Resumo: na presente investigação propõe-se estabelecer o alcance da proteção legal e constitucional dos rios como novos sujeitos de direito, com base na regulamentação nacional e no direito comparado. Para tanto, são revisadas diversas fontes jurídicas, jurisprudenciais e doutrinárias nas quais se enquadra a nova figura jurídica dos “rios como sujeitos de direitos” e se estabelecem os efeitos que isso gerou no quadro jurídico-social. Por isso, a discussão será percorrida a partir de três pontos fundamentais: o primeiro define o que se entende por sujeito de direito e por que os rios se enquadram em tal classificação; a seguir, são identificadas as garantias oferecidas pelo ordenamento jurídico colombiano a esses sujeitos e, por fim, a manifestação dessa novidade jurídica e sua aplicabilidade no contexto nacional serão analisadas a partir do direito comparado.

Abstract: the present investigation proposes the establishment of the scope of the legal and constitutional protection of rivers as new subjects of law, based on national regulations and comparative law. For this purpose, various legal, jurisprudential and doctrinal sources are reviewed in which the new legal figure of "rivers as subjects of rights" is framed, and the effects that this has generated in the legal-social framework are established. Hence, the discussion will include three fundamental points: the first defines what is meant by a subject of law and why rivers fit into such a classification; following this, the guarantees offered by the Colombian legal system to these subjects are identified, and finally, the manifestation of this legal novelty and its applicability in the national context will be analyzed from the point of view of comparative law.

Resumen: en la presente investigación se propone establecer el alcance de la protección jurídica y constitucional de los ríos como nuevos sujetos de derecho, a partir de la normativa nacional y el derecho comparado. Para tal efecto, se revisan diversas fuentes legales, jurisprudenciales y doctrinales en las que se enmarque la nueva figura jurídica de los “ríos como sujetos de derechos’’, y se establezcan los efectos que ello ha generado en el marco jurídico-social. Por tal razón, se abarcará la discusión desde tres puntos fundamentales: en el primero de ellos se define qué se entiende por sujeto de derecho y por qué los ríos encuadran en tal clasificación; seguido a esto, se entran a identificar las garantías que ofrece el sistema jurídico colombiano a estos sujetos, y por último, se analizará desde el derecho comparado la manifestación de esta novedad jurídica y su aplicabilidad en el contexto nacional.

Abstract Adding a biological apatite layer to the implant surface enhances bone healing around the implant. Objective This study aimed to characterize the mechanical properties and test human gingival fibroblasts behavior in contact with Zirconia and Titanium bioactive-modified implant materials. Methodology 6 groups were considered: Titanium (Ti6Al4V), Ti6Al4V with 5% HA and 5% ßTCP, Zirconia (YTZP), YTZP with 5% HA and 5% ßTCP. For each group, we produced discs using a novel fabrication method for functionally graded materials, under adequate conditions for etching and grit-blasting to achieve equivalent surface microroughness among the samples. Surface roughness (Ra, Rz), water contact angle, shear bond strength, and Vickers hardness were performed. Human gingival fibroblasts immortalized by hTERT gene from the fourth passage, were seeded on discs for 14 days. Cell viability and proliferation were assessed using a resazurin-based method, and cellular adhesion and morphology using field emission gun scanning electron microscopy (FEG-SEM). After 3 days of culture, images of fluorescent nucleic acid stain were collected by confocal laser scanning microscopy (CLSM). Results Results were presented as mean ± standard deviation (SD). We compared groups using one-way ANOVA with Tukey’s post-hoc test, and significance level was set at p<0.05. After 14 days of culture, cell viability and proliferation were significantly higher in YTZP group than in other groups (p<0.05). Samples of YTZP-ßTCP presented significantly higher wettability (p<0.05); yet, we observed no improvement in cell behavior on this group. Fibroblast spreading and surface density were more evident on YTZP specimens. Adding calcium-phosphate bioactive did not alter the tested mechanical properties; however, Ti6Al4V material shear bond strength was statistically higher than other groups (p<0.05). Conclusion Adding bioactive materials did not improve soft-tissue cell behavior. When compared to other zirconia and titanium groups, pure zirconia surface improved adhesion, viability and proliferation of fibroblasts. Cell behavior seems to depend on surface chemical composition rather than on surface roughness.

