Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos.

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos.

Abstract Purpose The aim of this study is to analyze how levels of political skill and work engagement vary among managers of different hierarchical levels in the scenario studied. Theoretical framework This research is based on the existing literature on leadership and is aligned with recent studies focusing on politics and engagement within work environments. Methodology Changes in the study variables, their effects and relationships were verified by multivariate analysis of variance in a sample (n=308) of professionals from three segments of the Brazilian private sector. The measurement instrument for political skill was adapted and validated for Portuguese. Findings Hierarchical level affects the linear interaction between engagement and political skill, but in the scenario studied, politics played a greater role in this dynamic. The results suggest that engagement in work is a consistent attribute for managers regardless of their managerial position, while political skill within the organization progressively increases with each advancement in hierarchical level. Practical & social implications of research It is expected that leadership development programs will take into account the importance of political skill in their actions and planning, particularly for activities where the need for negotiation, influence, and networking is crucial. The study suggests that the integration of engagement and political skill emerges as an opportunity to be explored in the pursuit of hierarchical advancement. Originality/value The findings expand current knowledge about the relationships among the constructs in the study by presenting evidence of their intrinsic interactions with the hierarchical position of managers. Complementarily, the study contributes a short version of the Political Skills Inventory, methodologically validated for Brazil.

Resumen En la región semiárida de Paraíba, el caupí es el principal producto de la agricultura familiar. El cultivo tiene baja productividad debido a lluvias irregulares y condiciones climá ticas desfavorables. Además, la productividad también se ve afectada por el uso deficiente de las tecnologías de producción. Con el objetivo de superar estas limitaciones y aumentar la eficiencia de la selección de cultivares superiores, se llevó a cabo un extenso estudio utili zando modelos biométricos en caupí. Este primer trabajo tuvo los siguientes objetivos: i. Cuantificar los efectos directos e indirectos de los componentes primarios y secundarios en la producción de granos; ii. Identificar variables con mayor potencial para la selección de cultivares de caupí en la región semiárida de Paraíba y iii. Determinar las estrategias de selección más adecuadas para el conjunto de variables evaluadas. El experimento se llevó a cabo en un campo experimental en el Centro de Ciencia y Tecnología Agroalimentaria de la Universidad Federal de Campina Grande. Se evaluó la influencia de 6 componentes primarios y 6 componentes secundarios de la producción sobre la variable rendimiento de grano. Los datos se sometieron a ANAVA y se estimaron parámetros genéticos. También se realizaron correlaciones y análisis de ruta. Se identificaron variables con mayor potencial para la selección de cultivares superiores de caupí en la región semiárida de Paraíba. Se encontró que la variable rendimiento de vaina es la más prometedora para la selección de cultivares con mayor rendimiento de grano debido a la magnitud de los efectos fenotípico y genotípico. La selección directa y la selección simultánea son las estrategias más adecuadas para el conjunto de variables evaluadas. Sin embargo, para maximizar las ganancias gené ticas, se continuó el estudio a través de índices de selección.

Abstract In the semi-arid region of Paraíba, cowpea has low productivity due to irregular rainfall and poor use of production technologies. An extensive study aimed at selecting more productive cultivars was conducted using biometric models. This first work had the following objectives: i. Quantify direct and indirect effects of primary and secondary compo nents on grain production; ii. Identify variables with greater potential for cultivar selection in the semiarid region of Paraíba and iii. Determine the most appropriate selection strat egies for the evaluated variables. The experiment was conducted in an experimental field. The influence of 6 primary and 6 secondary production components was evaluated on grain yield. Data were subjected to ANOVA. Genetic parameters, correlations and path analysis were estimated. Given the strong direct phenotypic and genotypic effects, pod yield results the most promising variable for higher grain yield selection. Direct and simultaneous selec tions are the most suitable strategies for the set of evaluated variables. However, further studies on selection indices are necessary to maximize genetic gains.

