Abstract Rationale Perianal tuberculosis is extremely rare without previous or active pulmonary infection. Ulcerative skin lesion is a rare presentation of extrapulmonary tuberculosis in the oral, perianal, or genital mucosa and the adjacent skin. Case report A 71-year-old woman complained of pain during evacuation and fecal incontinence for two years. There was an ulcerated lesion in the perianal and intergluteal region and perianal fistulous tracts. A polymerase chain reaction test on blood and biopsies of perianal ulcers, perianal fistula, and the intergluteal area was positive for Mycobacterium tuberculosis. The pathological examination revealed a chronic epithelioid granulomatous inflammatory process with the presence of multinucleated giant cells. After the end of the tuberculosis drug regimen, there was marked improvement in the patient's clinical condition. Conclusion Even in the absence of an identifiable primary focus, tuberculosis should be considered in the differential diagnosis of ulcerative and fistulous lesions of the perianal area.

ABSTRACT Objective To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn’s disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. Methods Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher’s exact test for qualitative variables. Results Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. Conclusion Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.

Abstract INTRODUCTION: The pool testing technique optimizes the number of tests performed and reduces the delivery time of results, which is an interesting strategy for the health crisis caused by the COVID-19 pandemic. This integrative review investigated studies in which pool testing was carried out for epidemiological or screening purposes to analyze its clinical or cost effectiveness and assessed the applicability of this method in high-, middle-, and low-income countries. METHODS: This integrative review used primary studies published in the MEDLINE, EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Cochrane Library databases. RESULTS: A total of 435 studies were identified: 35.3% were carried out in Asia, 29.4% in Europe, 29.4% in North America, and 5.9% in Oceania. CONCLUSIONS: This review suggests that pool testing in the general population may be a useful surveillance strategy to detect new variants of SARS-CoV-2 and to evaluate the period of immunogenicity and global immunity from vaccines.

Abstract Purpose To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique. Methods Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant. Results Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown. Conclusions Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Resumo O estudo objetivou criar um instrumento de medida que pudesse quantificar os desconfortos associados ao procedimento cirúrgico de pacientes submetidos a cirurgias dento-alveolares (QCirDental). O instrumento QCirDental foi desenvolvido em duas etapas iniciais: (1) geração e seleção das perguntas ou itens e, (2) teste do instrumento com avaliação das propriedades de medida (consistência interna e responsividade). A amostra foi composta por 123 pacientes. Nenhum deles apresentou qualquer dificuldade em entender o QCirDental. O instrumento mostrou excelente consistência interna com coeficiente alfa de Cronbach de 0,83. A análise de componentes principais (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 e Bartlett's Test of Sphericity com p < 0,001) mostrou seis (6) dimensões do instrumento que explicam 67,5% da variância. O QCirDental possui excelente consistência interna, sendo um instrumento de fácil leitura e interpretação compatível com uma adequada validade semântica e de conteúdo. Mais de 80% dos pacientes submetidos a extrações dentárias de rotina odontológica apresentam algum desconforto ou incomodo no período transoperatório o que ressalta a necessidade de utilização de um instrumento para avaliação de cuidados.

Abstract The scope of this study was to develop and validate a questionnaire (QCirDental) to measure the impacts associated with dental extraction surgery. The QCirDental questionnaire was developed in two steps; (1) question and item generation and selection, and (2) pretest of the questionnaire with evaluation of the its measurement properties (internal consistency and responsiveness). The sample was composed of 123 patients. None of the patients had any difficulty in understanding the QCirDental. The instrument was found to have excellent internal consistency with Cronbach's alpha reliability coefficient of 0.83. The principal component analysis (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 and Bartlett's Test of Sphericity with p < 0.001) showed six (6) dimensions explaining 67.5% of the variance. The QCirDental presented excellent internal consistency, being a questionnaire that is easy to read and understand with adequate semantic and content validity. More than 80% of the patients who underwent dental extraction reported some degree of discomfort within the perioperative period which highlights the necessity to assess the quality of care and impacts of dental extraction surgery.

