical outcomes. Methods We performed a prospective single-center cohort study, enrolling patients who received diagnosis of COVID-19 at our institution between March 23, 2020, and April 5, 2020. We collected patient demographics and medical history, laboratory data, and clinical outcomes. Furthermore, we used a specifically designed questionnaire, administered to patients at time of diagnosis, to obtain data on the presence and time of onset of fever, typical respiratory symptoms, gastrointestinal symptoms, and other symptoms (fatigue, headache, myalgia/arthralgia, anosmia, ageusia/dysgeusia, sore throat, and ocular symptoms). Results In our cohort, 138 (69%) of 190 patients showed at least 1 gastrointestinal symptom at diagnosis; if excluding hyporexia/anorexia, 93 patients (48.9%) showed at least 1 gastrointestinal symptom. Gastrointestinal symptoms, in particular diarrhea, were associated with a lower mortality. At multivariate analysis, diarrhea was confirmed as independent predictive factor of lower mortality. Discussion Gastrointestinal symptoms are very frequent in patients with COVID-19 and may be associated with a better prognosis. These data suggest that, in some patients, the gastrointestinal tract may be more involved than the respiratory system in severe acute respiratory syndrome coronavirus 2 infection, and this could account for the less severe course of disease.

Background and aims Restarting activity in Endoscopic Departments (ED) after COVID-19 lockdown raises critical issues. This survey investigates strategies and uncertainties on resumption of elective activity. Methods Directors of 55 EDs in Northern Italy received a questionnaire focusing on the impact of pandemic on activity and organization and on the resources available at re-opening. A section was devoted to gather forecasts and proposals on the return path to normality. Results All centres had reduced their activities of at least 50% of the pre-COVID-19 period. A rate of endoscopists (13.6%), nurses (25.2%), and health assistants (14%) were not available since infected, or relocated to other departments. One third of endoscopic rooms were converted to COVID-19 care. Two third had the waiting or the recovery areas too small for distancing. A dedicated pathway for infected patients could not be guaranteed in 20% of EDs. Only one third of EDs judged realistic to completely restore a pre-crisis workload by the next months. Optimizing appropriateness of procedures, closer interaction with GPs and triaging patients with telemedicine were the proposals to re-open EDs. Conclusions The critical issues while re-opening EDs calls for reducing the workload in the endoscopy units through appropriate rescheduling of procedures. Funding None

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Quantas vezes você leu ou ouviu expressões no seguinte sentido: “a política externa contribui para o desenvolvimento nacional pela promoção das exportações”. Essa noção está difundida entre a elite política brasileira, a opinião pública e a literatura acadêmica. Contudo, parte majoritária dos estudos desse campo produz suas inferências a partir de desenhos de pesquisa que dependem em demasia de fontes qualitativas, sobretudo discursos e entrevistas com atores diretamente envolvidos nesta política pública, o que reduz seu potencial explicativo. Esta tese visa a robustecer a compreensão da relação entre política externa e desenvolvimento nacional, bem como seus efeitos distributivos, verificando o nexo causal e avaliando os efeitos dessa política pública sobre o comércio exterior. Para tanto, esta tese aplica o modelo gravitacional para calcular os efeitos da política externa implementada entre 1985 e 2018, nomeadamente acordos de integração econômica, viagens presidenciais e a presença de embaixadas. Essa estimação realiza-se a partir de um banco de dados composto por 96,38% da corrente comercial do Brasil no período. Para esse esforço científico, o modelo gravitacional é adequado, pois controla variáveis econômicas, geográficas, históricas e políticas, isolando os efeitos da ação externa do Estado brasileiro. Os principais resultados mostram que a política externa do Brasil tem efeitos positivos sobre as exportações e negativos sobre as importações, promovendo uma proteção do mercado nacional. Não obstante, a magnitude desses efeitos é insuficiente para acompanhar o crescimento de competitividade internacional nas últimas décadas, notadamente por parte dos países em desenvolvimento, e da América Latina e Caribe. How many times have you read or heard expressions with the following meaning: “the foreign policy contributes to national development through the promotion of exports”. This perspective is spread among the Brazilian political elite, public opinion, and the academic literature. However, a large portion of the studies in this field produce inferences based on research designs that are heavily dependent on qualitative sources, mostly public discourses and interviews with actors directly involved in this public policy, thus diminishing its explanatory potential. This dissertation aims at enhancing the comprehension regarding the relationship between foreign policy and national development, as well as its distributives effects, by verifying the causal nexus and evaluating the effects of this public policy on trade. To do so, this dissertation applies the gravity model to calculate the effects of the foreign policy implemented between 1985 and 2018, namely economic integration agreements, presidential travels, and the presence of embassies. This estimation is carried out on a database that encompasses 96.38% of the Brazilian trade in this interim. For this scientific endeavor, the gravity model is adequate because it controls economic, geographic, historical, and political variables, isolating the effects of the external action of the Brazilian state. The main results show that the Brazilian foreign policy has positive effects on exports and negative ones on imports, protecting of the national market. Nonetheless, the magnitude of these effects is insufficient to keep up with the growth of international competition in recent decades, notably from other developing countries, and from Latin America and the Caribbean.