RESUMO Objetivo: Avaliar a eficácia de um novo marcador cirúrgico para ajudar na confecção da capsulorrexe anterior analisando o seu dimensionamento e formato, comparando com a capsulorrexe confeccionada manualmente de maneira livre. Métodos: Como experimento, 3 residentes (R3) de Oftalmologia do Hospital Universitário Onofre Lopes (HUOL) e 1 oftalmologista em treinamento, voluntários, realizaram (cada um) 10 capsulorrexes em olhos de porco enucleados. Em 5 olhos foi utilizado o marcador e em outros 5, não. Todos os olhos foram fotografados tendo ao lado uma régua para orientar e calibrar um aplicativo para a avaliação morfométrica do procedimento. O diâmetro alvo foi de 5 mm, cujo perímetro correspondente é 15,7 mm e a área 19,652 mm2. Foram avaliados em cada procedimento: os diâmetros máximo, mínimo e médio, o perímetro, a área e o desvio em relação ao diâmetro e quanto ao aspecto ideal. Resultados: No grupo utilizando o marcador o diâmetro médio foi 5,44mm (±0,89) contra 6,37mm (±0,67) (p=0,001), no grupo no qual não se utilizou o marcador; quanto ao perímetro, 17,52mm (±1,92) no grupo utilizando o marcador contra 20,14mm (±2,09) (p<0,001) sem o marcador e quanto a área, 24,73mm2 (±1,92) com o marcador, contra 32,62mm2 (±6,32) (p<0,001), sem o marcador. Em relação ao aspecto da capsulorrexe 1,26mm (±0,12), contra 1,21mm (±0,7) (p=0,09) e em relação ao desvio de curvatura: 0,87 (±0,05), contra 0,9 (±0,04), (p=0,06) respectivamente. Conclusão: O trabalho mostrou que o marcador avaliado é eficaz para auxiliar a confecção da capsulorrexe conduzindo a resultados melhores que o método a mão livre.

ABSTRACT Purpose: To evaluate the effectiveness of a surgical device that intented to help in the preparation of the anterior capsulorhexis analyzing the design and shape, comparing with capsulorhexis made by free hand. Methods: Three ophthalmology residents(R3) at the HUOL and one surgeon in training, participate in this research as volunteers. Each surgeon perform 5 capsulorhexis in porcine eyes using the device, and five others by free hand as a control. All capsulorhexis were photographed having a ruler as reference to guide and calibrate a computer application for morphometric evaluation (Cambuí Labs, Natal, Brazil). All surgeons aimed to produce a circular continuous capsulorhexis of 5 mm diameter that represents 15,7mm in perimeter and 19,652mm2 in area. Each wet-lab capsulorhexis was evaluated in regard to these criteria: diameter (mean, maximum and minimum), perimeter, area, deviation from the ideal diameter and ideal shape. Results: Compare to control groups, capsulorhexis with the aid of the surgical device showed: 5,44mm ±0,89 vs 6,37mm ±0,67, for capsulorhexis diameter (p=0,001); 17,52mm ±1,92 vs 20,14mm ±2,09 for capsulorhexis perimeter (<0.001); 24,73mm2 ±1,92 vs 32,62mm2 ±6,36 for capsulorhexis area (p<0,001). A tendency for better result with the aid of the surgical device was observed for deviation of an ideal diameter or ideal aspect were appreciated: 0,87mm ±0,05 vs 0,9 ±0,04 for deviation of a curve (p=0,06); 1,26mm ±0,12 vs 1,21mm ±0,7 for the capsulorhexis aspect (p=0,09). Conclusion: Capsulorhexis produced with the aid of the surgical device, significantly improved wet-lab capsulorhexis performance.

Introduction: obesity in children is a challenge for public health. Therefore, we conducted a comparative study of the results obtained in the present moment in our health area, to assess the nutritional status of children 2-15 years old who presented in different primary care centers, studying the prevalence of overweight, obesity and morbid obesity in our region and comparing them with previous studies nationwide. Subjects and method: the study population is composed of a representative sample of 15 142 children, aged 2 to 15 years old. The medical records were reviewed and anthropometric data (weight, height and BMI) were collected from the visits of the Well Child Program (Program do Neno San) to obtain a final sample of 12 643 individuals [6433 boys (50.9%) and 6210 girls (49.1%)]. The prevalence of overweight and obesity was analyzed according to age and sex variables, establishing a cutoff corresponding to the p85 percentile (overweight) and p95 (obesity). To categorize the BMI, charts for age and sex of the longitudinal growth study Orbegozo Foundation, contained in the SERGAS medical record (Galician Health), were used. Prevalence estimates were accompanied by the respective 95% confidence intervals (CI). Chi square test was used to compare qualitative variables. The data were analyzed using the statistical package SPSS for Windows, version 12.0. We compared our results with those of previous studies: the enKid study (1988-2000), and Aladino study (2010-2011). Results: the prevalence of overweight (9.3%) and obesity (9.7%) in our study is lower, overall, than that obtained in other studies of national reference: enKid (12.4 / 13.9%), Aladino (26.2 / 18.3%), etc., although it is difficult to make comparisons because the criteria used to define overweight andobesity are not the same, we do not use the same charts as a reference or the same cutoff. Conclusions: the prevalence of overweight and obesity varies depending on the baseline study used, being in our case far from the "official" expected figure. It requires consensus and unified criteria (WHO, IOTF, Orbegozo, etc.) to establish the diagnosis of overweight or obesity using the BMI.

