Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01–1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29–3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

ABSTRACT Scorpion envenoming is considered a public health problem in Brazil. A recent study described a variation in the clinical outcome of envenoming by Tityus obscurus in two populations separated by 850 km in the northeastern Amazon region. Our aim was to evaluate whether such clinical and toxinological variations are associated with underlying differences in genetic diversity between these two T. obscurus populations. We obtained DNA from five individuals of each population, in the municipalities of Belém and Santarém, located east and west of the state of Pará, Brazil, respectively. Gene regions encoding mitochondrial DNA (mtDNA) markers cytochrome oxidase subunit I (COI) and ribosomal 16S RNA (16S) were amplified and sequenced. Phylogenetic analyses were performed using maximum likelihood (ML) and Bayesian inferences (BA) for both molecular data (COI and 16S). The sampled T. obscurus populations corresponded to two distinct mtDNA lineages (genetic distance COI K2 P = 0.08 to 0.13; 16S K2 P = 0.10 to 0.11) with no shared mutations between groups and well supported by ML and BA inferences. Based on the divergence values found between eastern and western populations (COI, 0.07 to 0.12; 16S, 0.10), our study confirms the genetic heterogeneity of T. obscurus populations within the state of Pará, which correlates with observed venom and clinical differences, and reinforces the need for mapping the distribution of haplotypes throughout the geographic range of T. obscurus, to aid in future epidemiological, toxinological, and evolutionary studies.

RESUMO O envenenamento por escorpiões é considerado um problema de saúde pública no Brasil. Um estudo recente descreve a variação do quadro clínico de envenenamento por Tityus obscurus em duas populações separadas por uma distância de 850 km no nordeste da Amazônia. O objetivo deste estudo foi avaliar se tais variações clínicas e toxicológicas estão associadas a diferenças subjacentes na diversidade genética entre essas duas populações de T. obscurus. Obtivemos DNA de cinco indivíduos de cada população nos municípios de Belém e Santarém, localizados a leste e oeste do estado do Pará, Brasil, respectivamente. Regiões gênicas que codificam marcadores de DNA mitocondrial (mtDNA) citocromo oxidase subunidade I (COI) e RNA ribossômico 16S (16S) foram amplificadas e sequenciadas. As análises filogenéticas foram realizadas por máxima verossimilhança (ML) e inferência Bayesiana (BA) para ambos os dados moleculares (COI e 16S). As populações de T. obscurus amostradas corresponderam a duas linhagens distintas de mtDNA (distância genética COI K2 P = 0,08 a 0,13; 16S K2 P = 0,10 a 0,11) sem mutações compartilhadas entre os grupos, e bem corroboradas por inferências ML e BA. Com base nos valores de divergência encontrados entre as populações oriental e ocidental (COI, 0,07 a 0,12; 16S, 0,10), nosso estudo confirma a heterogeneidade genética das populações de T. obscurus no estado do Pará. Os resultados são congruentes com as diferenças observadas no quadro clínico dos acidentes e toxicidade do veneno, e reforçam a necessidade de mapear a distribuição de haplótipos em toda a distribuição geográfica de T. obscurus, para auxiliar em futuros estudos epidemiológicos, toxinológicos e evolutivos.

Resumo défice cognitivo ligeiro define-se por um estadio intermédio entre a cognição normal e a demência. Os tratamentos farmacológicos para esta condição clínica são escassos e têm uma taxa de eficácia ainda em avaliação. Esta revisão tem como objetivo reunir a atual evidência científica existente acerca do benefício da vortioxetina no défice cognitivo ligeiro. Foi efetuada uma pesquisa de meta-análises, revisões sistemáticas, ensaios clínicos, estudos observacionais e normas de orientação clínica indexados nas bases de dados eletrónicas MEDLINE/Pubmed, The Cochrane Library, Database of Abstracts of Reviews of Effects, National Guideline Clearinghouse, BMJ Evidence-Based Medicine, National Institute for Health and Care Excellence, Canadian Medical Association Practice Guidelines Infobase e Bandolier, utilizando-se os termos MeSH “Vortioxetine” e “Cognitive Dysfunction”. Não houve nenhuma restrição linguística nos artigos selecionados. O nível de evidência e a força de recomendação foram avaliados utilizando a escala Strength of Recommendation Taxonomy (SORT), da American Academy of Family Physicians. Da pesquisa inicial foram obtidos 127 artigos. Destes, após aplicação dos critérios de inclusão e exclusão, foram excluídos 125, pelo que foram incluídos nesta revisão dois artigos. Estes demostraram que a terapêutica com vortioxetina parece ser mais eficaz do que o placebo na obtenção de melhoria da função cognitiva em indivíduos com défice cognitivo ligeiro, pelo que a sua utilização pode ser benéfica em indivíduos sem contraindicação à sua utilização (Força de Recomendação B). No entanto, são necessários estudos mais robustos para comprovar este benefício.

