Abstract Introduction Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF.

Resumen La disección aórtica representa una afección relativamente poco común pero potencialmente mortal que se debe a un desgarro en la capa íntima de la arteria aorta o sangrado dentro de su pared, lo que da como resultado una separación de las capas de esta. Se han identificado varios factores de riesgo y comparten los mismos que para otras enfermedades cardiovasculares, como la edad, la hipertensión arterial, la dislipidemia y los trastornos genéticos del tejido conectivo. Es muy importante que el clínico pueda realizar un diagnóstico oportuno y un tratamiento adecuado en los pacientes afectados. El tipo de tratamiento depende de la extensión y de la localización de la disección. La reparación quirúrgica abierta suele ser la más usada para aquellas en las que están involucradas la aorta ascendente y el arco aórtico; por otro lado, la intervención endovascular está recomendada para las disecciones de la aorta descendente, que suelen ser complicadas. En este trabajo se revisará la epidemiología, la fisiopatología, las manifestaciones clínicas y finalmente el manejo de la disección aórtica.

Abstract Aortic dissection represents a relatively rare but highly fatal condition that is due to a tear in the intimal layer of the aortic artery or bleeding within its wall, resulting in a separation of its layers. Several risk factors have been identified and share the same as for other cardiovascular diseases such as age, high blood pressure, dyslipidemia and genetic disorders of connective tissue. It is very important that the clinician can make a timely diagnosis and appropriate treatment in patients affected by it; the type of treatment depends on the extent and location of the dissection. Open surgical repair is usually the most used for those that involve the ascending aorta and the aortic arch, on the other hand, endovascular intervention is recommended for dissections of the descending aorta that are usually complicated. In this work, the epidemiology, pathophysiology, clinical manifestations and finally the management of aortic dissection will be reviewed.

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1–10) and 3.50 (-6–10) in difference 1; 4.35 (-5–10) and 5.00 (-3–10) in difference 2; and 4.65 (1–10) and 3.80 (-3–10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1–10) e 3.50 (-6–10) na diferença 1; 4.35 (-5–10) e 5.00 (-3–10) na diferença 2; e 4.65 (1–10) e 3.80 (-3–10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

ABSTRACT Objective: Herein, we compared ambulatory blood pressure (ABP) between young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency and a control group. Additionally, we analyzed correlations between the glucocorticoid dose and androgen levels and ABP parameters. Subjects and methods: This case-control study included 18 patients (6 males and 12 females) and 19 controls (8 males and 11 females) matched by age (18-31 years). ABP monitoring was used to estimate blood pressure (BP) over a 24-h period. Results: No difference was noted between patients and controls in terms of systolic BP (males, 115.5 ± 5.6 vs. 117.0 ± 9.3, P = 0.733; and females, 106.4 ± 7.9 vs. 108.4 ± 7.6, P = 0.556, respectively) and diastolic BP during 24 h (males, 62.8 ± 7.5 vs. 66.2 ± 5.6, P = 0.349; and females, 62.7 ± 4.9 vs. 62.3 ± 4.9, P = 0.818, respectively). Systolic and diastolic BP and pulse pressure during daytime and nocturnal periods were similar between patients and controls. Furthermore, no differences were detected in the percentage of load and impaired nocturnal dipping of systolic and diastolic BP between patients and controls during the 24-h period. Additionally, the glucocorticoid dose (varying between r = −0.24 to 0.13, P > 0.05) and androgens levels (varying between r = 0.01 to 0.14, P > 0.05) were not associated with ABP parameters. Conclusion: No signs of an elevated risk for hypertension were observed based on ABP monitoring in young adults with CAH attributed to 21OHase deficiency undergoing glucocorticoid replacement therapy.

Abstract This work describes the circulation over the continental slope and the São Paulo Plateau in the Santos Basin during the SANSED winter 2019 survey. The cruise consisted of four legs in the period between June, 11 and August, 03 2019. The observed circulation is dominated by the Atlantic southwestern boundary current regime and remotely-generated anticyclones and cyclones. The former is composed by the Brazil Current, the Intermediate Western Boundary Current and their mesoscale meanders; the latter are 300km vortical rings with origin in the eastern side of the South Atlantic Basin. A Lagrangian scheme applied over satellite altimeter maps indicate that the origin of these rings is primarily the Cape Basin of South Africa. The interaction between the boundary currents, their cyclonic meanders, and the anticyclonic rings is complex, and varies widely. During the SANSED winter 2019 survey period, three anticyclones interacted with the Brazil Current, instabilizing it, forming dipoles with the current cyclonic meanders, leading to their downstream propagation. Ancienter cyclonic eddies within Santos Basin may interfere with the propagation of the large anticyclones further south. In addition, the continuous arrival of remotely-originated anticyclones, the larger portion over the São Paulo Plateau presented a tendency of counter-clockwise circulation during the whole cruise period.