Resumo O estudo objetivou criar um instrumento de medida que pudesse quantificar os desconfortos associados ao procedimento cirúrgico de pacientes submetidos a cirurgias dento-alveolares (QCirDental). O instrumento QCirDental foi desenvolvido em duas etapas iniciais: (1) geração e seleção das perguntas ou itens e, (2) teste do instrumento com avaliação das propriedades de medida (consistência interna e responsividade). A amostra foi composta por 123 pacientes. Nenhum deles apresentou qualquer dificuldade em entender o QCirDental. O instrumento mostrou excelente consistência interna com coeficiente alfa de Cronbach de 0,83. A análise de componentes principais (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 e Bartlett's Test of Sphericity com p < 0,001) mostrou seis (6) dimensões do instrumento que explicam 67,5% da variância. O QCirDental possui excelente consistência interna, sendo um instrumento de fácil leitura e interpretação compatível com uma adequada validade semântica e de conteúdo. Mais de 80% dos pacientes submetidos a extrações dentárias de rotina odontológica apresentam algum desconforto ou incomodo no período transoperatório o que ressalta a necessidade de utilização de um instrumento para avaliação de cuidados.

Abstract The scope of this study was to develop and validate a questionnaire (QCirDental) to measure the impacts associated with dental extraction surgery. The QCirDental questionnaire was developed in two steps; (1) question and item generation and selection, and (2) pretest of the questionnaire with evaluation of the its measurement properties (internal consistency and responsiveness). The sample was composed of 123 patients. None of the patients had any difficulty in understanding the QCirDental. The instrument was found to have excellent internal consistency with Cronbach's alpha reliability coefficient of 0.83. The principal component analysis (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 and Bartlett's Test of Sphericity with p < 0.001) showed six (6) dimensions explaining 67.5% of the variance. The QCirDental presented excellent internal consistency, being a questionnaire that is easy to read and understand with adequate semantic and content validity. More than 80% of the patients who underwent dental extraction reported some degree of discomfort within the perioperative period which highlights the necessity to assess the quality of care and impacts of dental extraction surgery.

ABSTRACT The phytochemical study of hexane, chloroform and methanol extracts from leaves of Psychotria viridis resulted in the identification of: the pentacyclic triterpenes, ursolic and oleanolic acid; the steroids, 24-methylene-cycloartanol, stigmasterol and β-sitosterol; the glycosylated steroids 3-O-β-D-glucosyl-β-sitosterol and 3-O-β-D-glucosyl-stigmasterol; a polyunsaturated triterpene, squalene; the esters of glycerol, 1-palmitoylglycerol and triacylglycerol; a mixture of long chain hydrocarbons; the aldehyde nonacosanal; the long chain fat acids hentriacontanoic, hexadecanoic and heptadenoic acid; the ester methyl heptadecanoate; the 4-methyl-epi-quinate and two indole alkaloids, N,N-dimethyltryptamine (DMT) and N-methyltryptamine. The chemical structures were determined by means of spectroscopic (IR, 1H and 13C NMR, HSQC, HMBC and NOESY) and spectrometric (CG-MS and LCMS-ESI-ITTOF) methods. The study of biologic properties of P. viridis consisted in the evaluation of the acetylcholinesterase inhibition and cytotoxic activities. The hexane, chloroform, ethyl acetate and methanol extracts, the substances 24-methylene-cycloartanol, DMT and a mixture of 3-O-β-D-glucosyl-β-sitosterol and 3-O-β-D-glucosyl-stigmasterol showed cholinesterase inhibiting activity. This activity induced by chloroform and ethyl acetate extracts was higher than 90%. The methanol and ethyl acetate extracts inhibit the growth and/or induce the death of the tumor cells strains B16F10 and 4T1, without damaging the integrity of the normal cells BHK and CHO. DMT also demonstrated a marked activity against tumor cell strains B16F10 and 4T1.