Abstract Mild cognitive impairment is a stage between the cognitive alterations and an initial stage of dementia. Pharmacologic treatments for this condition are scarce and their efficacy is still under assessment. This review aims at gathering existing scientific evidence regarding the benefits of vortioxetine in mild cognitive impairment. The research included metanalyses, systematic reviews, clinical trials, observational studies, and guidelines indexed in MEDLINE/Pubmed, The Cochrane Library, Database of Abstracts of Reviews of Effects (DARE), National Guideline Clearinghouse, BMJ Evidence-Based Medicine (BMJ EBM), National Institute for Health and Care Excellence (NICE), Canadian Medical Association Practice Guidelines Infobase, and Bandolier, using MeSH terms “Vortioxetine” and “Cognitive Dysfunction”. Publications from any linguistic background were considered, with no language restrictions. The evidence level and recommendation strength were defined using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT). In the original research, 127 articles were found, of which 125 were excluded for not meeting inclusion criteria or for meeting exclusion criteria. In the end, two studies were included in the revision. Both studies showed that vortioxetine appeared more effective than placebo in obtaining an improvement of cognitive function in individuals with mild cognitive impairment, thus it may be beneficial in those without contraindications to its use (Strength of Recommendation B). However, further studies are needed to prove this benefit.

Abstract Introduction: Family doctors play a key role in identifying patients in need of and prescribing rehabilitation and physical medicine treatments. Since there is no central record of rehabilitation prescriptions, it is impossible to know the population of patients undergoing rehabilitation. Objectives: Characterizing prescriptions of physical rehabilitation care from four primary care units in the North of Portugal, in 2019. Methods: Observational, analytical, retrospective study of a randomized sample of 400 prescriptions of a first cycle in rehabilitation care, in four primary care units, in 2019. Results: In the analyzed sample, the majority of the patients were female, with an average age of 58 years, an education level equal to or inferior to primary education, and not working at the moment of the prescription. Most prescriptions were due to musculoskeletal complaints (71%), followed by unspecific causes (17%), and the nervous system (5%). From the musculoskeletal motives, 43% were degenerative, 21% inflammatory, and 8% traumatic. From the analyzed initial prescriptions, 61% were not followed by subsequent prescriptions. Conclusions: This study characterizes the patients and the motives that lead physicians of four primary care units to prescribe rehabilitation care. Musculoskeletal diseases were the leading cause of rehabilitation care prescription. The majority of the population had low education and was retired/unemployed despite still being of working age. Most of the initial treatments were not followed by subsequent prescriptions. This study can be a starting point for future investigations and practice improvements in this care area.

Resumo Introdução: Os médicos de família assumem um papel fulcral na identificação e gestão das necessidades de medicina física e de reabilitação. Uma vez que não existe um registo centralizado de informação não é possível conhecer com rigor o universo dos utentes utilizadores. Objetivos: Caracterizar a prescrição de medicina física e de reabilitação em quatro unidades de saúde familiar da Administração Regional de Saúde do Norte, no ano de 2019. Método: Foi realizado um estudo observacional, analítico e retrospetivo numa amostra aleatória de 400 prescrições de primeira consulta de medicina física e de reabilitação, pertencentes a quatro unidades de saúde familiar, no ano de 2019. Resultados: Das prescrições analisadas mais de metade era de indivíduos do sexo feminino, que tinham em média 58 anos, um nível de escolaridade igual ou inferior ao primeiro ciclo do ensino básico e uma situação profissional não ativa. A maioria das prescrições estava relacionada com patologia do sistema músculo-esquelético (71%), seguindo-se causas gerais e inespecíficas (17%) e o sistema nervoso (5%). De entre os motivos músculo-esqueléticos, 43% relacionaram-se com patologia degenerativa, 21% com patologia inflamatória e 8% com patologia traumática. Dos pedidos analisados, 61% não foram seguidos de requisições subsequentes. Conclusões: Com este estudo foi possível definir as características de uma população de utentes utilizadores dos cuidados da medicina física e de reabilitação em quatro unidades de saúde familiar. Verificou-se que a patologia do foro músculo-esquelético foi a que mais frequentemente motivou tratamento. A maior parte da amostra estudada tinha um baixo grau de escolaridade e encontrava-se reformada/desempregada, apesar da idade ativa. Mais de metade das primeiras prescrições não foi renovada. Este estudo pode ser um ponto de partida para mais investigação e uma melhoria da qualidade dos serviços prestados neste âmbito.