Resumen En la región semiárida de Paraíba, el caupí (Vigna unguiculata (L.) Walp) es el prin cipal producto de la agricultura familiar. El cultivo tiene baja productividad debido a lluvias irregulares y al uso de cultivares de baja productividad. Con el objetivo de superar estas limitaciones y aumentar la eficiencia de la selección de cultivares superiores, se llevó a cabo un extenso estudio utilizando modelos biométricos en caupí, con los siguientes obje tivos: i. Estimar las ganancias genéticas de los componentes de la producción; ii. Identi ficar el modelo de índice de selección que proporciona las mayores ganancias mediante la selección simultánea de un conjunto de variables y iii. Seleccionar cultivares con mayor productividad. El experimento se llevó a cabo en el campo experimental del Centro de Ciencia y Tecnología Agroalimentaria de la Universidad Federal de Campina Grande. Se evaluaron 13 variables relacionadas con la productividad. Los datos se sometieron a ANOVA y las medias se agruparon según la prueba de Scott y Knott p≤ 0,05. También se estimó el coeficiente de heredabilidad de cada variable. Las ganancias genéticas se estimaron utili zando las siguientes metodologías: respuesta correlacionada, índice de selección clásico, suma de rango e índice basado en las ganancias deseadas. Se encontró que la selección directa del componente de rendimiento de la vaina secundaria proporciona ganancias genéticas significativas en rendimiento de grano. Entre las metodologías utilizadas, el índice de selección clásico proporcionó una mayor distribución de las ganancias genéticas para rendimiento de grano y para los componentes primarios de producción. Estos resultados permiten concluir que los cultivares Costela de vaca, BRS Marataoã y Paulistinha pueden seleccionarse para cultivo y explotación en la región semiárida de Paraíba.

Abstract Low cowpea productivity (Vigna unguiculata (L.) Walp) in the semi-arid region of Paraíba is due, among other factors, to poor-quality cultivars. This research tested biometric models intending to increase productivity of superior cultivars with the following objectives: i. Estimate genetic gains in production components; ii. Identify the selection index model providing the greatest gains through simultaneously selecting a set of variables, and iii. Select cultivars with higher productivity. The experiment was carried out in the experimental field of the Agrifood Science and Technology Center of the Federal University of Campina Grande. Eight cultivars and 13 variables were evaluated. Data were subjected to ANOVA and means were grouped using the Scott and Knott test. Genetic gains were estimated by correlated response, classic selection index, rank sum and index based on desired gains. Direct selection of the secondary pod yield component provides significant genetic gains in main grain yield. Among the methodologies used, the classic selection index provided greater distribution of genetic gains for main grain yield and primary production components. These results allow concluding that Costela de vaca, BRS Marataoã and Paulistinha cultivars should be selected for cultivation and commercial exploitation in the semiarid region of Paraíba.

Abstract Background Levodopa-induced dyskinesia (LID) is a common motor complication of levodopa therapy in patients with Parkinson’s disease (PD). Doxycycline is a widely used and inexpensive tetracycline with anti-inflammatory properties. Objective To evaluate the efficacy and safety of doxycycline in patients with PD and LID. Methods This was an open-label, uncontrolled, single-arm, single-center, phase 2 proof-of-concept study in patients with PD with functional impact of dyskinesia, which used levodopa three times daily, in a movement disorders clinic in Brazil. Participants were treated with doxycycline 200 mg/day for 12 weeks, with evaluations at baseline, week4, and week 12 of treatment. The primary outcome measure was the change from baseline in the Unified Dyskinesia Rating Scale (UDysRS) total score at week 12, evaluated by two blinded raters. Key secondary outcomes measures were OFF time and ON time with troublesome dyskinesia in the PD home diary. Results Eight patients with PD were treated and evaluated. Doxycycline 200 mg/day reduced the UDysRS total score at week 12, compared with baseline (Friedman χ2 = 9.6; p = 0.008). Further, doxycycline reduced the ON time with troublesome dyskinesia (Friedman χ2 = 10.8; p = 0.004) without worsening parkinsonism. There were no severe adverse events, and dyspepsia was the commonest event. Conclusion In this preliminary, open-label and uncontrolled trial, doxycycline was effective in reducing LID and safe after a 12-week treatment. Further well-designed placebo-controlled clinical trials with a longer duration and a larger number of participants are needed. Clinical trial registration https://ensaiosclinicos.gov.br, identifier: RBR-1047fwbf