Objetivo: Avaliar e descrever os cuidados envolvidos durante o procedimento de injeção intravítrea de drogas antiangiogênicas realizado pelos oftalmologistas membros da Sociedade Brasileira de Retina e Vítreo (SBRV). Métodos: Foi enviado um questionário aos 920 membros da SBRV, por meio de correio eletrônico, entre o período de 15/11/2013 a 31/04/2014, contendo 22 questões, relacionado aos cuidados pré, intra e pós-operatório da injeção intravítrea. Resultados: Foram obtidas 352 respostas (38% dos sócios). Houve um predomínio do sexo masculino (76%), procedentes da região Sudeste (51%). O tempo de experiência profissional se concentrou entre 6 a 15 anos após o término da especialização (50%). A maioria dos participantes tem média semanal de 1 a 10 (76%), sendo 88% das vezes realizado dentro do centro cirúrgico, utilizando iodopovidona (99%), luvas e blefarostato estéreis (94%). A anestesia tópica com colírio anestésico foi a técnica mais utilizada (65%). Entre os participantes, ranibizumabe (Lucentis®) é a droga mais utilizada (55%) e a degeneração macular relacionada a idade (DMRI) é a doença mais tratada (57%). Das complicações citadas pelos oftalmologistas, 6% já vivenciaram pelo menos um caso de descolamento de retina, 20% endoftalmite, 9% hemorragia vítrea e 12% toque cristaliniano. Conclusão: A injeção intravítrea é um procedimento realizado rotineiramente por retinólogos, com baixo índice de complicações. A realização do procedimento no centro cirúrgico com técnica asséptica é preferida pelos pesquisados. A droga mais utilizada foi o ranibizumabe e a doença mais tratada foi a DMRI.

Purpose: To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). Methods: A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. Results: 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizumab (Lucentis®) was the most common drug (55%), and age-related macular degeneration (AMD) was the most treated disease (57%). Regarding the complications treated, 6% of the ophthalmologists had treated at least one case of retinal detachment, 20% had treated cases of endophthalmitis, 9% had treated cases of vitreous hemorrhage, and 12% had encountered cases of crystalline lens touch. Conclusion: Intravitreal injection is a procedure routinely performed by retina specialists and has a low incidence of complications. Performing the procedure in the operating room using an aseptic technique was preferred by most of the respondents. Ranibizumab was the most used drug, and AMD was the most treated disease.

OBJETIVO: Avaliar o efeito no pré-operatório da injecao intravítrea de bevacizumab (IVB) ou triancinolona (IVT) sobre a taxa de hemorragia precoce pos-vitrectomia na retinopatia diabética proliferativa. MÉTODOS: Os olhos foram distribuídos em três grupos: IVB - 1,25 mg bevacizumab, IVT - 4,0 mg de triancinolona e o grupo controle - simulação da injeção. O objetivo primário foi a avaliação da incidência da hemorragia precoce pós-vitrectomia. Os objetivos secundários incluíram mudanças na acuidade visual corrigida e eventos adversos relacionados à injeção. RESULTADOS: Dos Vinte e sete olhos, 9 foram randomizados em cada grupo. A incidência de hemorragia vítrea foi menor no grupo IVB (P=0,18). A hemorragia vítrea em 1 mês também foi menor no grupo IVB (P > 0,05). A taxa de sangramento pós-operatório imediato foi maior no grupo IVT com 4 (44,4%) dos casos. A média da acuidade visual (AV) foi de 1,72 ± 0,37 logMAR no pré-operatório e 1,32 ± 0,73 logMAR em 6 meses após a cirurgia. Analisando a AV por grupo evidenciamos que o grupo IVB tinha inicialmente AV média logMAR de 1,87 e AV logMAR de 1,57 em seis meses (p = 0,84). No grupo IVT, a média inicial de AV foi de 1,75 logMAR e 0,96 logMAR em seis meses (p < 0,001). E no grupo controle, a média inicial foi de 1,85 logMAR e 1,57 logMAR no seis meses (p = 0,34). CONCLUSÃO: A injeção intravítrea de bevacizumab antes da vitrectomia parece diminuir a incidência de hemorragia vítrea precoce pós-vitrectomia em diabéticos. Houve um melhor resultado na acuidade visual no grupo da triancinolona.

PURPOSE: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) or triamcinolone (IVT) on the rate of early postvitrectomy hemorrhage in proliferative diabetic retinopathy (PDR). METHODS: Eligible eyes were assigned randomly to 1 of 3 groups: the IVB group received 1.25 mg bevacizumab, the IVT group received 4,0mg triamcinolone and the control group underwent a sham procedure. The primary outcome measure was the incidence of early postvitrectomy hemorrhage. Secondary outcome measures included changes in visual acuity (BCVA) and adverse events. RESULTS: Twenty and seven eyes, 9 in each group were randomized. The incidence of vitreous hemorrhage was lower in the IVB group (p=0.18). Postoperative vitreous hemorrhage at 1 month also was less in the IVB group compared with the control group (p > 0.05). The rate of bleeding immediately after surgery was higher in IVT group with 4 (44.4%) cases. The overall mean visual acuity was 1.72 ± 0.37 logMAR preoperatively and 1.32 ± 0.73 logMAR in 6 months after surgery. Accessing visual acuity by group evidenced that the IVB group had initial mean logMAR VA of 1.87 and 1.57 logMAR VA at the six months (p = 0.84). In IVT group, initial mean VA was 1.75 logMAR and 0.96 logMAR VA at six months (p < 0.001). And in control group, the initial mean VA was 1.85 logMAR and 1.57 logMAR VA at six months (p= 0.34). CONCLUSION: Intravitreal injection of bevacizumab 1 week before vitrectomy seems to reduce the incidence of early postvitrectomy hemorrhage in diabetic patients. There was a better visual acuity outcome in the triamcinolone group.

