This proposal brings the perspective of popular participation rights in decisions on the use of the waters of the Mamoré River, aiming at its governance and water security in the face of the social and environmental risks of the binational hydroelectric project, between Brazil and Bolivia, under study. The aim is to: 1) Verify the right to use international rivers and certain decisions on conflicts over the use of transboundary waters; 2) Evaluate environmental democracy in water governance in Pan-Amazonian rivers; and 3) Analyze how the Escazú Agreement can contribute to guaranteeing environmental democracy in decisions on the use of waters from the international Mamoré River in relation to the binational hydroelectric development project planned in the Madeira Complex. To achieve reconciliation between development and the environment in the Pan-Amazon, it is necessary to limit the global forces of exploitation of existing environmental assets, including the use of water resources to generate electrical energy.

A presente proposta traz a perspectiva dos direitos de participação popular nas decisões de uso das águas do rio Mamoré, visando sua governança e segurança hídrica frente aos riscos sociais e ambientais do projeto da hidrelétrica binacional, entre Brasil e Bolívia, em estudo. Pretende-se: 1) Verificar o direito dos usos dos rios internacionais e certas decisões sobre conflitos de uso de águas transfronteiriças; 2) Avaliar a democracia ambiental na governança de águas de rios da Pan-Amazônia; e 3) Analisar como o Acordo de Escazú pode contribuir para garantir a democracia ambiental nas decisões de uso das águas do rio internacional Mamoré frente ao projeto de desenvolvimento de hidrelétrica binacional planejado no Complexo do Madeira. Para ser alcançada a conciliação entre desenvolvimento e meio ambiente na Pan-Amazônia é necessário serem limitadas as forças globais de exploração dos bens ambientais existentes, entre os quais o uso dos recursos hídricos para geração de energia elétrica.

ABSTRACT: This research determined the adaptability and stability of soybean yield for organic systems in different environments. Grain yield data (GY, kg ha-1) from experiments with six soybean genotypes evaluated in six environments in Brazil and one environment in Paraguay were used. The experimental design used was randomized blocks, organized in an incomplete factorial scheme, with six environments in Brazil (Toledo- PR, Palotina- PR, Mangueirinha- PR, Três Passos- RS, Passo Fundo- RS, Major Vieira- SC) and one in Paraguay (Bela Vista do Norte- PY) with six soybean genotypes (BRS 284, BRS 391, BRS 511, BRS 523, BRS 525, BRS 535) arranged in four replications per environment. BRS 511 genotype was characterized by high average grain yield and stability by the AMMI method. BRS 284 genotype was identified as the ideal genotype in the GGE biplot method. WAASBY and BLUP index selected BRS511 and BRS284 genotypes.

RESUMO: O objetivo deste trabalho foi determinar a adaptabilidade e estabilidade da produtividade da soja para sistemas orgânicos em diferentes ambientes. Foram utilizados dados de produtividade de grãos (GY, kg ha-1) de experimentos com seis genótipos de soja avaliados em seis ambientes no Brasil e um ambiente no Paraguai. O delineamento experimental utilizado foi blocos casualizados, organizados em esquema fatorial incompleto, com seis ambientes no Brasil (Toledo - PR, Palotina - PR, Mangueirinha - PR, Três Passos - RS, Passo Fundo - RS, Major Vieira - SC) e um no Paraguai (Bela Vista do Norte - PY) com seis genótipos de soja (BRS 284, BRS 391, BRS 511, BRS 523, BRS 525, BRS 535) dispostos em quatro repetições por ambiente. O genótipo BRS 511 foi caracterizado por alta produtividade média de grãos e estabilidade pelo método AMMI. O genótipo BRS 284 foi identificado como o genótipo ideal pelo método GGE biplot. Os índices WAASBY e BLUP selecionaram os genótipos BRS511 e BRS284.