ABSTRACT Objectives To evaluate the complete response (CR) rate and surgeries performed in patients with rectal adenocarcinoma who underwent neoadjuvant therapy (NT) at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and at Hospital São Paulo, in Ribeirão Preto, from January 2007 to December 2017. Methods We evaluated 166 medical records of patients with locally advanced rectal adenocarcinoma (T3, T4 or N+) who underwent NT. The regimen consisted of performing conventional (2D) or conformational (three-dimensional-3D/ radiotherapy with modulated intensity – IMRT) at a dose of 45-50.4Gy associated with capecitabine 1650mg/m2 or 5-fluorouracil (5FU) and leucovorin (LV). The following variables were analyzed: gender, age, pretreatment stage, radiotherapy, CR index, local and distant recurrence rates. Surgical treatment and complications were also evaluated. Results The CR index was 28.3%. Patients treated with 3D/IMRT radiotherapy had a higher rate of CR (36.3% x 4.8%; p < 0.001), higher rates of clinical follow-up (21% x 0%; p < 0.001), lower surgery rates (79% x 100%; p < 0.001), higher rates of transanal resection (37.1% x 9.5%; p = 0.001), lower rates of abdominal rectosigmoidectomy (25.8% x 50%; p = 0.007) and lower rates of abdominoperineal resection of the rectum (16.1% x 40.5%; p = 0.002), when compared to patients treated with 2D radiotherapy. Conclusion Modern radiotherapy techniques such as 3D conformal and IMRT, by offering greater adequacy and precision of treatment, could result in better local control and less toxicity in organs at risk, enabling organ preservation strategies and less invasive approaches in selected cases.

Abstract Introduction: Anastomotic leakage after esophagectomy is associated with high mortality and impaired quality of life. Aim: The objective of this work was to determine the effec-tiveness of management of esophageal anastomotic leakage (EAL) after esophagectomy for esophageal and gastro-esophageal junction (GEJ) cancer. Methods: Patients submitted to esophagectomy for esophageal and GEJ cancer at a tertiary oncology hospital between 2014 and 2019 (n = 119) were retrospectively reviewed and EAL risk factors and its management outcomes determined. Results: Older age and nodal disease were identified as independent risk factors for anastomotic leak (adjusted OR 1.06, 95% CI 1.00-1.13, and adjusted OR 4.89, 95% CI 1.09-21.8). Patients with EAL spent more days in the intensive care unit (ICU; median 14 vs. 4 days) and had higher 30-day mortality (15 vs. 2%) and higher in-hospital mortality (35 vs. 4%). The first treatment option was surgical in 13 patients, endoscopic in 10, and conservative in 3. No significant differences were noticeable between these patients, but sepsis and large leakages were tendentially managed by surgery. At follow-up, 3 patients in the surgery group (23%) and 9 in the endoscopic group (90%) were discharged under an oral diet (p = 0.001). The in-hospital mortality rate was 38% in the surgical group, 33% in the conservative group, and 10% in endoscopic group (p = 0.132). In patients with EAL, the presence of septic shock at leak diagnosis was the only predictor of mortality (p = 0.004). ICU length-of-stay was non-significantly lower in the endoscopic therapy group (median 4 days, vs. 16 days in the surgical group, p = 0.212). Conclusion: Risk factors for EAL may help change pre-procedural optimization. The results of this study suggest including an endoscopic approach for EAL.