Na literatura sobre redes interorganizacionais, parte das abordagens de pesquisa afirma que tal tipo de ambiente favorece as condições para a aprendizagem por meio da combinação de capacidade de diferentes membros. Igualmente, existem correntes de estudo que apontam haver ressalvas relacionadas às próprias características dos membros. Esta aparente contradição instigou um questionamento: como a configuração de posições de membros de redes interorganizacionais afeta o sentido que a aprendizagem adquire para os próprios membros? Utilizando-se referências conceituais da área de aprendizagem em redes interorganizacionais, o estudo apresenta os resultados da análise de um caso empírico de uma comunidade epistêmica (rede de cooperação científica formalmente instituída) brasileira no campo da biotecnologia. Adotou-se como método de pesquisa a triangulação de técnicas quantitativas e qualitativas. Inicialmente, utilizou-se a análise quantitativa sociométrica evidenciando a posição do membro de acordo com a centralidade para a aprendizagem e a produção acadêmica. Após essa identificação, foram aplicadas entrevistas semiestruturadas aos membros localizados em diferentes posições, fossem elas de alto valor agregado (membros com alta centralidade) ou marginais (membros com baixa centralidade). A partir de um referencial de análise qualitativo com foco nos conceitos de práticas e gêneros discursivos, foi possível delinear diferentes sentidos sobre a aprendizagem decorrida de acordo com a posição dos membros. A partir dos resultados, evidenciou-se a relação da posição ocupada pelo membro da rede o sentido dado à aprendizagem. Apesar das limitações associadas à pesquisa sobre um caso único que dificulta a possível generalização dos resultados, o estudo abre possibilidades de aprofundar novas pesquisas sobre a relação entre as características dos membros e sua posição com a aprendizagem em redes interorganizacionais.

Part of literature on interorganizacional network learning states that this environment (networks) allows Learning through the ability's combination of different members. Also, there are current studies that link the same member's characteristics with issues and barriers to learning. This apparent contradiction stimulated a question: how the configuration of network member's positions affects the sense that learning has to the own members? Our study presents the empirical results of a case analysis related to one Brazilian epistemic network in biotechnology field. The methodology was based on combined methods of quantitative and qualitative techniques. Initially, we used quantitative analysis highlighting the sociometric member's position according the centrality to learning and academic production. After that, we applied a semistructured interview with members located in different positions, independently of high value added (members with high centrality) or marginal value (low centrality members). Using the reference of qualitative analysis focusing on the concepts of practices and genres, it was possible to devise different senses to learning in accordance with the position of members. From results, there it was possible to establish a relationship concerning the interorganizational network member position occupied and the sense given to learning. Despite the limitations associated with a unique case, which makes impossible to generalize the results, the study opens new possibilities for further research on the relationship between the member's characteristics in networks and the sense of learning.