Abstract The adaptation of specialized care for newborns with Down syndrome (DS) requires recognition of its characteristics at the local level. Goal: to characterize newborns diagnosed with DS and their mothers in maternal and child care units in the city of Medellín. Also, explore the factors associated with timely prenatal diagnosis. Methods: observational, cross-sectional study, based on medical records of newborns diagnosed with DS in seven institutions in Medellín, Antioquia between January 2015 and December 2019, taking into account both maternal and neonatal variables. Initially, a univariate analysis was performed using absolute and relative frequencies, then a bivariate analysis was performed taking into account neonatal outcomes according to access to prenatal care and the time at which the diagnosis was made (prenatal or neonatal), and finally a multivariate analysis for late neonatal diagnosis. Results: 50.2% of the mothers at the time of delivery were 35 years old or younger, of these 59.9% belonged to the contributory regime and 83.4% had 4 prenatal check-ups or more, despite this, it was found that only 33.7% had a prenatal diagnosis of DS. The majority (91.4%) of the neonates had a diagnosis of congenital heart disease and the prolonged hospital stay was related to related morbidity. Conclusion: DS is one of the most common chromosomal abnormalities in our environment, which can be diagnosed early. However, in our study it was possible to show that despite the high coverage of prenatal controls, the frequency of antenatal diagnosis is lower, which requires that these controls be carried out by medical personnel trained in patients with this type of pathology. This will finally be reflected in a better acceptance by the family towards the arrival of a child with this condition and, of course, better access to specialized health services.

Resumen La adaptación de una atención especializada para recién nacidos con Síndrome de Down (SD) requiere el reconocimiento de sus características a nivel local. Objetivo: caracterizar los recién nacidos diagnosticados con SD y sus madres en unidades de atención materno infantil de la ciudad de Medellín. Adicionalmente, se exploraron factores asociados al diagnóstico oportuno antenatal. Método: estudio observacional descriptivo de tipo transversal con intención analítica basado en registros médicos de recién nacidos diagnosticados con SD en siete instituciones de Medellín, Antioquia entre enero de 2015 y diciembre de 2019 teniendo en cuenta variables tanto maternas como neonatales. Se realizó un análisis univariado mediante frecuencias absolutas y relativas, luego se realizó un análisis bivariado teniendo en cuenta los desenlaces neonatales según el acceso al control prenatal y el momento en el cual se realizó el diagnóstico (prenatal o neonatal) y finalmente se realizó un análisis multivariado para diagnóstico neonatal tardío. Resultados: el 50,2% de las madres al momento del parto tenía 35 años o menos, de estas el 59,9% pertenecía al régimen contributivo y el 83,4% realizó 4 controles prenatales (CPN) o más, a pesar de esto, se encontró que sólo el 33,7% tenían diagnóstico prenatal de SD. La mayoría (91,4%) de los neonatos tuvo diagnóstico de cardiopatía congénita y la estancia hospitalaria prolongada estuvo en relación a morbilidad relacionadas. Conclusión: el SD es una de las cromosomopatías más común en nuestro medio, la cual se puede diagnósticar de forma temprana. Sin embargo en nuestro estudio se pudo evidenciar que pese a la alta cobertura de CPN la frecuencia del diagnóstico antenatal es menor, lo cual requiere que estos controles sean realizados por personal médico entrenado en pacientes con este tipo de patología. Esto finalmente se va a ver reflejado en una mejor aceptación por parte de la familia hacia la llegada de un hijo con esta condición y por supuesto, mejor acceso a servicios de salud especializados.

ABSTRACT Introduction: Infiltrating and diffuse gliomas of the brain stem in children and adolescents lead to a poor prognosis and a short survival time. Objective: Present the results obtained with the combination of nimotuzumab and radiotherapy in brain stem tumors in children and adolescents. Methods: The monoclonal antibody called nimotuzumab combined with radiotherapy was applied in a series of 69 patients aged between 2 and 18 years, from 2008 to 2020, and followed until August 2021. They were irradiated at the National Institute of Oncology and Radiobiology in Havana, with a dose in a range of 54 to 59 Gy. Nimotuzumab was applied at the dose of 150 mg/m2 of body surface area, once a week while the radiation treatment was active, then every 2 weeks with the same dose, and finally once a month for 1, 2 or more years. Results: At the end of the combined treatment of radiotherapy and nimotuzumab, there was a response in 89.9% of the patients. The median overall survival time was 18.8 months and series survival rates were 76.4; 45.4; 38.9; 32.8; and 31.5% at one, two, three, four, five and more years, respectively, and it was stabilized from this time to 10 years and more. Three relapsed patients were re-radiated. Conclusions: The combination of radiotherapy and nimotuzumab was well tolerated and is an option for the treatment in brain stem tumors in children and adolescents.