Resumo Antecedentes A discinesia induzida por levodopa (DIL) é uma complicação motora comum da terapia com levodopa em pacientes com doença de Parkinson (DP). A doxiciclina é uma tetraciclina amplamente usada e barata, com propriedade anti-inflamatória. Objetivo Avaliar a eficácia e segurança da doxiciclina em pacientes com DP e DIL. Métodos Este foi um estudo aberto, não-controlado, de braço único, monocêntrico, fase 2 e de prova de conceito, em pacientes com DP e impacto funcional das discinesias, que usavam levodopa três vezes ao dia, em um ambulatório de distúrbios de movimento no Brasil. Os participantes foram tratados com doxiciclina 200 mg/dia por 12 semanas, com avaliações na base, na semana 4 e na semana 12 do tratamento. A medida de desfecho primário foi a mudança no escore total da Unified Dyskinesia Rating Scale (UDysRS) da base à semana 12, avaliada por dois avaliadores cegos. As medidas-chave de desfecho secundário fora o tempo em OFF e tempo em ON com discinesia problemática. Resultados Oito pacientes com DP foram tratados e avaliados. A doxiciclina 200 mg/dia reduziu o escore total da UDysRS na semana 12, comparado com a avaliação inicial (χ2 de Friedman = 9.6; p = 0.008). Além disso, a doxiciclina reduziu o tempo em ON com discinesia problemática (χ2 de Friedman = 10.8; p = 0.004) sem piorar o parkinsonismo. Não houve eventos adversos graves, e dispepsia foi o evento mais comum. Conclusão No presente estudo preliminar, aberto e não-controlado, a doxiciclina foi eficaz em reduzir as DIL e segura após tratamento por 12 semanas. Estudos clínicos bem-desenhados e placebo-controlados adicionais, com duração mais longa e maior número de participantes, são necessários.

ABSTRACT This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant-primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding ow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on buid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para el manejo de la pancreatitis aguda en el Seguro Social del Perú (EsSalud). Su objetivo es proveer recomendaciones clínicas basadas en evidencia para el manejo de la pancreatitis aguda en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed durante el 2022. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y flujogramas correspondientes. Finalmente, la GPC fue aprobada con Resolución N° 105-IETSI-ESSALUD-2022. La presente GPC abordó 7 preguntas clínicas sobre fluidoterapia, momento de inicio de nutrición enteral, analgesia, tipo de nutrición, tratamiento antibiótico y quirúrgico. En base a dichas preguntas se formularon 8 recomendaciones (1 fuerte y 7 condicionales), 13 BPC, y 1 flujograma. El presente artículo resume la metodología y las conclusiones basadas en evidencia de la GPC para el manejo de la pancreatitis aguda en EsSalud.

Resumen En trabajos previos se desarrolló un método para la diferenciación a nivel foliar de la respuesta de plantas de banano a la marchitez por Fusarium raza 1, el cual constituye una herramienta útil para incrementar la eficiencia de la selección de la resistencia en condiciones ex vitro. El objetivo de este trabajo consistió en evaluar la resistencia a esta enfermedad en nuevos clones de banano mediante el método de evaluación mencionado. Para ello se realizaron seis momentos de evaluación; y se utilizaron diez plantas de cada línea seleccionada del clon ‘Zanzíbar’ irradiado. Los resultados evidenciaron que las plantas de las líneas evaluadas del clon ‘Zanzíbar’ irradiado indican ser materiales promisorios para el mejoramiento genético en el cultivo dirigido a la resistencia a esta enfermedad. Por otra parte, se obtuvo una respuesta a la selección en un reducido tiempo (48 horas), así como evaluar las líneas seleccionadas a partir de grandes poblaciones de plantas (60 plantas) con la exclusión de otros organismos; y el control de las condiciones ambientales que pudieran interferir en los resultados obtenidos. Sin embargo, constituye una necesidad continuar estudios adicionales en campo para confirmar la resistencia en las líneas evaluadas.

Abstract In previous works, a method was developed for the differentiation at the foliar level of the response of banana plants to Fusarium race 1 wilt, which constitutes a useful tool to increase the efficiency of resistance selection in ex vitro conditions. The objective of this work was to evaluate resistance to this disease in new banana clones using the evaluation method mentioned. For this, six moments of evaluation were made; and ten plants of each selected line of the irradiated ‘Zanzíbar’ clone were used. The results showed that the plants of the evaluated lines of the irradiated ‘Zanzíbar’ clone indicate that they are promising materials for genetic improvement in the crop aimed at resistance to this disease. On the other hand, a response to selection was obtained in a short time (48 hours), as well as evaluating the lines selected from large populations of plants (60 plants) with the exclusion of other organisms; and the control of environmental conditions that could interfere with the results obtained. However, it is necessary to continue additional studies in the field to confirm the resistance in the evaluated lines.

