Abstract Biliary drainage for Perihilar Cholangiocarcinoma (PCCA) can be performed either by endoscopic retrograde cholangiopancreatography or Percutaneous Transhepatic Biliary Drainage (PTBD). To date there is no consensus about which method is preferred. Taking that into account, the aim of this study is to compare Endoscopic Biliary Drainage (EBD) versus percutaneous transhepatic biliary drainage in patients with perihilar cholangiocarcinoma through a systematic review and metanalysis. A comprehensive search of multiple electronic databases was performed. Evaluated outcomes included technical success, clinical success, post drainage complications (cholangitis, pancreatitis, bleeding, and major complications), crossover, hospital length stay, and seeding metastases. Data extracted from the studies were used to calculate Mean Differences (MD). Seventeen studies were included, with a total of 2284 patients (EBD = 1239, PTBD = 1045). Considering resectable PCCA, the PTBD group demonstrated lower rates of crossover (RD = 0.29; 95% CI 0.07–0.51; p = 0.009 I2 = 90%), post-drainage complications (RD = 0.20; 95% CI 0.06–0.33; p < 0.0001; I2 = 78%), and post-drainage pancreatitis (RD = 0.10; 95% CI 0.05–0.16; p < 0.0001; I2 = 64%). The EBD group presented reduced length of hospital stay (RD = -2.89; 95% CI -3.35 - -2,43; p < 0.00001; I2 = 42%). Considering palliative PCCA, the PTBD group demonstrated a higher clinical success (RD = -0.19; 95% CI -0.27 - -0.11; p < 0.00001; I2 = 0%) and less post-drainage cholangitis (RD = 0.08; 95% CI 0.01-0.15; p = 0.02; I2 = 48%) when compared to the EBD group. There was no statistical difference between the groups regarding: technical success, post-drainage bleeding, major post-drainage complications, and seeding metastases.

Resumo As denúncias promovidas pela abordagem decolonial a respeito de práticas coloniais que permaneceram e permanecem ativas, mesmo depois do fim oficial do colonialismo, assim como a crítica que esta abordagem faz à universalidade do pensamento, contribuem para o avanço do conhecimento. Por outro lado, existe na abordagem decolonial uma lacuna sobre quais são as possibilidades metodológicas mais coerentes a serem utilizadas em pesquisas decoloniais. Diante disso, buscamos contribuir para a ampliação do processo de escolha de abordagens metodológicas em pesquisas da área dos Estudos Organizacionais (EOR), que sejam, epistemologicamente, alinhadas à abordagem decolonial, ou seja, que respeitem a pluriversalidade de seres, saberes e territórios. Para isso, apontamos a investigação temática1 como uma possibilidade de metodologia alinhada à abordagem decolonial. Por fim, apresentamos um exemplo de planejamento metodológico para uma pesquisa na perspectiva decolonial, da área dos EOR, que utilizará como metodologia a investigação temática. Concluímos apontando que a investigação temática é uma perspectiva muito alinhada à abordagem decolonial, uma vez que respeita o ser e o território, mas não deve ser adotada sem prévia reflexão crítica, ou seja, como uma fórmula.

Abstract The denunciations promoted by the decolonial approach regarding colonial practices that remain active, even after the official end of colonialism, and the criticism that this approach makes to the universality of thought, contribute to the advance of knowledge. However, there is a gap in the decolonial approach over the most coherent methodological possibilities that can be used in decolonial research. Therefore, we seek to contribute to the expansion of choosing methodological approaches in research in the area of Organizational Studies that are epistemologically aligned with the decolonial approach; they respect the pluriversality of beings, knowledge, and territories. We point to the thematic investigation1 as a possibility of a methodology aligned with the decolonial approach. Finally, we present an example of methodological planning for research under a decolonial perspective in the area of Organizational Studies, which will use the thematic investigation as a methodology. We conclude that the thematic investigation has a perspective aligned with the decolonial approach since it respects the being and the territory, but that it should not be adopted without prior critical reflectivity, i.e., as a formula.