Resumo Introdução: A deiscência anastomótica após esofagectomia está associada a uma elevada taxa de mortalidade e qualidade de vida comprometida. Objetivo: Avaliar a eficácia da abordagem da deiscência de anastomose esofágica após esofagectomia por neoplasia do esófago e da junção esofagogastrica (JEG). Métodos: Foram revistos retrospetivamente todos os doentes submetidos a esofagectomia por neoplasia do esófago e da JEG num hospital terciário entre 2014 e 2019 (n = 119) e analisados os fatores de risco e as diferentes abordagens na deiscência anastomótica. Resultados: A idade avançada e a presença de metastização ganglionar foram identificados como fatores de risco independentes para deiscência anastomótica (OR 1.06, 95% IC 1.00-1.13 e 4.89, IC 1.09-21.8). Os doentes com deiscência anastomótica estiveram mais dias internados na unidade de cuidados intensivos (UCI) (mediana 14 vs. 4 dias) e tiveram uma mortalidade aos 30 dias e intrahospitalar mais elevada (15% vs. 2% e 35% vs. 4%, respectivamente). A primeira abordagem terapêutica foi cirúrgica em 13 doentes, endoscópica em 10 e conservadora em 3. Não foram encontradas diferenças estatisticamente significativas entre estes doentes, com uma tendência para a presença de sépsis e de deiscências de maior dimensão nos doentes abordados cirurgicamente. Durante o seguimento, 3 doentes do grupo cirúrgico (23%) e 9 do grupo endoscópico (90%) tiveram alta hospitalar sob dieta oral (p = 0.001). A taxa de mortalidade intra-hospitalar foi de 38% no grupo cirúrgico, 33% no grupo conservador e 10% no grupo endoscópico (p = 0.132). Nos doentes com deiscência anastomótica, a presença de choque sético ao diagnóstico foi o único preditor de mortalidade (p = 0.004). O tempo de internamento na UCI não foi significativamente menor no grupo sub-metido a tratamento endoscópico (mediana de 4 dias vs. 16 dias no grupo cirúrgico, p = 0.212). Conclusão: A identificação de fatores de risco para deiscência anastomótica após esofagectomia pode ajudar a alterar a optimização pré-procedimento. Os resultados deste estudo sugerem incluir uma abordagem endoscópica nos doentes com deiscência anastomótica.

ABSTRACT Introduction: with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. Purpose: to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. Methods: this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. Results: we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. Conclusions: videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.

RESUMO Introdução: com o aperfeiçoamento e a ampla aceitação da laparoscopia nas operações colorretais, houve necessidade de treinamento específico dos cirurgiões em formação. Existem poucos estudos avaliando os resultados pós operatórios das colectomias videolaparoscópicas realizadas por médicos residentes e seu impacto na segurança do paciente. Objetivo: analisar os resultados cirúrgicos e oncológicos das colectomias videolaparoscópicas realizadas por residentes de coloproctologia e comparar com dados da literatura. Métodos: trata-se de uma análise retrospectiva de pacientes submetidos a cirurgias colorretais laparoscópicas, realizadas por médicos residentes do Hospital das Clínicas de Ribeirão Preto, entre 2014 e 2018. Foram estudadas as características clínicas dos pacientes bem como os principais aspectos cirúrgicos e oncológicos em um período de um ano. Resultados: analisou-se 191 operações, cuja principal indicação cirúrgica foi adenocarcinoma, a maioria estadio III. A duração média das cirurgias foi 210±58 minutos. Houve necessidade de estoma em 21,5% dos pacientes, principalmente colostomia em alça. A taxa de conversão foi 23%, sendo 79,5% por dificuldades técnicas, e os principais fatores preditores de conversão foram obesidade e acidentes intra-operatórios. A mediana do tempo de internação foi 6 dias. Anemia pré operatória associou-se a uma maior taxa de complicações (11,5%) e reoperações (12%). Houve comprometimento das margens de ressecção cirúrgica em 8,6% dos casos. A taxa de recidiva em um ano foi de 3,2%, e a taxa de mortalidade, 6,3%. Conclusões: a cirurgia colorretal videolaparoscópica realizada por residentes apresentou eficácia e segurança semelhante aos dados encontrados na literatura.

Abstract Background Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. Methods Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. Results ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. Conclusion We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).