ABSTRACT Introduction: Surface treatment is an important technique to increase adhesion between implants and bones, improving its mechanical characteristics and consequently the patient’s comfort. Objectives: Ni-Cr alloys were the object of study in this work, with the purpose of analyzing and evaluating the effect of thin films deposition of titanium nitride via plasma, on its surface and comparing with cathodic cage (CC) and hollow cathode (HC) methods, for dental applications. Methods: Eighteen samples were prepared and the experiment was conducted in two steps: the pre-sputtering (1h, 350 °C, gases: Ar and H) and sputtering (4h, 450 °C, gases: Ar, Ni, and H). To characterize and compare the samples with those of reference, the Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD), Vickers Microhardness and wettability tests were used. Results: The results presented by SEM showed that during the surface treatment using CC, voids were formed, and using HC, the samples showed a more homogenous behavior. In microhardness tests, using a 25gf load, it was possible to observe that the HC method allowed an increase of 87% when compared to the reference and treated samples. Significance: Lastly, it can be concluded that both methods are suitable for Ni-Cr alloy surface treatment, and the HC technique, a method already used by dental professionals, presents better results due to the formation of a thicker film layer.

ABSTRACT Purpose: To present a scientific mapping of the concept of Political Skill in Organizations and its measurement instrument to show how production has evolved, which themes cover this field, trends, and a global panorama of collaborations Methodology: Statistical methods to delineate the structure of the scientific field and its dynamics. We used the RStudio (Bibliometrix package) and Vosviewer tools to examine metadata from two samples from the Scopus database (n 1=797 and n 2=807), covering the last 40 years of production on the subject Findings: Political Skill in Organizations is a current and well-structured construct; its relationship constantly expands with several other concepts; its driving themes are job performance, power, and organizational politics. Emerging topics are stress, impression management, and leader political skill. We also highlighted the most influential authors and publications. The Political Skill Inventory measurement instrument remains widely used in different contexts. However, there need to be more collaborations in Latin America. Originality: An up-to-date analysis of the paths and scope of a concept in conjunction with its measurement instrument promotes theoretical-empirical integration and provides insights and starting points for researchers interested in organizational politics.

RESUMO Finalidade: Apresentar um mapeamento científico acerca do conceito Habilidade Política nas Organizações e seu instrumento de medida, para evidenciar como a produção evoluiu, que temáticas abrangem esse campo, tendências e panorama global de colaborações. Metodologia: Aplicação de um conjunto de métodos estatísticos para delinear a estrutura do campo científico e sua dinâmica. As ferramentas RStudio (Bibliometrix package) e Vosviewer foram utilizadas para examinar metadados de duas amostras da base de dados Scopus (n1=797 e n2=807), abrangendo os últimos 40 anos de produção sobre a temática. Resultados: Habilidade Política nas Organizações é um construto atual e bem estruturado; sua relação com diversos outros conceitos é constantemente ampliada; seus temas motores são performance no trabalho, poder e política organizacional. Os tópicos emergentes são estresse, gerenciamento de impressão e habilidade política do líder. Autores e publicações mais influentes são evidenciados no estudo. O instrumento de medida Political Skill Inventory permanece amplamente utilizado em diversos contextos, entretanto há uma carência de colaborações na América Latina. Originalidade: Uma análise atualizada sobre os caminhos e a abrangência de um conceito em conjunto com seu instrumento de mensuração promove integração teórico-empírica e promove insights e pontos de partida para pesquisadores interessados em política organizacional.

Abstract The aim of the present study was to evaluate semen cryopreservation with ACP-Lact® diluent, which consists of coconut water powder (ACP) added to goat milk powder. After thawing, the samples were evaluated for sperm kinetics, membrane evaluation and in vivo insemination. For cryopreservation, a pool was made with the ejaculate of six goats, diluted in four equal aliquots for the respective treatments: T1 (ACP-Lact®); T2 (ACP-Lact® 50%); T3 (ACP + 2.5% egg yolk) and T4 (Tris + 2.5% egg yolk). After dilution of the treatments, the samples were placed in 0.5 ml straws and chilled at a rate of -1.07°C/min. After reaching 4°C and stabilizing for one hour, the straws were placed in nitrogen vapour at -60°C for 15 minutes and then immersed in liquid nitrogen (-196ºC). The straws were thawed in a 37°C water bath and kinetic assessments were performed immediately using a computerized semen analysis program (CSA), viability (EN), membrane functionality (HOST), mitochondrial activity (DAB) and DNA integrity assessment of spermatozoa. For the in vivo experiment, ten goats were inseminated, divided into two groups of five goats each, G1 inseminated with ACP-Lact® and G2 with ACP, by fixed-time artificial insemination (FTAI). Regarding the kinetic parameters, the ACP-Lact® treatment showed higher progressive motility (PM) and sperm velocity than the other treatments (36.77%). In the VSL parameter the ACP-Lact diluent was superior to ACP and Tris. In viability the treatment with ACP-Lact® was superior to the treatment with Tris, 95% and 83% respectively. In FTAI two goats were born out of the 5 goats inseminated with ACP-Lact®. It was concluded that the use of ACP-Lact® for cryopreservation of caprine semen is efficient in maintaining seminal parameters during thawing in vitro and in vivo and proved to be a good alternative extender for the caprine species.