RESUMEN Introducción: Los gliomas infiltrantes y difusos del tallo cerebral en los niños y adolescentes comportan un mal pronóstico y un tiempo corto de supervivencia. Objetivo: Presentar los resultados obtenidos con la combinación de nimotuzumab y radioterapia en tumores del tallo cerebral en niños y adolescentes. Métodos: El anticuerpo monoclonal nimotuzumab combinado con la radioterapia fue aplicado en una serie de 69 pacientes con edades entre 2 y 18 años, incluidos desde 2008 hasta 2020, y seguidos hasta agosto de 2021. Fueron irradiados en el Instituto Nacional de Oncología y Radiobiología de La Habana, con una dosis en un rango de 54 a 59 Gy. El nimotuzumab se aplicó a la dosis de 150 mg/m2 de superficie corporal, una vez por semana mientras duró el tratamiento radiante, luego cada 2 semanas con igual dosis, y finalmente, una vez por mes durante 1, 2 o más años. Resultados: Al terminar el tratamiento combinado de la radioterapia y el nimotuzumab existió respuesta en 89,9 % de los pacientes. La mediana del tiempo de supervivencia global fue de 18,8 meses y las tasas de supervivencia de la serie fueron de 76,4; 45,4; 38,9; 32,8 y 31,5 % a uno, dos, tres, cuatro, cinco y más años, respectivamente, estabilizada a partir de este tiempo hasta diez años y más. Tres pacientes en recaída fueron reirradiados. Conclusiones: La combinación de radioterapia y nimotuzumab fue bien tolerada y es una opción de tratamiento en tumores del tallo cerebral en niños y adolescentes.

ABSTRACT Objective: The present study investigated the anti-inflammatory effect of the probiotic Lacticaseibacillus rhamnosus (Lr) on lung inflammation induced by Lipopolysaccharide (LPS) of Escherichia coli in C57BL/6 mice. Methods: C57BL/6 mice were divided into four groups: control, LPS, Lr (1 day) + LPS, and Lr (14 days) + LPS. Total and differential cells from Bronchoalveolar Lavage Fluid (BALF) were counted in a Neubauer 40X chamber, and pro-and anti-inflammatory cytokines (IL-1β, IL-6, CXCL-1, TNF-α, TGF-β, and IL-10) were measured by ELISA assay. The analysis of whole leukocytes in blood was performed using the automated system Sysmex 800i. Morphometry of pulmonary tissue evaluated alveolar hemorrhage, alveolar collapse, and inflammatory cells. Pulmonary vascular permeability was assessed by Evans blue dye extravasation, and bronchoconstriction was evaluated in a tissue bath station. The transcription factor NF-kB was evaluated by ELISA, and its gene expression and TLR-2, TLR-4, MMP-9, MMP-12, and TIMP by PCR. Results: The probiotic Lr had a protective effect against the inflammatory responses induced by LPS. Lr significantly reduced pro-inflammatory cells in the airways, lung parenchyma, and blood leukocytes. Furthermore, Lr reduced the production of pro-inflammatory cytokines and chemokines in BALF and the expression of TLRs, MMPs, and NF-kB in lung tissue and maintained the expression of TIMP in treated animals promoting a protective effect on lung tissue. Conclusions: The results of the study indicate that pre-treatment with the probiotic Lr may be a promising way to mitigate lung inflammation in endotoxemia.