Resumen Las denuncias promovidas por el enfoque decolonial sobre las prácticas coloniales que se mantuvieron y se mantienen activas, incluso después del fin oficial del colonialismo, así como las críticas que este enfoque hace a la universalidad del pensamiento, contribuyen al avance del conocimiento. Por otro lado, hay un vacío en el enfoque decolonial sobre cuáles son las posibilidades metodológicas más coherentes para utilizar en la investigación decolonial. Por eso, buscamos contribuir a la expansión del proceso de elección de enfoques metodológicos en la investigación, en el área de Estudios Organizacionales, que estén epistemológicamente alineados al enfoque decolonial, es decir, que respeten la pluriversalidad de los seres, conocimientos y territorios. Apuntamos la investigación temática como una posibilidad de metodología alineada al enfoque decolonial. Finalmente, presentamos un ejemplo de planificación metodológica para una investigación bajo la perspectiva decolonial, en el área de Estudios Organizacionales, que utilizará la investigación temática como metodología. Concluimos señalando que la investigación temática tiene una perspectiva muy alineada al enfoque decolonial, ya que respeta el ser y el territorio, pero que no se debe adoptar sin una reflexión crítica previa, es decir, como una fórmula.

Resumo Esta pesquisa analisa o processo de internacionalização do International Master Program for Managers (IMPM) por meio de uma parceria estabelecida com uma Instituição de Ensino Superior brasileira. O IMPM foi concebido por Henry Mintzberg, em 1996, como um programa forte o suficiente para desafiar os programas tradicionais de MBA da América do Norte, uma vez que Mintzberg propõe que os “Managers, Not MBAs” devem prevalecer. É adotada uma perspectiva crítica para investigar se o IMPM privilegia o ponto de vista anglo-saxão ou não. A fim de atingir esse objetivo, foi utilizada uma abordagem qualitativa, com noventa e seis entrevistas em profundidade com docentes e diretores de ambas as instituições responsáveis pelo estabelecimento da parceria e pela realização do módulo Brasil do programa, neste artigo, nós abordamos oito dessas. O professor Henry Mintzberg está entre os entrevistados. Os resultados mostram que, apesar de todos os esforços para preservar as culturas locais, a lógica anglo-saxônica prevalece e existe um desequilíbrio entre a proposição inicial e os resultados. Há muitas questões inexploradas a serem resolvidas considerando essa estrutura e isso sugere que estudos futuros considerem e proponham o reconhecimento da produção local de conhecimento e da diversidade cultural como elementos-chave para o sucesso de parcerias internacionais

Abstract This research analyzes the International Master’s Program for Managers (IMPM) internationalization process through a partnership established with a Brazilian Higher Education Institution. IMPM was conceived by Henry Mintzberg in 1996 as a program strong enough to challenge traditional American MBA programs since Mintzberg proposes that “managers not MBAs” should prevail. A critical perspective is adopted here to investigate whether the IMPM privileges an Anglo-Saxon point of view or not. We used a qualitative approach involving ninety-six in-depth interviews with faculty members and directors from both institutions responsible for establishing this partnership and carrying out the Brazilian module of the program, eight of which are addressed in this paper. Professor Henry Mintzberg was one of the interviewees. The findings show that despite all the efforts to preserve local culture, an Anglo-Saxon logic prevails, and there is an imbalance between the initial proposition and the results. There are a lot of unexplored issues to solve considering this framework, and future studies should consider and propose the recognition of the local production of knowledge and cultural diversity as key elements for the success of international partnerships.

Resumen Esta investigación analiza el proceso de internacionalización del International Master Program for Managers (IMPM), a través de una asociación establecida con una institución brasileña de educación superior. El IMPM fue concebido por Henry Mintzberg, en 1996, para ser un programa suficientemente fuerte como para desafiar a los programas tradicionales de MBA de América del Norte, ya que Mintzberg propone que prevalezcan los “Gerentes, no los MBA”. Se adoptó una perspectiva crítica para investigar si el IMPM privilegia el punto de vista anglosajón o no. Para lograr este objetivo, se utilizó un enfoque cualitativo, con ocho entrevistas en profundidad con docentes y directores de las dos instituciones responsables de establecer la asociación y llevar a cabo el módulo del programa realizado en Brasil. El propio profesor Henry Mintzberg es uno de los entrevistados. Los resultados muestran que, a pesar de todos los esfuerzos por preservar las culturas locales, prevalece la lógica anglosajona y existe un desequilibrio entre la propuesta inicial y los resultados. Hay muchas problemas inexplorados por resolver teniendo esta estructura en cuestión y esto sugiere que los estudios futuros consideren y propongan el reconocimiento de la producción local de conocimiento y la diversidad cultural como elementos clave para el éxito de las asociaciones internacionales.