En la literatura sobre redes interorganizacionales, parte de la investigación establece que este tipo de ambiente favorece las condiciones para aprendizaje mediante la combinación de la capacidad de los diferentes miembros. Además, hay estudios que establecen advertencias relacionadas con las características especiales de los miembros. Esta aparente contradicción se le solicite una pregunta: ¿cómo las configuraciones de posición de miembros de redes interorganizacionales afecta el sentido de que el aprendizaje para sus proprios miembros? Utilizando referencias conceptuales en el área de aprendizaje en redes interorganizacionales, el estudio presenta los resultados del análisis de un caso empírico de una comunidad epistémica (red de cooperación científico formalmente establecida) de Brasil en biotecnología. Fue adoptado como el método la triangulación de las técnicas de investigación cuantitativas y cualitativas. Inicialmente, se utilizó un estúdio sociométrico cuantitativo que muestra la posición del miembro de acuerdo con la centralidad del aprendizaje. Después de esta identificación se aplicaron entrevistas semi-estructuradas con miembros ubicados en diferentes posiciones, ya sea de alto valor añadido (miembros con centralidad alta) o marginal (miembros con centralidad baja). Desde el cualitativo analítico centrado en las posiciones, fue posible delinear sentidos diferentes sobre el aprendizaje transcurrido de acuerdo con la posición de los miembros. Los resultados mostraron la relación de la posición ocupada por el miembro de la red con significado dado al aprendizaje. A pesar de las limitaciones asociadas con la investigación de un caso único que no hace posible la generalización de los resultados, el estudio abre nuevas posibilidades para la investigación sobre la relación entre las características de los miembros y su posición con el aprendizaje en redes interorganizacionales.

Background: Cellulases and lipases have broad industrial application, which calls for an urgent exploration of microorganisms from extreme environments as valuable source of commercial enzyme. In this context, the present work describes the bioprospection and identification of deep-sea bacteria that produce cellulases and lipases, as well their optimal temperature of activity. Results: The first step of this study was the screening of cellulolytic and lipolytic deep-sea bacteria from sediment and water column, which was conducted with substrates linked with 4-Methylumbelliferyl. Among the 161 strains evaluated, 40 were cellulolytic, 23 were lipolytic and 5 exhibited both activities. Cellulolytic and lipolytic bacteria are more common in sediment than at the water column. Based on the ability to produce cellulases and lipases three isolates were selected and identified (16S rRNA sequencing) as Bacillus stratosphericus, B. aerophilus and B. pumilus. Lipases of strain B. aerophilus LAMA 582 exhibited activity at a wide temperature range (4º to 37ºC) and include psychrophilic behaviour. Strain Bacillus stratosphericus LAMA 585 can growth in a rich (Luria Bertani) and minimal (Marine Minimal) medium, and does not need an inducer to produce its mesophilic cellulases and lipases. Conclusions: Deep-sea sediments have great potential for bioprospection of cellulase and lipase-producing bacteria. The strains LAMA 582 and LAMA 585 with their special features, exhibit a great potential to application at many biotechnology process.

O propósito deste artigo é analisar os processos da aprendizagem organizacional que levaram ao desenvolvimento das competências necessárias para que instituições de ensino superior passassem a oferecer Cursos Superiores de Tecnologia [CSTs]. O escopo do estudo está limitado à cidade de Curitiba-PR e seus pressupostos assumem que a aprendizagem organizacional é o meio pelo qual as instituições adquirem as competências necessárias para viabilizar suas estratégias. A natureza da pesquisa é exploratória, de abordagem qualitativa, e o método utilizado é o estudo de casos múltiplos, em perspectiva longitudinal. Os resultados mostraram que o desenvolvimento da competência de ofertar CSTs demandou mudanças profundas na articulação dos recursos das duas instituições estudadas e a institucionalização de novos conhecimentos. Com base nos dados encontrados em cada caso, foi possível conduzir uma análise transversal, que permitiu constatar que determinadas competências podem ser construídas enquanto outras são desconstruídas, configurando o caráter dinâmico do desenvolvimento de competências e do processo de aprendizagem. Assim, foi possível não só corroborar o modelo de análise adotado, de Patriotta (2003), mas também revisá-lo, a fim de incorporar os resultados desta pesquisa teórico-empírica.

The aim of this article is to analyze the organizational learning processes that led to the development of the necessary competences for higher education institutions to begin offering Higher Technological Courses. The range of this study is limited to Curitiba in Paraná State, and its assumption is that organizational learning is the way for institutions to obtain the necessary competences to make their strategies practical. The nature of this research is exploratory, using a qualitative approach, and the method used is the multiple case study in a longitudinal time perspective. The results of this multiple-case study showed that the development of the competences required profound changes in the articulation of resources in both institutions that were analyzed, in addition to the institutionalization of new knowledge. Based on the data found in each case, it was possible to conduct a transversal analysis, which made it possible to certify that some competences can be built and others extinguished, shaping the dynamic character of the competences and the learning process. Thus, it was possible to corroborate the analysis model that was used (Patriotta, 2003) and suggest advances for it.