Resumo Objetivou-se avaliar as características microbiológicas e físico-químicas do fluido ruminal e histológicas do trato gástrico intestinal (TGI) de ovinos sob dieta de alto grão com probiótico fungos Aspergillus terreus e/ou Rhizomucor spp. Analisou-se quatro probióticos (sem inóculos, com Rhizomucor spp., com Aspergillus terreus e com mistura dos dois fungos) e dois processamentos de milho (moído/inteiro), em fatorial 4x2 em em Delineamento Inteiramente Casualizados (DIC). Borregos Santa Inês/Dorper foram alojados em oito baias com cinco borregos em cada, durante 75 dias. Coletou-se fluido ruminal para o estudo do perfil microbiológico do rúmen, da característica macroscópica, da concentração de nitrogênio amoniacal e da atividade microbiológica, além dos fragmentos do TGI para análises histológicas. Pelas análises dos fluidos, os animais apresentaram baixo índice de acidose. O odor aromático e a cor castanho-enegrecido predominaram, o que caracteriza ambiente com pH neutro. As amostras do fluido apresentaram alta atividade microbiana. O pH ruminal diferenciou-se (P<0,05) quanto ao tipo de processamento, sendo maior para milho grão moído (MGM). Não houve diferença para nenhuma das comunidades microbiológicas analisadas (P>0,05) (bactérias Lac+ e Lac-, fungos, leveduras e protozoários). Seis gêneros de fungos anaeróbicos facultativos foram identificados num total de 15 observações. O Cladosporium spp. foi o gênero mais prevalente (46,66%), seguido do Aspergillus spp. (26,66%). A largura da base das papilas ruminais apresentou interação significativa, sendo maior para MGM (P<0,05) com Rhizomucor e o controle (P<0,05). O fluido ruminal de ovinos sob dieta de alto concentrado de grão com adição dos fungos Aspergillus terreus e Rhizomucor spp. não tiveram afetadas as características microbiológicas e físico-químicas.

Abstract This study aimed to evaluate the microbiological and physicochemical characteristics of the ruminal fluid and histological characteristics of the gastrointestinal tract (GIT) of sheep on a high-grain diet containing the probiotic fungi Aspergillus terreus and Rhizomucor spp. The study included four treatment groups (without probiotic, with Rhizomucor spp., with Aspergillus terreus, and with a mixture of both fungi), and two types of corn (ground/whole), in a Completely Randomized Design (CRD) arranged in 4 x 2 factorial design. Santa Inês x Dorper lambs were housed in eight pens with five lambs each for 75 days. Rumen fluid was collected to study the rumen microbiological profile, macroscopic characteristics, ammonia nitrogen concentration, and microbiological activity. In addition, GIT samples were taken for histological analysis. Fluid analyses showed that the animals presented a low acidosis index. The samples presented a predominantly aromatic odor and blackish-brown color, indicating a neutral pH and high microbial activity. The rumen pH differed (P < 0.05) according to the level of processed corn consumed, being higher for ground grain corn (GGC). There was no difference for any of the microbiological communities analyzed (P > 0.05) (Lac+ and Lac- bacteria, fungi, yeasts, and protozoa). Six genera of facultative anaerobic fungi were identified in 15 observations. Cladosporium spp. was the most prevalent genus (46.66%), followed by Aspergillus spp. (26,66%). The width of the base of rumen papillae showed significant correlation being greater for GCG (P < 0.05) with Rhizomucor and for the control (P < 0.05). The rumen fluid of sheep on a high-grain diet with added Aspergillus terreus and Rhizomucor spp. showed no microbiological and physicochemical changes.