Biogenic amines (BAs) are involved in physiological processes. Foods where typically high levels of BAs occur are fermented food and beverage. This work set out to evaluate the occurrence of BAs in red and white wines, and to also ascertain the dietary exposure to BAs among consumers. Besides, a case report of a probable histamine intoxication upon ingestion of contaminated wine was described. The samples were analyzed through derivatization with dansyl chloride and HPLC-UV detection. Red wines showed higher levels of BAs, especially putrescine (PUT) and histamine (HIS), than white wines (median concentrations of 7.30 and 2.45 mg/L, respectively). However, results of our investigation showed that the dietary exposure to BAs through the consumption of wine (red and white) were lower than the recommended maximum levels for the acute exposure to HIS and tyramine (TYR). In contrast, the levels of BAs in wine on tap were much higher than in bottled wine and close to recommended values. The levels of HIS, TYR, and PUT in tap wine of 9.97, 8.23, and 13.01 mg/L, respectively, were associated with histamine-mediated symptoms in six young individuals after consumption of about three glasses of wine. The overall results and multivariate analysis confirm that red wine shows a higher concentration of BAs than white wine, especially putrescine and histamine. This finding is attributable to the malolactic fermentation that is common for most red wine production. It is also evident that incorrect preservation processes can lead to an increase in BA levels, probably due to the action of bacteria with high decarboxylase activity. The exposure values, although below the toxicity thresholds, could lead to histamine-mediated symptoms in susceptible individuals, also according to the case report discussed in this study.

Background IBD patients are intended to undergo several times colonoscopy during their lifespan. Adequate bowel preparation and sedation greatly contribute to high-quality colonoscopy and are even more important in this setting. However, few and low-quality studies addressed these issues. Aims: to prospectively evaluate the tolerability of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn’s disease (CD) patients compared with subjects participating in a colorectal cancer population screening programme. Methods we consecutively enrolled CD and UC patients and screening subjects (SS) undergoing colonoscopy between August 2017 and August 2019. Bowel preparation was done by macrogol 4.000 + simethicone + sodium-sulphate-anhydrous. We recorded endoscopic, clinical and demographic features; quality of cleansing by Boston Bowel Preparation Scale (BBPS; from 0 the worst to 9 the best); sedation dose and need to increase the initial doses of midazolam (3.0 mg) and fentanyl (0.05 mg). Tolerability of bowel preparation, discomfort and pain during colonoscopy were assessed by Visual Analogue Scale (VAS) from 0 to 100 mm. Results 65 UC (26 women, mean age 50.6 ± 15.4 years), 65 CD (29 women, mean age 44.7 ± 3.9) and 94 SS (47 women, mean age 61.9 ± 6.9) enrolled. Bowel preparation was similarly tolerated in UC (70.3 ± 17.7 mm), CD (73.1 ± 12.7 mm) and SS (73.2 ± 12.6 mm) (p = 0.397). Complete colonoscopy was similarly done in UC (61/65, 93.8%), CD (60/65, 92.3%) and SS (91/94, 96.8%) (p = 0.364). BBPS did not show significant differences between UC (6.5 ± 1.0), CD (6.4 ± 1.1) and SS (6.4 ± 1.0) (p = 0.824). The need to increase sedation doses was significantly higher in CD (26/65, 40.0%) and UC (16/65, 24.6%) than in SS (4/94, 4.3%) (p < 0.0001). The mean increases in midazolam and fentanyl doses were significantly higher in CD (0.446 ± 0.660 mg and 0.009 ± 0.019 mg, respectively) and UC (0.300 ± 0.620 and 0.008 ± 0.018 mg) than in SS (0.042 ± 0.250 mg and 0.001 ± 0.007 mg) (p < p < 0.0001 in both cases). Discomfort and pain during colonoscopy were similar in UC (35.0 ± 23.0 mm and 27.6 ± 24.6 mm, respectively), CD (37.5 ± 22.2 mm and 28.8 ± 22.5 mm) and SS 33.7 ± 18.7 and 26.9 ± 19.8 mm) (p = 0.530 and p = 0.866, respectively). Conclusion in IBD patients, higher sedation doses are needed in order to warrant a tolerated colonoscopy. Bowel preparation is equally tolerated and efficacious in IBD patients and in screening subjects.