ABSTRACT. The present study was carried out with the objective of determining the requirements for digestible lysine in Nile tilapia during the 500 to 600 g live weight stage. Isocaloric and isonitrogenous diets were tested with increasing amounts of digestible lysine. L-lysine HCl (78%) were used to replace glutamic acid at increasing levels, resulting in treatments of 9.3, 12.3, 15.3, 18.3 and 21.3 g kg-1 of digestible lysine. Three hundred Nile tilapias with an average weight of 519 ± 27.23 g were used and distributed among 25 tanks. The physical and chemical parameters of the water were pH, dissolved oxygen, salinity, conductivity and temperature. The mortality rate was registered daily. Two slaughters were performed at 28 and 50 days after the beginning of the experiment. It was estimated that an amount of 13.1 g kg-1 of digestible lysine was ideal for obtaining higher WG. Fish slaughtered after 50 days, the digestible lysine requirements were determined to be 14.5 g kg-1 for the lowest carcass humidity and 14.6 g kg-1 for the greatest carcass ethereal extract. Nile tilapias with live weight between 500 and 600 grams require 13.1 g kg-1 of digestible lysine in the diet for greater WG (90.53 g) and better FCR (2.55).

Abstract The Itajaí-Mirim river basin, SC (Brazil) is a reference in the collection of water for public supply compared to the other basins that make up its territory. However, it presents a greater contribution of sanitary sewage throughout its course. In this context, the objective of the present article is to select streams allocated to different land uses and to understand the influence of land use on water quality, as a provision ecosystem service and preponderant to the health of the population. The methodological steps developed for the choice of streams were geoprocessing and field activity, while for the monitoring of water quality, the analysis of physical-chemical parameters was carried out. The results obtained showed that the use of land influences the quality of water in streams, being negative in rural and urban areas, as a chemical and physical contaminant attribute regarding the discharge of untreated effluents into the watercourse; and positive to the potability of water in forested area. It is important to encourage action by the public power for the development of policies and guidelines aimed at territorial planning, whose essential resource for the provision of human activities is in potential degradation.

Résumé Le bassin hydrographique du Itajaí-Mirim, SC (Brésil) est une référence en matière de collecte d’eau pour l’approvisionnement public par comparaison des autres bassins qui composent son territoire. Toutefois, ce bassin présente le plus apport d’eaux usées sanitaires le long de son parcours. À cette occasion, l’objectif du présente article est de sélectionner des ruisseaux alloués à différentes utilisations des terres et de comprendre l’influence de l’utilisation des terres sur la qualité de l’eau, tandis que le service écosystémique de la provision et prépondérante pour la santé de la population. Les étapes méthodologiques développées pour le choix des cours d’eau ont été: le géotraitement et l’activité de terrain, tandis que pour le suivi de la qualité de l’eau, l’analyse des paramètres physico-chimiques a été réalisée. Les résultats obtenus indiquent que l’utilisation des terres influence la qualité de l’eau dans les ruisseaux, qui est négative dans les zones rurales et urbaines, en tant qu’attribut chimique et physique contaminant en ce qui concerne le rejet d’effluents non traités pas dans le cours d’eau; et positif pour la potabilité de l’eau dans le espace boisé. Il est important de susciter l’action du pouvoir public pour le développement des politiques et des directrices visant la planification du territoire, dont la ressource essentielle pour l’approvisionnement des activités humaines est en voie de dégradation.

Resumen La cuenca del río Itajaí-Mirim, SC (Brasil) es referencia en la captación de agua para abastecimiento público en comparación con otras cuencas que componen su territorio. Sin embargo, presenta un mayor aporte de alcantarillado sanitario a lo largo de su curso. En este contexto, el objetivo de lo presente artículo consiste en elegir riachuelos destinados a diferentes usos de la tierra y comprender la influencia del uso de la tierra en la calidad del agua, mientras un servicio ecosistémico de provisión y preponderante para la salud de la población. Las etapas metodológicas desarrolladas para la elección de riachuelos fueron: geoprocesamiento y la actividad de campo, mientras que para el monitoreo de la calidad del agua se realizó el análisis de parámetros físico-químicos. Los resultados obtenidos apuntan que el uso del suelo influye en la calidad del agua en los riachuelos, lo cual es negativo en las zonas rurales y urbanas, como atributo contaminante químico y físico mientras a la descarga de efluentes sin tratar al curso hídrico; y positivo a la potabilidad del agua en una zona boscosa. Surge la necesidad de una acción del poder público para el desarrollo de políticas y pautas destinadas a la ordenación territorial, cuyo recurso esencial para la provisión de las actividades humanas se encuentra en potencial degradación.