Resumo Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

Resumen Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Abstract Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Resumen: El objetivo fue identificar los relatos de síntomas de depresión, ansiedad y estrés entre cuidadores de niños sin discapacidad visual, con baja visión y con ceguera y su relación con el grado de apoyo social, emocional, material y afectivo. Estudio transversal y multicéntrico realizado en la ciudad de Río de Janeiro, Brasil, entre el 2019 y el 2020. Se aplicó un cuestionario para obtener datos sociodemográficos y económicos del cuidador. Se utilizaron la Escala de Apoyo Social (The Medical Outcomes Study Social Support Scale - MOS-SSS) y Escala de Depresión, Ansiedad y Estrés (The Depression, Anxiety, and Stress Scale - DASS-21). Al comparar las escalas, se utilizaron pruebas para comparaciones múltiples. Se estimó la razón de prevalencia de síntomas de depresión, ansiedad y estrés. Del total de cuidadores (N = 355), más del 90% eran mujeres madres y la mayor proporción de cuidadores sin escolaridad o con primaria incompleta y con menor ingreso mensual promedio fueron los de niños con discapacidad visual. La mayoría de los cuidadores de niños con ceguera reportó síntomas de depresión, ansiedad y estrés, respectivamente, 66,7%, 73,3% y 80%, mismo comportamiento observado en el grupo de cuidadores de niños con baja visión. Al evaluar la relación entre los resultados de las escalas MOS-SSS y DASS-21, entre los cuidadores de niños sin discapacidad o con menor compromiso visual, se observó mayor apoyo y menores puntajes de relatos de depresión, ansiedad y estrés. Entre los cuidadores de niños ciegos, la mayor prevalencia de tales relatos no dependió del apoyo recibido. Los resultados indican la necesidad de una Política de Cuidado con mecanismos para proteger la salud mental de los cuidadores de niños con discapacidad visual.

Abstract: We aimed to identify the reports of symptoms of depression, anxiety, and stress among caregivers of children without visual impairment, with low vision, and with blindness and their relationship with the degree of social, emotional, material, and affective support. This cross-sectional and multicenter study was conducted in the municipality of Rio de Janeiro, Brazil, from 2019 to 2020. A questionnaire was applied to obtain caregivers’ sociodemographic and economic data. The Medical Outcomes Study Social Support Scale (MOS-SSS) and The Depression, Anxiety, and Stress Scale (DASS-21) were used. Tests were used for multiple comparisons of these scales. The prevalence ratio of symptoms of depression, anxiety, and stress was estimated. Of all caregivers (N = 355), more than 90% were women-mothers. Caregivers of children with visual impairment show the highest proportion of no schooling, incomplete elementary education, or lower average monthly income. Most caregivers of children with blindness reported symptoms of depression, anxiety, and stress (66.7%, 73.3%, and 80%, respectively) as did those of children with low vision. The evaluation of the relationship between MOS-SSS and DASS-21 results shows greater support and lower scores of reports of depression, anxiety, and stress for caregivers of children without disabilities or with less visual impairment. For caregivers of blind children, the highest prevalence of such reports was independent of the received support. Results indicate the need for a care policy with mechanisms to protect the mental health of caregivers of visually impaired children.

