ABSTRACT Ulcerative colitis is a chronic recidivist disease of the gastrointestinal tract, evolving by relapses and is one of the intestinal inflammatory diseases. It affects the colon mucosa and sub-mucosa, characterized for an ulcerative process and mucosa exudation. Chronic diarrhea with blood is the most important symptom. Periods of crisis and remission alternated in its course; there is not a pathognomonic criteria for its definition and its diagnosis is based in a series of clinical, endoscopic and histological criteria. This entity, infrequent in extensive severe form, appears in a patient arriving to the hospital referring having intermittent diarrheas with blood for two years, treated in the health area. He undergone a radiography and colonoscopy, showing the presence of an erythema, mucosa granularity, friability, lost of submucosa vascularization, deep extensive erosions and ulcerations, edema signs, pseudo polyps, haustras lost, stiffness, bleeding, fibrous tracts and presence of luminal exudates. Severe ulcerative extensive colitis was diagnosed and was prescribed an endovenous medical treatment, continued orally, achieving the disease remission from the clinical and endoscopic point of view.

RESUMEN La colitis ulcerativa es una enfermedad crónica recidivante del tracto gastrointestinal, que evoluciona por recaídas formando parte de las enfermedades inflamatorias intestinales (EII). Afecta la mucosa y submucosa del colon, caracterizada por un proceso ulcerativo y supurado de la mucosa. La diarrea crónica con sangre es el síntoma más importante. En su curso alternan periodos de remisión y de crisis. No existe un criterio patognomónico para su definición, su diagnóstico se basa en una serie de criterios clínicos, endoscópicos e histológicos. Esta entidad infrecuente en su forma extensa severa. Aparece en un paciente, que llega a la institución de salud refiriendo que hace aproximadamente dos años, presenta cuadros de diarreas intermitentes con sangre, tratadas en el área de salud. Se le realizó Rx y colonoscopia constatando presencia de eritema, granularidad mucosa, friabilidad, pérdida de la vascularización submucosa, erosiones y ulceraciones extensas, profundas, signos de edema, pseudopólipos, pérdida de haustras, rigidez, sangrado, tractos fibrosos y presencia de exudado luminal. Se diagnosticó colitis extensa ulcerativa severa y se orientó tratamiento médico endovenoso y se continuó por via oral, obteniendo la remisión del cuadro clínico desde el punto de vista clínico y endoscópico.

OBJECTIVE: To establish a resistance (R) surveillance program monitoring antimicrobial susceptibility patterns in Latin America (LATAM; Argentina [ARG], Brazil [BRA], Chile, Colombia [CBA], Costa Rica, Ecuador [ECU], Guatemala [GUA], Mexico [MEX], Panama [PAN], Peru, and Venezuela [VEN]). METHODS: In 2011, 4979 organisms were collected from 11 nations (20 laboratories) for susceptibility testing in a central laboratory design. Antimicrobials were tested by CLSI methods and results interpreted by CLSI and EUCAST breakpoints. Most common Gram-positive (Staphylococcus aureus [SA, 921], other staphylococci [CoNS; 299], enterococci [218], Streptococcus pneumoniae [SPN; 182], β-haemolytic streptococci [115]) and Gram-negative (E. coli [EC; 644], Klebsiella spp. [KSP; 517], Enterobacters [272], Pseudomonas aeruginosa [PSA; 586], Acinetobacters [ACB; 494]) pathogens were analyzed against linezolid (LZD), vancomycin (VAN), tigecycline (TIG), colistin (COL), cefoperazone/sulbactam (C/S), and amikacin (AMK). RESULTS: MRSA rates varied from 29% (CBA, BRA) to 79% (Peru); but LZD (MIC90, 2 mg/L), TIG (MIC90, 0.12mg/L) and VAN (MIC90, 1mg/L) covered all strains. Enterococci showed a 14% VRE rate, highest in BRA and MEX; all inhibited by TIG and daptomycin, but not LZD (three non-susceptible with G2576T mutations or cfr). Penicillin-R among SPN and viridans streptococci was 51.6 and 41.1%, respectively. LZD overall R against Gram-positives was 0.3%. High ESBL rates were observed in EC (54-71%) and KSP (>50%) from GUA, MEX and Peru, and six nations, respectively. Carbapenem-R in KSP was 9%, highest rates associated with KPC in BRA, CBA, ECU, PAN and VEN; also a NDM-1 in KSP from CBA. AMK, TIG, C/S and carbapenems were the broadest-spectrum agents tested against Enterobacteriaceae. Only COL inhibited >90% of PSA; COL and TIG (<2 mg/L) covered >85% of ACB. CONCLUSIONS: LATAM nations demonstrated variable levels of antimicrobial R especially among Enterobacteriaceae (β-lactamase-mediated), PSA and ACB. MRSA (48%), VRE (14%) and multidrug-R SPN were also regional therapeutic challenges.