Resumo A bacia hidrográfica do rio Itajaí-Mirim, SC (Brasil) é referência na captação de água para abastecimento público em comparação com as demais bacias que compõem seu território. Entretanto, esta apresenta maior aporte de esgotamento sanitário ao longo de seu curso. Nesse ensejo, o objetivo do presente artigo consiste em selecionar riachos alocados em diferentes usos das terras e compreender a influência dos usos na qualidade da água, enquanto serviço ecossistêmico de provisão e preponderante à saúde da população. As etapas metodológicas desenvolvidas para a escolha dos riachos foram: geoprocessamento e atividade de campo. Já para o monitoramento da qualidade da água foi realizada a análise de parâmetros físico-químicos. Os resultados obtidos apontaram que o uso das terras influencia a qualidade da água nos riachos, sendo esta negativa em áreas rurais e urbanas, como atributo contaminante químico e físico no tocante ao despejo de efluentes sem tratamento ao curso hídrico, e positiva à potabilidade da água em área florestada. Emerge suscitar a ação do poder público para o desenvolvimento de políticas e diretrizes voltadas ao planejamento territorial, cujo recurso essencial ao provisionamento das atividades humanas encontra-se em potencial degradação.

Abstract Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between June 2003 and July 2021. After applying the exclusion criteria to 305 patients, 166 patients were analyzed. Global recurrence was found in 18.7% of them, while 7.8% have had local recurrence. Recurrences were diagnosed from 5 to 92 months after the surgical procedure, with a median of 32.5 months. Follow-up varied from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years and shows a 5-year survival rate of only 5%. In around 50% of cases, recurrence is local, confined to the pelvis. This study was consonant with the literature in most aspects evaluated, although a high rate of local recurrence remains a challenge in seeking better surgical outcomes.

Resumo Em Portugal, a apresentação, em 2003, da carta educativa como instrumento de planeamento prospetivo da rede escolar representou o início de uma fase diferente nas políticas públicas de Educação, que permitiu a requalificação da rede escolar pública do 1.º ciclo do Ensino Básico. Mais de uma década depois, no início de um novo ciclo nas políticas públicas de Educação, arranca um segundo momento da reorganização da rede escolar pública, com a revisão das cartas educativas. O presente artigo propõe-se, com base numa investigação qualitativa desenvolvida em 34 municípios da Região Centro com realidades distintas, realizar uma análise comparativa destes dois períodos, identificando as principais divergências e convergências e avaliando a influência dos fatores territoriais e humanos nas soluções adotadas. Parece possível concluir o aparecimento de novas lógicas municipais de ação, que privilegiam um planeamento direcionado para a defesa das especificidades locais em detrimento do anterior planeamento centrado no cumprimento das determinações do Estado central.

Abstract The presentation of the Education charter in 2003 in Portugal as an instrument for future planning of school network represented the beginning of a different phase in public Education policies, seen as a necessary step towards the modernization of the primary school network. More than a decade later, at the start of a new cycle in public Education policies, a second phase of the reorganization of the public-school network began, with the revision of the Education charters. This paper aims to carry out a comparative analysis of these two periods, based on a qualitative research conducted in 34 municipalities in Central Portugal, featuring different realities, to identify the main differences and similarities and to determine the influence of territorial and human factors on the solutions adopted. It seems possible to conclude that new municipal actions have emerged that prioritize planning aimed at local specificities, in contrast to the previous approach, focused on compliance with central government stipulations.

Resumen La presentación de la carta de educación en 2003 en Portugal como un instrumento de planificación prospectiva de la red escolar representó el comienzo de una fase diferente en las políticas públicas de Educación vistas como un paso necesario para la modernización de la red escolar primaria. Más de una década después, al inicio de un nuevo ciclo en las políticas públicas de Educación, se ha iniciado una segunda fase de reordenación de la red de escuelas públicas, con la revisión de las cartas educativas. Este artículo tiene como objetivo realizar un análisis comparativo de estos dos períodos a partir de una investigación cualitativa realizada en 34 municipios del centro de Portugal, con realidades diferentes, para identificar las principales diferencias y similitudes y determinar la influencia de los factores territoriales y humanos en las soluciones adoptadas. Parece posible concluir que han surgido nuevas acciones municipales que priorizan la planificación dirigida a las especificidades locales en contraste con el enfoque anterior, centrado en cumplir con las estipulaciones del gobierno central.