RESUMO Introdução: a acalasia é uma doença crônica. Por não haver tratamento curativo, os pacientes diagnosticados dispõem de técnicas farmacológicas e/ou cirúrgicas, visando minimizar o quadro. A POEM surge como um novo tipo de tratamento paliativo promissor com boas taxas de melhora dos sintomas. Objetivo: avaliar o perfil das POEM realizadas no Hospital das Clínicas da Universidade Federal de Pernambuco (HC - UFPE) e correlacioná-lo com o cenário mundial. Métodos: a coleta de dados foi realizada retrospectivamente no período de setembro de 2017 a outubro de 2019 com todos os pacientes submetidos a POEM no HC - UFPE. Variáveis sociodemográficas, clínicas e hospitalares foram avaliadas antes e três meses após o procedimento. Resultados: total de 27 pacientes (52,41 ± 19,24 anos) que realizaram o procedimento, 66,7% com etiologia idiopática e 33,3% com etiologia secundária à doença de Chagas. 48% tinham sido submetidos a procedimentos prévios, dos quais sete usaram algum tipo de medicamento para controle dos sintomas, dois foram submetidos à dilatação endoscópica pneumática e quatro à cardiomiotomia a Heller com fundoplicatura parcial. 62,5% dos pacientes avaliados tinham acalasia tipo ii antes do procedimento. Sete (25,9%) apresentaram eventos adversos: quatro sangramentos, dois pneumoperitônio e um ambas as complicações, todos foram tratados de forma conservadora. O escore de Eckardt reduziu de 8,37 ± 1,45 para 0,85 ± 1,06 (valor de p<0,001). Conclusão: melhora clínica e o perfil dos pacientes acompanhou a tendência mundial, destaque para a etiologia secundária à doença de Chagas, endêmica no Brasil. O refluxo gastroesofágico continua sendo o principal sintoma pós-operatório.

ABSTRACT Introduction: achalasia is a chronic disease. Since there is no curative treatment, diagnosed patients have pharmacological and/or surgical techniques available, aimed at minimizing the condition. POEM appears as a promising new type of palliative treatment with good rates of symptom improvement. Objective: evaluate the profile of POEM at the Clinical Hospital of the Federal University of Pernambuco (HC - UFPE) and correlate it with the world scenario. Methods: data collection was performed retrospectively from September 2017 to October 2019 with all patients undergoing POEM at the HC - UFPE. Sociodemographic, clinical, and hospital variables were evaluated before and three months after the procedure. Results: of 27 patients (52.41 ± 19.24 years old) who underwent the procedure, 66.7% had idiopathic etiology and 33.3% had etiology secondary to Chagas disease. 48% patients underwent previous procedures, of which seven used some type of medication for symptom control, two underwent pneumatic endoscopic dilation, and four underwent Heller cardiomyotomy with partial fundoplication. 62.5% of the evaluated patients had type II achalasia before the procedure. Seven (25.9%) patients presented the following adverse events: four presented bleeding, two pneumoperitoneum, and one both complications, all being treated conservatively. The Eckardt score reduced from 8.37 ± 1.45 to 0.85 ± 1.06 (p-value <0.001). Conclusion: clinical improvement of symptoms and the patient profile followed the worldwide trend, with emphasis on the etiology secondary to Chagas disease, endemic in Brazil. Gastroesophageal reflux remains the main post-operative symptom.

Resumo Fundamento A baixa escolaridade tem sido considerada um fator de risco modificável significativo para o desenvolvimento de doenças cardiovasculares há bastante tempo. Apesar disso, ainda não se sabe muito sobre esse fator impactar ou não os desfechos após infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Objetivo Investigar se a escolaridade é um fator de risco independente para mortalidade em pacientes com IAMCSST. Métodos Os pacientes com diagnóstico de IAMCSST foram consecutivamente incluídos em uma coorte prospectiva (Brasília Heart Study) e categorizados de acordo com os anos dos quartis de estudo (0-3, 4-5, 6-10 e >10 anos). Os grupos foram comparados pelo teste t de Student para variáveis contínuas e qui-quadrado para categóricas. A incidência de mortalidade por todas as causas foi comparada com Kaplan-Meyer com regressão de Cox ajustada por idade, sexo e escore GRACE. Valores de p < 0,05 foram considerados significativos. SPSS21.0 foi utilizado para todas as análises. Resultados A média de escolaridade foi de 6,63±4,94 anos. Durante o período de acompanhamento (média: 21 meses; até 6,8 anos), 83 pacientes vieram à óbito (mortalidade cumulativa de 15%). A taxa de mortalidade foi maior entre o quartil inferior em comparação com aqueles do quartil superior [18,5 vs. 6,8%; RR 2,725 (IC 95%: 1,27-5,83; p=0,01)]. Na análise multivariada, a baixa escolaridade perdeu significância estatística para mortalidade por todas as causas após ajuste para idade e sexo, com RR 1,305 (IC 95%: 0,538-3,16; p=0,556), e após ajuste pelo escore GRACE com RR 1,767 (IC 95%: 0,797-3,91; p=0,161). Conclusão Investigar se a escolaridade é um fator de risco independente para mortalidade em pacientes com IAMCSST.