Resumo: O objetivo foi identificar os relatos de sintomas de depressão, ansiedade e estresse entre cuidadores de crianças sem deficiência visual, com baixa visão e com cegueira e sua relação com o grau de apoio social, emocional, material e afetivo. Estudo transversal e multicêntrico, realizado no Município do Rio de Janeiro, Brasil, entre 2019 e 2020. Aplicou-se um questionário para obter dados sociodemográficos e econômicos do cuidador. Foram utilizadas a Escala de Apoio Social (The Medical Outcomes Study Social Support Scale - MOS-SSS) e a Escala de Depressão, Ansiedade e Estresse (The Depression, Anxiety, and Stress Scale - DASS-21). Na comparação entre as escalas, foram utilizados testes para comparações múltiplas. Estimou-se a razão de prevalência de sintomas de depressão, ansiedade e estresse. Do total de cuidadores (N = 355), mais de 90% eram mulheres-mães e a maior proporção de cuidadores sem instrução ou Ensino Fundamental incompleto e com menor renda média mensal foi daqueles de crianças com deficiência visual. A maioria dos cuidadores de crianças com cegueira relatou sintomas de depressão, ansiedade e estresse (respectivamente, 66,7%, 73,3% e 80%), mesmo comportamento observado no grupo de cuidadores de crianças com baixa visão. Na avaliação da relação entre os resultados das escalas MOS-SSS e DASS-21, entre os cuidadores de crianças sem deficiência ou com menor comprometimento visual, observou-se maiores apoios e menores escores de relatos de depressão, ansiedade e estresse. Entre os cuidadores de crianças cegas, as maiores prevalências não dependeram dos apoios recebidos. Os resultados indicam a necessidade de uma política de cuidado com mecanismos de proteção à saúde mental dos cuidadores de crianças com deficiência visual.

Abstract Recent studies have shown promising uses of geotechnologies in the study and management of cities, with important contributions to the regulation of land use. In this article, we address the real estate dynamics and its relation with land use through a study of urban voids in infrastructure-served areas. This approach meets the prescriptions of Transit-Oriented Development (TOD), which proposes, among other things, a better use of urban land in the proximity of mass transit infrastructure. To assess the reconvertion of land in these areas, with a view to better distributing land value and meeting the social function of land and property, we have defined our study in the northern section of Niterói/RJ, along one of the main roads in the city. We have used different public data to identify both vacant land and property that is vacant or underutilized in the context they are located.

Resumo Estudos recentes mostram aplicações promissoras das geotecnologias no estudo e na gestão da cidade, com subsídios especialmente importantes para a regulação do uso do solo. Neste artigo, tratamos da dinâmica imobiliária e sua relação com o uso do solo com base no estudo de vazios urbanos em áreas infra-estruturadas. Esse enfoque atende aos princípios do Desenvolvimento Orientado ao Transporte Sustentável (DOTS), que, dentre outros objetivos, pretende incentivar o melhor aproveitamento do solo urbano no entorno dos sistemas de transportes coletivos. Para analisar o potencial aproveitamento dessas áreas, visando ao cumprimento da função social da propriedade e ao acesso mais justo a serviços e infraestruturas, foi definido um recorte no município de Niterói, no Rio de Janeiro, junto a um importante corredor viário da cidade. Apoiados em diferentes fontes de dados, buscamos identificar nessas áreas tanto os vazios formados por áreas livres como os imóveis edificados considerados ociosos ou subutilizados, no contexto em que se inserem.

ABSTRACT. This study aimed to evaluate the intake, digestibility, and ingestive behavior of sheep fed with different species of forage cacti. Fifteen sheep (17.27kg ± 1 kg) were distributed in a completely randomized experimental design with three treatments and five replicates. The treatments were diets on a dry matter basis composed of 430.9 g kg-1 of thornless Mandacaru cactus (Cereus hildmannianus), 525.7 g kg-1 of cactus pear cv. Orelha de Elefante Mexicana (Opuntia stricta) and 492.1 g kg-1 of cactus pear cv. Miúda (Nopalea cochenillifera) in addition to Sabiá hay (Mimosa caesalpiniaefolia) (194.7 to 233.8 g kg-1), plus concentrate feed. The intake of the dry matter, organic matter, ether extract, neutral detergent fiber, total carbohydrates, non-fiber carbohydrates, total digestible nutrients and voluntary water intake in g day-1 was not differ (p > 0.05) by experimental diets. There were no differences (p > 0.05) in digestibility coefficients of the dry matter, organic matter, neutral detergent fiber, total carbohydrates, non-fiber carbohydrates, and total digestible nutrients between the experimental diets. The feeding times differed (p < 0.05) between diets, with a higher value for the Opuntia diet, while the rumination times, feeding efficiency, and rumination efficiency did not differ (p > 0.05). The cactus Cereus and Opuntia and Nopalea have similar nutritional value in sheep’s diet.