RESUMO CONTEXTO: A ingestão de soda cáustica e o desenvolvimento de estenoses esofágicas são reconhecidos como importantes problemas de saúde pública na infância. Diferentes métodos terapêuticos têm sido propostos no manejo dessas estenoses. OBJETIVO: Avaliar a eficácia e o risco da aplicação endoscópica tópica de mitomicina C no tratamento de estenoses esofágicas cáusticas. MÉTODOS: Buscamos as bases de dados MEDLINE, EMBASE, Central Cochrane e LILACS. Os desfechos avaliados foram taxa de resolução da disfagia, número de dilatações realizadas nos casos resolvidos e número de dilatações realizadas em todos os pacientes. RESULTADOS: Três ensaios clínicos randomizados foram incluídos para análise final com um total de 190 pacientes. O grupo de aplicação de mitomicina C tópica apresentou aumento significativo na taxa de resolução da disfagia, correspondendo a uma resolução da disfagia 42% maior em comparação à dilatação endoscópica isolada, com significância estatística entre os dois grupos (RD: 0,42 - [IC: 0,29-0,56]; P-valor <0,00001). O número médio de dilatações realizadas em casos resolvidos foi significativamente menor no grupo de aplicação tópica de mitomicina C, em comparação com as dilatações endoscópicas isoladas, com significância estatística entre os dois grupos (MD: 2,84 [IC: 1,98-3,69]; P-valor <0,00001). Ao comparar o número de dilatações em todos os pacientes, não houve diferença estatística entre os dois grupos (MD: 1,46 [IC: -1,53-4,44]; valor de P=0,34). CONCLUSÃO: A aplicação de mitomicina C tópica com dilatações endoscópicas em estenoses esofágicas cáusticas foi mais eficaz na resolução da disfagia do que a terapia endoscópica isolada na população pediátrica. Além disso, a aplicação tópica de mitomicina C também reduziu o número de sessões de dilatação necessárias para aliviar a disfagia sem aumentar a morbidade.

ABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.

A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.

BACKGROUND Toxoplasma gondii causes toxoplasmosis and is controlled by activated macrophages. However, infection of macrophages by tachyzoites induces TGF-β signaling (TGF-s) inhibiting nitric oxide (NO) production. NO inhibition may be a general escape mechanism of distinct T. gondii strains. OBJECTIVES To evaluate in activated macrophages the capacity of T. gondii strains of different virulence and genetics (RH, type I; ME-49, type II; VEG, type III; P-Br, recombinant) to evade the NO microbicidal defense system and determine LC3 loading to the parasitophorous vacuole. METHODS Activated peritoneal macrophages were infected with the different T. gondii strains, NO-production was evaluated by the Griess reagent, and inducible nitric oxide synthase expression, TGF-s, and LC3 localisation assayed by immunofluorescence. FINDINGS Only RH persisted in macrophages, while VEG was more resistant than P-Br and ME-49. All strains induced TGF-s, degradation of inducible nitric oxide synthase, and NO-production inhibition from 2 to 24 h of infection, but only RH sustained these alterations for 48 h. By 24 h of infection, TGF-s lowered in macrophages infected by ME-49, and P-Br, and NO-production recovered, while VEG sustained TGF-s and NO-production inhibition longer. LC3 loading to parasitophorous vacuole was strain-dependent: higher for ME-49, P-Br and VEG, lower for RH. All strains inhibited NO-production, but only RH sustained this effect probably because it persisted in macrophages due to additional evasive mechanisms as lower LC3 loading to parasitophorous vacuole. MAIN CONCLUSIONS These results support that T. gondii can escape the NO microbicidal defense system at the initial phase of the infection, but only the virulent strain sustain this evasion mechanism.