Introducción: la obesidad, en la edad pediátrica, constituye un desafío de salud pública. Por este motivo, llevamos a cabo un estudio comparativo de los resultados obtenidos en el momento actual en nuestra área sanitaria, para valorar el estado de nutrición de la población infantil de 2 a 15 años, atendidos en distintos centros de Atención Primaria, estudiando la prevalencia de sobrepeso, obesidad y obesidad mórbida en nuestra comunidad autónoma y confrontarlos con estudios previos a nivel nacional. Material y métodos: la población del estudio está compuesta de una muestra representativa de 15 142 niños, de edades comprendidas entre 2 y 15 años. Se revisaron las historias clínicas y se recogieron los datos antropométricos (peso, talla e índice de masa corporal [IMC]) procedentes de los controles establecidos en el Programa de Salud Infantil (Programa do Neno San), obteniendo una muestra final de 12 643 individuos (6433 [50,9%] niños y 6210 niñas [49,1%]). La prevalencia de sobrepeso y obesidad se analizó en función de las variables edad y sexo, estableciéndose como puntos de corte los correspondientes a los percentiles p85 (sobrepeso) y p95 (obesidad). Para categorizar el IMC se utilizaron las gráficas para edad y sexo del estudio longitudinal de crecimiento de la Fundación Orbegozo que figuran en la historia clínica del SERGAS (Servizo Galego de Saúde). Las estimaciones de prevalencia se acompañaron de los respectivos intervalos de confianza del 95% (IC 95). Para la comparación de variables cualitativas se utilizó la prueba Χ². Los datos se analizaron con el paquete estadístico SPSS® para Windows®, versión 12.0. Comparamos nuestros resultados con los de estudios previos: el estudio enKid (1988-2000), y el estudio Aladino (2010-2011). Resultados: la prevalencia de sobrepeso (9,3%) y obesidad (9,7%) en nuestro estudio es inferior, globalmente, a la obtenida en otros estudios de referencia nacionales: enKid (12,4/13,9%), Aladino (26,2/18,3%), etc., aunque no es fácil establecer comparaciones puesto que los criterios empleadospara definir sobrepeso y obesidad no son los mismos, no usan las mismas tablas como referencia ni el mismo punto de corte. Conclusiones: la prevalencia de sobrepeso y obesidad varía según sea el estudio de referencia utilizado alejándose, en nuestro caso, de la cifra "oficial" esperada. Es necesario consensuar y unificar criterios (Organización Mundial de la Salud [OMS], International Obesity TaskForce [IOTF], Orbegozo, etc.)para establecer el diagnóstico de sobrepeso u obesidad a partir del IMC.

OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

OBJETIVO: Detectar a frequência e os subtipos do HPV na cérvice uterina de mulheres infectadas pelo HIV. MÉTODOS: A amostra era composta por 288 mulheres infectadas pelo HIV, recrutadas do sistema público de saúde de cinco cidades de Minas Gerais, Brasil. As mulheres foram avaliadas de agosto de 2003 a agosto de 2008. Amostras cervicais foram coletadas para análise citológica e para detecção do HPV DNA, usando a reação em cadeia de polimerase (PCR). O HPV DNA foi classificado de acordo com seu potencial oncogênico em baixo risco (tipos 6,11) e alto risco (tipos 16, 18, 31, 33, 35). Foi realizada colposcopia, seguida de biópsia cervical, quando indicada. Variáveis categóricas foram comparadas usando o teste do quiquadrado, com nível de significância estabelecido de 5%. RESULTADOS: A prevalência do HPV foi 78,8%. Os genótipos mais frequentes foram HPV-6 (63,9%) e HPV-16 (48,5%). Genótipos de HPV de alto risco foram observados em 70,5% das mulheres; de baixo risco em 71,4%; HPV de alto e baixo risco foram detectados em 55,1% das pacientes. Múltiplos genótipos de HPV foram detectados em 64,8% das pacientes; dois genótipos em 23,8%, e três em 18,9%. CONCLUSÃO: A prevalência do HPV foi alta entre mulheres infectadas pelo HIV. Múltiplos genótipos de HPV foram comuns em amostras da cérvice uterina destas mulheres