RESUMO Este artigo debruçou-se sobre a Assembleia Constituinte de 1987-1988 para investigar a construção social dos dispositivos constitucionais que regulamentam metas e abordagens da política externa brasileira. Para tanto, mobilizou-se literatura sobre grupos de interesse com o intuito de identificar os atores e interesses que participaram da elaboração destes dispositivos durante a Constituinte, bem como os constrangimentos internacionais que se impunham sobre esses atores. A partir da individualização e sistematização do conjunto de propostas analisadas, esta pesquisa recorreu aos ferramentais de process tracing para identificar os atores e interesses que buscaram influenciar o processo constituinte e conformaram os dispositivos constitucionalizados. Dentre os resultados, observaram-se a participação do Itamaraty como importante fonte e agente para a constitucionalização de valores e práticas da política externa, e, principalmente, mobilizações de grupos de interesse de diversos níveis de organização que, ao promoverem suas preferências para limitar e orientar a política externa, provocaram uma expansão da agenda internacional do Brasil. ABSTRACT The following article delves into the Constituent Assembly of 1987-1988 in order to investigate the social construction of the constitutional devices regulating the aims and approaches of Brazilian foreign policy. Research has therefore been conducted into literature on groups of interest in order to identify the actors and interests to have informed the development of such devices during the years mentioned, as well as the international restrictions to have affected the actors. By means of isolating and systematically dealing with each of the proposals analyzed, the study harnesses the tools employed in process training in order to identify the actors and interests that sought to influence the constituent process and served to shape the constitutional devices. The results demonstrate the Ministry of Foreign Affairs’ role as an important source and agent in the constitutionalization of values and practices in foreign policy, mainly mobilizing groups of interests across various organizational levels, which, in promoting their preferences for limiting and orienting foreign policy, led to an expansion of the international agenda in Brazil. RÉSUMÉ Cet article se penche sur l’Assemblée constituante de 1987-1988 afin d’analyser la construction sociale des dispositifs constitutionnels qui règlementent les objectifs et les approches de la politique étrangère brésilienne. À cette fin a été mobilisée la littérature relative aux groupes de pression dans le but d’identifier les acteurs et les intérêts ayant participé de l’élaboration desdits dispositifs à l’époque de la Constituante, ainsi que les contraintes internationales s’imposant à ces acteurs. À partir de l’individualisation et de la systématisation de l’ensemble des propositions analysées, cette recherche a eu recours aux outils du process tracing pour identifier les acteurs et les intérêts qui ont cherché à influencer le processus constituant et à modeler les dispositifs constitutionnalisés. Parmi les résultats obtenus, nous avons observé dans la participation du ministère de Affaires étrangères (Itamaraty) une source et un agent importants de la constitutionnalisation de valeurs et de pratiques de la politique étrangère, moyennant la mobilisation de groupes de pression de différents niveaux d’organisation qui, par la promotion de leurs choix pour délimiter et orienter la politique étrangère, ont provoqué une expansion de l’agenda international du Brésil. RESUMEN Este artículo se enfocó en la Asamblea Constituyente de 1987-1988 para investigar la construcción social de los dispositivos constitucionales que reglamentan las metas y los enfoques de la política externa brasileña. Para ello, se buscó literatura sobre grupos de interés con la intención de identificar a los actores e intereses que participaron en la elaboración de estos dispositivos durante la Constituyente, así como a las obligaciones internacionales que se imponían a esos actores. A partir de la individualización y sistematización del conjunto de propuestas analizadas, esta investigación usó las herramientas de process tracing para identificar a los actores e intereses que trataron de influir en el proceso constituyente y conformaron los dispositivos constitucionalizados. Entre los resultados, se observaron la participación de Itamaraty como una importante fuente y agente para la constitucionalización de valores y prácticas de la política externa y, sobre todo, movilizaciones de grupos de interés de diversos niveles de organización que, al promover sus preferencias para limitar y orientar la política externa, provocaron una expansión de la agenda internacional de Brasil.