ABSTRACT Several studies have shown that the survival and reproduction of lacewings varies depending on the type of prey they consumed, especially during the first instar. In this study, we evaluated the effect of a diet consisting of Ephestia kuehniella (EK) and/or Planococcus-citri (PC) eggs offered to first instar Chrysoperla externa on subsequent development and survival. Larvae supplied only with P. citri (PC) nymphs had extended immature development, low survival, adults with lower weight and longevity, low fecundity and egg viability, and lower net reproduction rate (R0). Larvae submitted to the treatment EK+PC responded positively to the diet, showing results similar to those obtained in the control-EK treatment. Therefore, this mealybug supports suitable development and reproduction of C. externa when it is provided to second instar larvae after they fed on E. kuehniella eggs as first instars. As far as we know, this is the first report that demonstrates the effect of natural prey and alternatives on different larval stages of lacewings. This information is valuable in developing protocols for use of C. externaas a pest control agent.

Abstract This study describes the hydrography and water masses of the Santos Basin Continental Shelf (SBCS) during two hydrographic campaigns (SANAGU, SANSED) in 2019. Coastal Water (CW) is the dominant water mass in the southern portion of the SBCS, with relatively low salinity values (S<35.5 g kg–1), and satellite data show that local precipitation and river discharge could not account for the low salinity observed during the cruises in the southern region of the domain. The low salinity observed is explained by the transport from the south influenced by Subtropical Shelf Water (STSW), which was influenced by the La Plata River discharge. In the northern region of the SBCS, the South Atlantic Central Water (SACW) dominates the bottom layers of the water column, with the wind playing a major role in the uplift of this water mass, as evidenced by a wind impulse analysis. In this part of the shelf, Tropical Water (TW) was the second water mass in volume and occupied the surface layers and offshore the shelf. CW is restricted to a thin surface layer, which reaches distances of a few kilometers from the coast. Our analysis show the differences in the hydrographic structure of the SBCS and suggests that the SBCS can be divided in two regions with distinct characteristics: 1) the area southwest of São Sebastião, where the hydrographic parameters were modulated by the presence of the Subtropical Shelf Water (STSW); 2) the area northeast of São Sebastião, where the uplifting of SACW was the dominant process.

ABSTRACT. In soils with adequate levels of fertility, it is possible to manage phosphate fertilization aiming at the grain production system, instead of each isolated crop. The objective was to evaluate the effects of the management of phosphate fertilization, place and time, on the soil and leaf P content, and crop yield in grain production systems. An experiment was conducted at the farm level in the municipality of Nazareno, state of Minas Gerais, Brazil, for four years on soil with adequate level of fertility. The treatments consisted of the management of phosphate fertilization by broadcast or furrow and dose for each crop or for the production system (spring/summer and autumn/winter crops), being: Control = without phosphate fertilization; Conventional = phosphate fertilization in the furrow in each crop; BTP = phosphate fertilization of the grain production system to broadcast; TPS = phosphate fertilization of the grain production system in the furrow of the spring/summer crop; TPW = phosphate fertilization of the grain production system in the furrow of the autumn/winter crop. Soil P content was evaluated in the third year of implantation, and the crops yield every season crop (maize, soybean, common bean and wheat). The P content in the leaves of maize and soybeans were evaluated in the spring/summer crops. The application of the total dose of phosphate fertilization for both crops in the sowing furrow of the spring/summer or autumn/winter crops (TPS and TPW) promoted operational advantages and increased soil P content in the 0-0.20 m layer, without reducing the yield of the spring/summer crops. Leaf P content was not affected. The Conventional management (phosphate fertilization in the furrow in each crop) provide greater yield of common beans and wheat during autumn/winter crops, which are more subject to water restriction due to less rainfall, even without increasing the soil P content.

Abstract The flora of the Brazilian rupestrian grasslands represents a hotspot of species richness and endemisms. Stachytarpheta cassiae (Verbenaceae), is a micro endemic species, from which nothing is known. Here, we quantified the activity and intensity of vegetative and reproductive phenophases throughout 12 months and tested for their seasonality and their relationship with local climatic variables. Both vegetative and reproductive phenophases were continuous. No seasonality was observed in the vegetative phenophases and none of them was influenced by climatic variables. Only flower buds and mature fruits’ intensities showed seasonality in February (rainy season) and July (dry season), respectively. Accordingly, increased temperature and humidity combined explained increased production of flower buds whereas decreased rainfall explained increased mature fruits. Higher intensity in flower buds may respond to similar climatic conditions as other species in the community. However, S. cassiae is much different as it continues producing flowers continuously. Higher intensity of mature fruits in the dry season is expected as their seeds are abiotically dispersed. Due to constant flower and leaf production, S. cassia may be a key species for the conservation of many vertebrate and invertebrate species and for maintaining the biogeochemical functioning of the impoverished soils of the rupestrian grasslands.