We investigate the structural, optical, thermal-optical, and electronic properties of TiNx thin films utilizing a variety of experimental techniques, including spectroscopic ellipsometry, Raman spectroscopy, scanning electron microscopy, atomic force microscopy, thermal lens spectroscopy, and UV-VIS spectroscopy. Our experimental results indicate a remarkable metallic character in the TiNx thin films deposited under lower N2 flow during treatment, as well as an increase in reflectance in the infrared region and thermal diffusivity as the partial N2 flow is reduced, which is consistent with previous experimental studies. The microscopic origin of these trends is explained in terms of the atomic structure of the system, where Ti atoms contribute free carriers that interact with IR radiation and N atoms create imperfections in the lattice, causing greater scattering of phonons, respectively. The experimental results also indicate that the roughness of the films produced with a lower N2 partial flow was lower than that of the films with a higher N2 partial flow. To explain the deviation of optical properties from the ideal case, surface oxidation is also investigated. This facilitates the coating of smarting windows with TiNx thin films. structural thermaloptical, thermaloptical thermal-optical techniques ellipsometry spectroscopy microscopy UVVIS UV VIS treatment reduced studies system lattice phonons respectively case investigated

ABSTRACT The article aims to discuss the challenges and consequences of health inequalities and vulnerabilities, focusing on current phenomena that have reshaped such context, namely financial crisis, fiscal austerity, and the COVID-19 pandemic. Differences between levels of access to wealth and opportunities among and within countries belonging to different income groups create and perpetuate social inequalities that frequently become health inequities. It is challenging to understand both the recent changes and the persistence of inequalities and social stratification, and the issue has thus taken on new dimensions that extrapolate studies focused exclusively on income distribution. The financial crisis, fiscal austerity, and the COVID-19 pandemic have aggravated preexisting health inequalities. Thus, the issue of inequalities in health should be an intrinsic part of public policy, with clear and stable standards and objectives based on explicit political agreements and a legal framework with sustainability ensured by an adequate financing policy. Only then will it be possible to achieve greater levels of equity, even in the face of dramatic situations such the one now faced by the world.

RESUMO O texto teve por objetivo discutir os desafios e as consequências das desigualdades e das vulnerabilidades em saúde, trazendo para discussão fenômenos atuais que vêm reconfigurando esse contexto – crise financeira, austeridade fiscal e pandemia da Covid-19. As diferenças nos níveis de accesso à riqueza e a oportunidades, presentes entre e dentro dos países de distintos grupos de renda, criam e perpetuam as desigualdades sociais, que, muitas vezes, tornam-se iniquidades em saúde. Compreender as recentes mudanças e, também, as permanências, no que se refere às desigualdades e à estratificação social, é desafiador, o que fez com que o tema adquirisse novas dimensões que ultrapassaram os estudos centrados exclusivamente na distribuição de renda. A crise financeira, a austeridade fiscal e a pandemia da Covid-19 agravaram as desigualdades em saúde já existentes. Assim, a questão das desigualdades na saúde deve ser intrinsecamente parte da política pública, com normas e objetivos claros e estáveis, baseados em acordos políticos explícitos e em uma estrutura legal, com sua sustentabilidade assegurada por uma política de financiamento adequada. Somente dessa forma, será possível alcançar maiores níveis de equidade, mesmo diante de situações dramáticas como a que se vive.