Abstract Background Low schooling has been considered an important modifiable risk factor for the development of cardiovascular disease for a long time. Despite that, whether this factor impacts the outcomes following ST-segment elevation myocardial infarction (STEMI) is poorly understood. Objective To investigate whether schooling stands as an independent risk factor for mortality in STEMI patients. Methods STEMI-diagnosed patients were consecutively enrolled from a prospective cohort (Brasilia Heart Study) and categorized according to years of study quartiles (0-3, 4-5, 6-10 and >10 years). Groups were compared by student’s t test for continuous variables and qui-square for categorical. Incidence of all-cause mortality was compared with Kaplan-Meyer with Cox regression adjusted by age, gender, and GRACE score. Values of p < 0.05 were considered significant. SPSS21.0 was used for all analysis. Results The mean schooling duration was 6.63±4.94 years. During the follow-up period (mean: 21 months; up to 6.8 years), 83 patients died (cumulative mortality of 15%). Mortality rate was higher among the lowest quartile compared to those in the highest quartile [18.5 vs 6.8%; HR 2.725 (95% CI: 1.27-5.83; p=0.01)]. In multivariate analysis, low schooling has lost statistical significance for all-cause mortality after adjustment for age and gender, with HR of 1.305 (95% CI: 0.538-3.16; p=0.556), and after adjustment by GRACE score with an HR of 1.767 (95% CI: .797-3.91; p=0.161). Conclusion Low schooling was not an independent risk factor for mortality in STEMI patients.

Abstract The extraction, and stability of polyphenols from the grape residue were studied. The extractions were performed following the Box-Behnken design, and the surface response methodology was used to model the extraction of total anthocyanins (TA), flavonols (TF), and phenolics (TP). The extraction was optimized simultaneously by the desirability function. The degradation kinetics of monomeric anthocyanins, and the increase in polymeric color were modeled under refrigeration conditions. The extraction with a temperature of 60 °C, solid:liquid ratio of 1/25 g/mL, and time of 80 min, maximized the recovery of TA (30.96 mg/100 g), TF (73.34 mg/100 g), and TP (856.78 mg EAG/100 g). The degradation of monomeric anthocyanins, and the increase in polymeric color followed a kinetic first-order reaction, with reaction rates (k) of 4.10 x 10-3 days-1, and 3.46 x 10-3 days-1, respectively. The half-life (t1/2) of anthocyanins was 169 days. The ethanol-citric acid solution allowed polyphenols to be efficiently extracted from the grape residue, and had a positive effect on the stability of anthocyanins.

Abstract The photocatalytic activity and stability of TiO2 thin films deposited by reactive sputtering were evaluated through many cycles of aqueous methylene blue solutions photodegradation. Tests were performed in TiO2 films deposited onto silica, silicon, and lanthanum aluminate substrates under UV light irradiation. The dye degradation was determined using the optical absorbance spectra at pre-established exposure times. After 16 cycles of reaction, 180 minutes each, no systematic losses in the photocatalytic activity were observed in the samples. The best activity was observed on films deposited onto silica glass. The results indicate that the TiO2 samples deposited by the sputtering technique are stable concerning the UV degradation of methylene blue.