ABSTRACT Chromium contamination in soils affects plant growth and this metal can accumulate in plants tissues. In addition, Cr can affect soil microbial biomass and activity. On the other hand, plant growth-promoting rhizobacteria (PGPR) can protect plants against metals and, at the same time, promote plant growth and could alleviate adverse effects on microbial biomass. This study evaluated five PGPR on maize growth, Cr accumulation and soil microbial biomass in a Cr-contaminated soil. Five PGPR (LCC04, LCC41, LCC69, LCC81 and IPA403), isolated from soil under permanent application of composted tannery sludge and contaminated with Cr, were inoculated in maize plants grown in soils with (+Cr) and without (–Cr) Cr. In Cr-contaminated soil, LCC41 promoted the highest growth of maize, while LCC04 contributed with the highest N accumulation. The shoots of maize accumulated less Cr with LCC81, while LCC41 contributed to the highest Cr accumulation in roots. The translocation of Cr was highest with IPA403, while LCC81 contributed to reduce Cr translocation. In conclusion, LCC41 and LCC81 could be effective as PGPR inoculants to promote plant growth and reduce Cr accumulation in maize, respectively, in Cr contaminated soil.

ABSTRACT Oxisols are important soils that have been converted from native vegetation to croplands, and can affect soil biological properties such as microbial biomass and enzyme activity. Thus, the aim of this study was to evaluate the changes on soil microbial biomass and enzyme activity when native vegetation (NV) was converted to cropland (CL), such as maize or sugarcane in six oxisols from São Paulo state, Brazil. Soil microbial biomass C (MBC) and N (MBN), and the activity of arylsulphatase, dehydrogenase and fluorescein diacetate hydrolysis (FDA) were assessed in samples collected at 0-0.20 m. In general, MBC was higher under NV than CL (about + 40%), while MBN and FDA did not show a consistent pattern between NV and CL. All soils showed higher values of arylsulfatase (increased from 101 to 717%) and dehydrogenase (increased 15 to 220%) under NV than CL. In conclusion, soil microbial biomass C is usually higher under native vegetation than cropland. Arylsulphatase and dehydrogenase were the attributes that presented better differentiation between native and cropped soils.

RESUMO Esse ensaio discorre sobre as possibilidades que o conceito de perspectivismo ameríndio de Viveiros de Castro oferece aos Estudos Organizacionais. O "Manifesto antropófago" de Oswald de Andrade é o fio condutor de nossa investigação. O perspectivismo ameríndio sugere um deslocamento reflexivo para a posição ocupada pelo objeto de investigação que, assim, se torna o sujeito a partir do qual devemos questionar nossas próprias premissas. O que importa saber é como nosso sujeito/ex-objeto percebe nossas categorias/conceitos criadas para descrevê-lo. Para Viveiros de Castro, o deslocamento reflexivo deve ocorrer considerado-se uma equivocidade intencional. Portanto, devemos refletir sobre as consequências que nossas escolhas ontoepistemológicas terão sobre nossa pesquisa a partir do ponto de vista do Outro. Os conceitos de deslocamento reflexivo e equivocidade intencional têm muito a contribuir com a construção do Outro em EOR e com o conceito de border thinking nos estudos decolonais.

ABSTRACT This essay discusses the possibilities that Viveiros de Castro's concept of Amerindian perspectivism offers to Organizational Studies. Oswald de Andrade's Anthropophagous Manifesto is the guiding thread of our investigation. Amerindian perspectivism suggests a reflexive shift to the position occupied by the object of inquiry, which, thus, becomes the subject from which we must question our own premises. What matters is knowing how our subject/former object perceives the categories/concepts we created to describe it. For Viveiros de Castro, the reflexive displacement should occur using a controlled equivocation. Therefore, we must be reflexive on the consequences that our onto-epistemological choices will have on our research from the Other's point of view. The concepts of reflexive displacement and controlled equivocation have much to contribute to the construction of the other in Organizational Studies and to the concept of border thinking in decolonial studies.