OBJECTIVE: To detect the frequency and subtypes of HPV in the uterine cervix of HIV-infected women. METHODS: Sample consisted of 288 HIV-infected women, recruited from the public health system of five cities of Minas Gerais, Brazil. Women were seen from August 2003 to August 2008. Cervical samples were collected for cytological analysis and for HPV DNA detection, using polymerase chain reaction (PCR). HPV DNA was classified according to its oncogenic potential in low risk (types 6, 11) and high risk (types 16, 18, 31, 33, 35). Colposcopy was performed, followed by cervical biopsy when necessary. Categorical variables were compared using the Chi-squared test, with a significance level established at the 5% level. RESULTS: HPV prevalence was 78.8%. Most frequent genotypes were HPV-6 (63.9%) and HPV-16 (48.5%). High-risk HPV were observed in 70.5% of the women; low-risk in 71.4%; both high and low-risk HPV were detected in 55.1% of the patients. Multiple HPV genotypes were detected in 64.8% of the patients; two genotypes in 23.8%, and three in 18.9%. CONCLUSION: HPV prevalence was high among HIV-infected women. Multiple HPV genotypes were common in samples from the uterine cervix of HIV-infected women

Resumen Introducción: la desnutrición en el niño hospitalizado es un problema importante. No hay estudios nacionales sobre su prevalencia. Objetivo: conocer la prevalencia de desnutrición en niños hospitalizados y su relación con distintas variables. Material y métodos: corte transversal, con única valoración realizada a los pacientes internados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Se midió peso y longitud/talla. Se calcularon los índices peso/edad (P/E), talla/edad (T/E), peso/talla (P/T) e índice de masa corporal (P/T2). Se consideró evidencia de desnutrición a la presencia de uno o más índices antropométricos por debajo de -2 Z. Se relacionó el estado nutricional con la edad, la duración de la internación, el medio socioeconómico y la presencia de enfermedad crónica previa. Resultados: 95% de todos los niños estaba por debajo de la línea de pobreza. Presentaron evidencia de desnutrición 34 niños (25,2%). Entre los menores de 2 años, 18,2% tenían un índice P/E afectado y 21,2% tenían talla baja. Entre los mayores de 2 años, 13% tenían un índice P/E afectado, 8,7% tenían talla baja. En el grupo de desnutridos la mayoría presentaban enfermedad crónica previa y la duración de la internación fue mayor. Discusión: los niños internados en el HP-CHPR tienen altas cifras de desnutrición, corresponden a los estratos más bajos de la sociedad, los más afectados son los menores de 2 años, con enfermedad crónica previa y que requirieron internaciones más prolongadas. Se deberán diseñar estrategias para evitar la posible repercusión nutricional de la hospitalización e iniciar la recuperación de los que ya están desnutridos

Summary Introduction: malnutrition in hospitalized children is an important problem. In our country there are no studies about its prevalence. Objective. to learn the prevalence of malnutrition in the hospitalized children at the CHPR and its relation with different variables. Material and methods. a cross-sectional survey with a single assessment was carried out in all hospitalized patients. Weight and length was measured. Weight for age (W/A), height for age (H/A), weight for height (W/H) and body mass index (W/H²) were calculated. Malnutrition was considered when one or more anthropometric values were under score Z -2. The nutritional state was correlated with age, hospitalization time, socioeconomic conditions and with previous chronic disease. Results: 95 % of the children hospitalized at the CHPR are under the line of poverty. Thirty four children (25.2 %) had one or more anthropometric values below score Z -2 . Among children under 2 years of age, 18.2 % had a W/A value affected and 21.2 % presented growth retardation. In the group older than 2 years of age 13 % had an affected W/A value, 8.7 % had growth retardation and 5.8 % had an altered W/H. In the group of malnourished children the majority had chronic previous disease and the hospital stay was longer. Discussion: malnutrition incidence is high among hospitalized children at the CHPR. They usually belong to the lower socioeconomic stratus. The most affected were children under 2 years of age, with previous chronic disease and who usually required a longer hospital stay. It is necessary to design strategies to prevent the nutritional repercussion during hospitalization and begin the recovery of the already malnourished children