Resumo: Introdução: Compreendendo a abordagem holística de saúde e considerando as desigualdades brasileiras, infere-se a discrepância dos estados de saúde entre grupos sociais, sobretudo no que concerne à população em situação de rua (PSR). Essas pessoas lidam com o desamparo institucionalizado, e a pandemia da Covid-19 expôs ainda mais essa situação. Quanto à formação dos profissionais de saúde, torna-se fundamental a abordagem do tema. Relato de Experiência: Com base na inclusão de experiências de docentes que articulavam ações de integração ensino-serviço com a equipe do Consultório na Rua de Mossoró, bem como a abordagem de temas relacionados às populações mais vulneráveis em eixo longitudinal ao curso, despertou-se o interesse dos discentes do curso de Medicina da Ufersa para ações direcionadas à PSR. Destarte, surge, em 2019, a ação “Saúde nas Ruas”, em parceria com o Consultório na Rua, que fornece suporte à PSR em diversos aspectos, com a participação dos alunos do curso de Medicina. A ação, proposta a partir de iniciativa dos próprios alunos, marcou o início do planejamento da inclusão do atendimento a essa população no programa do internato do curso, bem como a criação de um projeto de extensão longitudinal para ações voltadas à PSR. Nesse processo, os discentes puderam imergir na realidade dessa população, e os usuários tiveram autonomia para compartilhar suas experiências e dores. Discussão: Mediante uma formação acadêmica que visa romper com o modelo tecnicista, os estudantes possibilitaram voz à PSR e, compreendendo essas pessoas como sujeitos do processo, refletiram sobre o agir médico na transformação da realidade em que se inserem. Conclusão: O corpo acadêmico participante potencializou em si a empatia e o desejo por uma saúde pública democrática e acessível. Ficou evidente ainda a imprescindibilidade de trabalhar temas específicos sobre populações vulneráveis, com o objetivo de fortalecer a atuação médica como forma de garantir o direito à saúde.

Abstract: Introduction: A clear discrepancy in the health status between social groups in Brazil, particularly the homeless population (HP), can be inferred from the apparent inequalities when considering health from a holistic perspective. The homeless have to deal with institutionalized abandonment, and the COVID-19 pandemic has accentuated this issue. Addressing this theme has become an essential element of the training of health professionals. Experience Report: The interest of medicine students at UFERSA in actions directed at the HP was triggered by teachers’ experiences of coordinating service-learning integration actions with the street health care unit in Mossoró, and tackling issues related to the most vulnerable groups throughout the course. In 2019 the “Health on the Streets” action is therefore launched in partnership with the street health care unit, providing support to the HP in several aspects, and involving the participation of the medicine students. The action, proposed based on the students’ own initiative, marked the start of the planning for including care for this group in the internship program of the course, as well as the creation of a longitudinal community outreach project for actions with the HP. The students had the opportunity to immerse themselves in the reality of this population, while the users had the autonomy to share their experiences and sufferings. Discussion: Following an academic method that aims to break away from the technicist model, the students gave voice to the HP and, understanding these people as subjects of the process, reflected on the role of medicine in transforming their reality. Conclusion: The academics who participated in this project enhanced their empathy and desire for democratic and accessible public health. It also became evident that tackling specific issues regarding vulnerable groups is indispensable, with a view to strengthening the role of the physician in guaranteeing the right to health.

Introduction: Chronic suppurative otitis media (CSOM) is a persistent inflammation of the middle ear, with cholesteatoma as one of its many complications. Cholesteatoma is a progressive, non-neoplastic formation of keratinized squamous epithelium that causes bone destruction in the middle ear. There are multiple theories that may explain its physiopathogenesis; however, none of them have been proved yet. Inflammatory mediators, such as interleukins (ILs), have a role in the genesis of the cholesteatoma and it is necessary to study their role in detail. Objective: The objective of this study was to compare the IL (IL-2 and IL-9) expression in patients with CSOM with and without cholesteatoma. Methodology: A cross-sectional study, comparing two groups of patients with CSOM, five of them without cholesteatoma and eleven with cholesteatoma. Samples of problem tissue (inflammatory tissue and cholesteatoma) and control tissue (retroauricular tissue for both groups) were studied. Histopathological and immunohistochemistry analyses were conducted, in addition to imaging and morphometric analysis was performed. The statistical comparison was performed by t-test for independent groups. Conclusions: There are statistical differences on the IL-2 and IL-9 expression in the cholesteatoma tissue compared with the inflammatory tissue.