Resumo A flora dos campos rupestres brasileiros representa um hotspot de riqueza de espécies e endemismos. Stachytarpheta cassiae (Verbenaceae) é uma espécie micro endêmica, da qual nada se sabe sobre sua história natural. Aqui, quantificamos ao longo de 12 meses a atividade e intensidade das fenofases vegetativas e reprodutivas e testamos sua sazonalidade e sua relação com as variáveis climáticas locais. Tanto as fenofases vegetativas quanto as reprodutivas foram continuas. Não foi observada nenhuma sazonalidade nas fases vegetativas e nenhuma delas foi influenciada por variáveis climáticas. Somente os botões florais e a intensidade de frutos maduros mostraram sazonalidade significativa em fevereiro (estação chuvosa) e julho (estação seca), respectivamente. Assim, o aumento da temperatura e umidade combinados explicaram o aumento da produção de botões florais, enquanto a diminuição da precipitação explicou o aumento dos frutos maduros. A maior intensidade dos botões florais pode responder a condições climáticas semelhantes às de outras espécies na comunidade. No entanto, S. cassiae é muito diferente, pois produz flores continuamente. É esperada maior intensidade de frutos maduros na estação seca, já que suas sementes são dispersas por vetores abióticos. Devido à produção constante de flores e folhas, S. cassia pode ser uma espécie chave para a conservação de muitas espécies de vertebrados e invertebrados e para a manutenção do funcionamento biogeoquímico dos solos empobrecidos dos campos rupestres.

Abstract Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with lamino-plasty. Both of them had uneventful recovery and remission in surgery follow-up. Conclusion The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.

Resumo Antecedentes Hipotensão intracraniana espontânea (HIE) é uma causa secundária de cefaleia e uma doença subdiagnosticada. A apresentação clínica pode ser muito variável. Tipicamente, se apresenta com queixas isoladas de cefaleia ortostática clássica, porém pode evoluir com complicações significativas como trombose venosa cerebral (TVC). Objetivo Relatar 3 casos de diagnóstico de hipotensão intracraniana espontânea manejados em uma enfermaria de neurologia de nível terciário. Métodos Revisão dos prontuários de três pacientes e descrição dos resultados clínicos e cirúrgicos. Resultados Três pacientes do sexo feminino com média de idade de 25.6 ± 10.0 anos. As pacientes apresentavam cefaleia ortostática e uma delas apresentou sonolência e diplopia devido a TVC. A ressonância magnética (RM) do encéfalo varia de achados normais até achados clássicos de HIE como realce paquimeníngeo e deslocamento inferior das tonsilas cerebelares. A RM da coluna mostrou coleções anormais de líquido epidural em todos os casos e a mielografia por tomografia computadorizada (TC) foi capaz de determinar fístula liquórica identificável em apenas uma paciente. Uma paciente recebeu abordagem conservadora e as outras duas foram submetidas a cirurgia aberta com laminoplastia. Ambas tiveram recuperação e remissão sem intercorrências no seguimento cirúrgico. Conclusão O diagnóstico e manejo da hipotensão intracraniana ainda são desafios na prática neurológica. Destacamos no presente estudo casos graves, complicação com TVC e bons resultados com tratamento neurocirúrgico.

Abstract This work evaluated the effect of fiscal policy on the effectiveness of monetary policy by the Central Bank of Brazil. Using monthly data from January-2003 to January-2020, a test was conducted to gauge how the cyclicality degree of the fiscal policy-in light of the variations in the public debt-affected the variability of the short-term real interest rate. To this goal, we extracted a fiscal response index from an unobservable state variable using the Kalman filter. Applying the cointegration method and GMM estimation, the results revealed that the smoothing and effectiveness of monetary policy depend on the degree of fiscal responsiveness to the level of public indebtedness. JEL Codes E31, H30, H63