Introduction. Submersion injury is associated with high morbidity and mortality, being the third leading cause of accidental death among children. Objectives. To analyze and describe risk factors, prognosis, and survival of victims, admitted to a third level Community Teaching Hospital. Population, material and methods. A retrospective, observational, analytical study. We studied patients admitted to the pediatric critical care unit, between 06/2000 and 01/2008. The following variables were analyzed: age, sex, length of stay, days of mechanical ventilation, Glasgow Coma Scale (GCS) score, apnea, bradycardia; baseline, 24 and 48 h lactacidemia, submersion time, swimming pool watchers of the victims. Stata 8.0 software was used; continuous variables were analyzed using Wilcoxon test; for categorical variables Z test and Chi square test were used, and a logistic regression analysis was performed. Results. 30 near-drowning victims were admitted, median age was 25 months (R = 11-144 months). 41.3% occurred during summer, 60% were under parental supervision. Sibling supervision was associated with an increased risk of neardrowning (RR: 2.1; 95% CI 1.1-3.2). Immersion time was > 10 minutes in 3.4%; 26% had apnea, and the GCS score was < 5 in 19.99%. Lactic acid at admission was > 3 mmol/l in 10 patients. Risk factors like glucose level ≥ 300 mg% (OR: 3.325), apnea (OR: 2.752), bradycardia (OR: 4.74), GCS <5 (OR: 3.550) and inmersion time > 10 minutes (OR: 5.12), were associated with poor prognosis. Mortality was 2/30 patients. Conclusion. In our population, the presence of apnea, bradycardia, GCS <5, glucose level ≥ 300 mg%, submersion time > 10 minutes, and lactic acid > 6 mmol/l at admission and the first 24 h, were associated with a poor prognosis and serious injury.

Introducción. El ahogamiento por sumersión es un cuadro con alta morbimortalidad; es la tercera causa accidental de muerte en la población infantil. El objetivo fue analizar y describir factores de riesgo, pronóstico y supervivencia de las víctimas por casi ahogamiento, admitidas en un hospital universitario de alta complejidad. Población, material y métodos. Estudio retrospectivo, observacional, analítico. Se estudiaron los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátricos, entre junio del año 2000 y enero de 2008. Se analizaron múltiples variables. Resultados. Ingresaron 30 pacientes, cuya mediana de edad fue 25 meses (intervalo: 11-144 meses), predominio masculino. El 41,3% de los episodios ocurrieron en verano, 60% de los niños estaba bajo supervisión de los padres. El tiempo medio de sumersión fue > 10 minutos en el 3,4 %, tuvieron apnea al ingreso 26% y el Puntaje de Glasgow fue < 5 en 19,99%. El ácido láctico fue mayor a 3 mmol/l en 10 pacientes. Se asociaron con mal pronóstico, quienes al ingreso tuvieron glucemia ≥ 300 mg% (OR: 3,325), apnea (OR: 2,752), bradicardia (OR: 4,74), Glasgow < 5 (OR: 3,550) y tiempo de sumersión > a 10 minutos (OR: 5,12). Murieron 2/30 pacientes. Conclusión. En nuestra población, la presencia de apneas, bradicardia, glucemia ≥ 300 mg%, Puntaje de Glasgow < 5 y sumersión mayor a 10 minutos, se asociaron a mal pronóstico. La elevación de ácido láctico > 6 mmol/l al ingreso y a las 24 h fue marcador de lesión grave.