RESUMO Os atributos do solo podem ser facilmente alterados pelo uso e manejo, comprometendo a capacidade produtiva das áreas. O objetivo da pesquisa foi avaliar a variabilidade e inter-relações dos atributos físicos, químicos e estruturais do solo em agroecossistemas no Semiárido Potiguar Brasileiro, apontando os atributos mais sensíveis na distinção dos ambientes por meio da análise multivariada. A pesquisa foi realizada na comunidade rural de Piracicaba, município de Upanema, Rio Grande do Norte, região Semiárida Brasileira. Foram selecionados quatro agroecossistemas: Área de Mata nativa (AMN), Área de consórcio milho feijão (ACMF), Área de Pastagem (AP) e Área de Cajueiro (AC). Foram coletadas amostras de solo indeformadas e deformadas nas camadas 0,00-0,10, 0,10-0,20 e 0,20-0,30 (m), e realizadas as análises dos atributos físicos, químicos e estruturais. Os dados foram submetidos a técnicas de estatística multivariada, por meio da matriz de correlação, análise de agrupamento, análise fatorial e componentes principais. A análise fatorial revelou os atributos mais sensíveis na distinção dos agroecossistemas, sendo microporosidade, capacidade de campo (CC), ponto de murcha permanente (PMP), água disponível (AD), areia, argila, grau de floculação (GF), Ca2+, Mg2+ e soma de bases (SB) (F1) e densidade do solo (DS), porosidade total (PT), macroporosidade, condutividade elétrica (CE) e carbono orgânico total (COT) (F2). A análise de agrupamento formou três grupos distintos. O COT foi discriminante para agrupar as áreas de mata nativa e de cajueiro, evidenciando a influência do manejo do solo. Os demais ambientes foram agrupados pela diferenciação da textura influenciando na variabilidade dos atributos.

ABSTRACT The soil attributes can be easily changed according to its management and use, compromising the productive capacity of the areas. The objective of this research was to evaluate the variability and interrelationships of soil physical, chemical and structural attributes in agroecosystems in the Brazilian Semiarid region (Rio Grande do Norte State), pointing out the most sensitive attributes in the environment distinction through multivariate analysis. The research was carried out in the rural community of Piracicaba, Upanema municipality, Rio Grande do Norte State, Brazil. Four agroecosystems were selected: Native Forest Area (ANF), Corn Bean Consortium Area (ACBC), Pasture Area (AP) and Cashew Area (AC). Undisturbed and deformed soil samples were collected in the 0.00-0.10, 0.10-0.20 and 0.20-0.30 m layers, and the physical, chemical and structural attributes were analyzed. The data were submitted to multivariate statistical techniques, using the correlation matrix, cluster analysis, factor analysis and principal component analysis. Factorial analysis revealed the most sensitive attributes in distinguishing agroecosystems: microporosity, field capacity (FC), permanent wither point (PWP), available water (AW), sand, clay, flocculation degree (GF), Ca2+, Mg2+ and sum of bases (SB) (F1) and soil density (SD), total porosity (PT), macroporosity, electrical conductivity (EC) and total organic carbon (TOC) (F2). Cluster analysis formed three distinct groups. The TOC was discriminant to group the native forest and cashew tree areas, showing the influence of soil management. The other environments were grouped according to the texture differentiation, influencing the attributes variability.

ABSTRACT. The cashew pseudo fruit can be used to animal feeding in tropical and subtropical countries as Brazil, Ivory Coast and Vietnam. Thus, our objective was to evaluate the intake, digestibility of nutrients and nitrogen balance of dehydrated cashew apple by-product to sheep. The experiment was carried out with 24 sheep in a completely randomized design with the treatments distributed in a 4 x 2 factorial scheme to test the inclusion (11, 21, 28 and 33% dry matter basis) and the grinding sizes (3 and 19 mm diameter) of dehydrated cashew apple by-product. To grinding sizes there was no effect to intake and digestibility, suggesting the use of dehydrated cashew apple by-product either finely or coarsely milled. The inclusion up to 33% of dehydrated cashew apple by-product inclusion did not affect voluntary intake and nitrogen balance. However, when including above 21%, there was a reduction of ether extract digestibility and more than 28% reduced dry matter and organic matter digestibility.