Resumo Objetivo: Avaliar a eficácia e segurança da embolização da artéria uterina (EAU) com microesferas calibradas de alta compressibilidade no tratamento de miomas uterinos. Materiais e Métodos: Este foi um estudo prospectivo e multicêntrico. Foram selecionadas 32 mulheres com miomas uterinos sintomáticos para EAU de janeiro de 2019 a março de 2020. As participantes preencheram o questionário Uterine Fibroid Symptom and Quality of Life (UFS-QOL), realizaram ressonância magnética (RM) pélvica com contraste e teste para medição dos hormônios antimüllerianos, seguido de embolização de miomas com microesferas Embosoft. Após seis meses, as pacientes novamente preencheram o UFS-QOL e realizaram RM pélvica. Resultados: Os sintomas mais relatados foram sangramento uterino anormal (81,3%), dor pélvica (81,3%) e compressão (46,9%). Doze pacientes (37,5%) apresentaram anemia consequente a sangramento uterino anormal. Nas 30 pacientes que completaram o estudo, observou-se redução mediana de 21,4% no volume uterino e 15,9% no volume do mioma dominante. Não foram identificados eventos adversos possivelmente relacionados ao material utilizado, apenas em relação ao procedimento de EAU. Conclusão: EAU com microesferas Embrosoft mostrou resultados satisfatórios no tratamento de miomas uterinos, com redução dos volumes uterino e do mioma dominante, baixa taxa de eventos adversos e melhora na qualidade de vida, demonstrando segurança e eficácia.

Abstract Objective: To evaluate the safety and efficacy of using highly compressible calibrated microspheres in uterine artery embolization (UAE) for the treatment of uterine fibroids. Materials and Methods: This was a prospective multicenter study. Thirty-two women with symptomatic uterine fibroids were selected for UAE between January 2019 and March 2020. The participants completed the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire, underwent contrast-enhanced pelvic magnetic resonance imaging (MRI), and were submitted to anti-Müllerian hormone measurement, subsequently undergoing UAE with Embosoft microspheres. After six months, the patients again completed the UFS-QOL questionnaire and underwent pelvic MRI. Results: The most common symptoms were abnormal uterine bleeding (in 81.3% of the cases), pelvic pain (in 81.3%), and compression (in 46.9%). Of the 32 patients evaluated, 12 (37.5%) had anemia due to abnormal uterine bleeding. Thirty patients completed the study. Among those patients, we observed median reductions of 21.4% in uterine volume and 15.9% in dominant fibroid volume. We identified no adverse events that could be attributed to the material itself, although there were events attributed to the UAE procedure in general. Conclusion: For the treatment of uterine fibroids, UAE using Embosoft microspheres shows satisfactory results, providing reductions in uterine and dominant fibroid volumes, with a low rate of adverse events, and improving patient quality of life, as well as demonstrating safety and efficacy.

ABSTRACT Introduction McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder.

RESUMO O texto teve por objetivo discutir os desafios e as consequências das desigualdades e das vulnerabilidades em saúde, trazendo para discussão fenômenos atuais que vêm reconfigurando esse contexto – crise financeira, austeridade fiscal e pandemia da Covid-19. As diferenças nos níveis de accesso à riqueza e a oportunidades, presentes entre e dentro dos países de distintos grupos de renda, criam e perpetuam as desigualdades sociais, que, muitas vezes, tornam-se iniquidades em saúde. Compreender as recentes mudanças e, também, as permanências, no que se refere às desigualdades e à estratificação social, é desafiador, o que fez com que o tema adquirisse novas dimensões que ultrapassaram os estudos centrados exclusivamente na distribuição de renda. A crise financeira, a austeridade fiscal e a pandemia da Covid-19 agravaram as desigualdades em saúde já existentes. Assim, a questão das desigualdades na saúde deve ser intrinsecamente parte da política pública, com normas e objetivos claros e estáveis, baseados em acordos políticos explícitos e em uma estrutura legal, com sua sustentabilidade assegurada por uma política de financiamento adequada. Somente dessa forma, será possível alcançar maiores níveis de equidade, mesmo diante de situações dramáticas como a que se vive.

ABSTRACT The article aims to discuss the challenges and consequences of health inequalities and vulnerabilities, focusing on current phenomena that have reshaped such context, namely financial crisis, fiscal austerity, and the COVID-19 pandemic. Differences between levels of access to wealth and opportunities among and within countries belonging to different income groups create and perpetuate social inequalities that frequently become health inequities. It is challenging to understand both the recent changes and the persistence of inequalities and social stratification, and the issue has thus taken on new dimensions that extrapolate studies focused exclusively on income distribution. The financial crisis, fiscal austerity, and the COVID-19 pandemic have aggravated preexisting health inequalities. Thus, the issue of inequalities in health should be an intrinsic part of public policy, with clear and stable standards and objectives based on explicit political agreements and a legal framework with sustainability ensured by an adequate financing policy. Only then will it be possible to achieve greater levels of equity, even in the face of dramatic situations such the one now faced by the world.