Em relação aos fundos de pensão, existem poucos estudos relativos à estratégia. Este trabalho contribui para a construção da estratégia nos fundos de pensão no Brasil. Utilizando uma pesquisa exploratória baseada em estudo de caso múltiplo, o objetivo do artigo é propor um modelo orientador para a análise das estratégias dos fundos. Com base em conceitos de competitividade, concorrência e vantagem competitiva, desenvolveu-se um modelo teórico. Em virtude das características específicas desse setor, foram adicionados os conceitos de governança e responsabilidade social. Com base no modelo proposto, elencaram-se os fatores relevantes à formulação de estratégias e as vantagens competitivas para cada um dos casos estudados, tendo sido sugerido um padrão de concorrência de caráter dinâmico para o setor. Propôs-se também uma classificação dos fundos estudados, de acordo com o padrão concebido, e foi possível verificar que os fundos de pensão possuem diferentes percepções sobre o tema concorrência, conforme distintas orientações estratégicas gerais.

As for Pension Funds, there is a limited amount of studies related to the strategy theme. This work contributes to the construction of the Brazilian Pension Fund's strategy. Using an exploratory research based in a Multiple Case Study, this article aims to propose a model capable of guiding the Funds strategies' analysis. Based in concepts such as competitiveness, competition and competitive advantage, a theoretical model was built. Because of the specific characteristics of that industry, Governance and Social Responsibility concepts were added. Based in this proposed model, relevant factors to the strategies' formulation and competitive advantages to each one of the studied cases were established, enabling the authors to suggest a dynamic competition' behavior pattern for that industry. According to the conceived pattern, a classification of the studied Funds was also proposed, allowing one to verify that Pension Funds present different perceptions about competition, following different general strategic orientations.

Vivemos em uma época marcada pela hegemonia da ciência e da tecnologia, carregada de questões à espera de respostas, para que o futuro da humanidade seja alcançado de forma segura e sustentável. O desenvolvimento de processos agroindustriais - especificamente, a produção de alimentos - com tecnologia de DNA recombinante tem trazido perspectivas de bons lucros apenas para os grandes conglomerados da biotecnologia e para produtores rurais com alto grau de desenvolvimento tecnológico. Discordamos de uma moratória para a tecnologia do DNA recombinante. Além disso, afirmações de ausência de risco podem levar a conclusões precipitadas, pois pouquíssimos testes foram realizados até hoje. É premente que se estabeleça uma política nacional de biossegurança, que envolva a sociedade civil organizada e todos os órgãos de governo (federal e estaduais) responsáveis pela fiscalização, e que se implantem um programa de biovigilância e um código de ética de manipulações genéticas.

We live in an era characterized by the hegemony of science and technology, an era fraught with questions awaiting answers which would enable a safe and sustainable future for humankind. The development of agro-industrial processes - food products in particular - through recombinant DNA technology has enhanced the profit prospects of the few big biotechnology companies and of large-scale farmers who have access to the latest technological developments. We thus oppose a moratorium on recombinant DNA technology. Moreover, hasty statements about risk-free transgenics may be misleading in the absence of extensive safety tests. There is a pressing need for the establishment of a biosafety policy in this country involving the organized civil society and every government agency responsible for monitoring such matters. There is also the need to put in place a bio-surveillance and a code of ethics regarding genetic manipulation.