RESUMEN Este ensayo analiza las posibilidades que el concepto de perspectivismo amerindio de Viveiros de Castro ofrece a los Estudios Organizacionales. El Manifiesto Antropófago de Oswald de Andrdade es el hilo conductor de nuestra investigación. El perspectivismo amerindio sugiere un desplazamiento reflexivo a la posición ocupada por el objeto de la investigación, que se convierte así en el sujeto a partir del cual debemos cuestionar nuestras propias premisas. Lo que importa es saber cómo nuestro sujeto/objeto anterior percibe nuestras categorías/ conceptos creados para describirlo. Para Viveiros de Castro, el desplazamiento reflexivo debe ocurrir considerando una equivocidad intencional. Por lo tanto, debemos reflexionar sobre las consecuencias que nuestras elecciones onto-epistemológicas tendrán en nuestra investigación desde el punto de vista del otro. Los conceptos de desplazamiento reflexivo y equivocidad intencional tienen mucho que aportar a la construcción del otro en EO y al concepto de pensamiento fronterizo en los estudios decoloniales.

RESUMO A imobilidade pode causar várias complicações que influenciam na recuperação de doentes críticos, incluindo atrofia e fraqueza muscular esquelética. Esse efeito pode ser amenizado com a realização de mobilização precoce. Seis questões primordiais nortearam essa pesquisa: É segura? Quem é o candidato à mobilização precoce? Quais são as contraindicações? Qual a dose adequada e como defini-la? Quais os resultados obtidos? Quais os indicadores prognósticos em sua utilização? O objetivo desta diretriz foi elaborar um documento que reunisse recomendações e sugestões baseadas em níveis de evidência sobre a mobilização precoce do paciente crítico adulto, visando melhorar o entendimento sobre o tema, com impacto positivo no atendimento aos pacientes. Esta diretriz foi desenvolvida com base em uma revisão sistemática de artigos, utilizando a estratégia de busca no modelo PICO, conforme recomendado pelo Projeto de Diretrizes da Associação Médica Brasileira. Foram selecionados ensaios clínicos randomizados, estudos de coortes prognósticos, revisões sistemáticas com ou sem metanálise, sendo as evidências classificadas segundo Oxford Centre for Evidence-based Medicine - Levels of Evidence. Em todas as questões abordadas, foram encontradas evidências suficientes para a realização da mobilização precoce de forma segura e bem definida, com indicadores prognósticos que evidenciam e recomendam a técnica. A mobilização precoce está associada a melhores resultados funcionais, devendo ser realizada sempre que indicada. É segura e deve ser meta de toda equipe multidisciplinar.

ABSTRACT Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.

Resumo Objetivo O momento da admissão para o parto pode ser considerado inapropriado para oferecer o dispositivo intrauterino (DIU) para mulheres sem aconselhamento contraceptivo pré-natal. Entretanto, em países com elevadas taxas de cesáreas e aconselhamento contraceptivo deficiente, essa estratégia pode reduzir o risco de gestações não programadas e cesáreas repetidas. Métodos Estudo de coorte envolvendo 100 mulheres sem aconselhamento contraceptivo pré-natal. A inserção de DIU pós-dequitação foi oferecida após a admissão para o parto e indicação de cesárea. As taxas de continuidade com o DIU, perfuração uterina e endometrite foram avaliadas após 6 semanas e 6 meses, e a proporção de mulheres que continuaram com o DIU após 6 meses foi analisada em relação ao número de cesáreas prévias. Resultados Noventa e sete mulheres completaram o seguimento. A taxa de permanência do DIU foi de 91% em 6 semanas e 83,5% em 6 meses. A taxa de expulsão/ remoção nas primeiras 6 semanas foi não foi diferente daquela observada entre 6 emanas e 6 meses (9 vs 9,1%, respectivamente). Houve dois casos de endometrite (2,1%), e nenhum caso de perfuração uterina. Entre as 81mulheres que permaneceram como DIU após 6 meses, 31% haviam sido submetidas a apenas uma cesárea, em que o DIU foi inserido, 44% a 2, e 25% a 3 ou mais cesáreas. Conclusão Dois terços das mulheres que continuaram com o DIU após 6 meses haviam sido submetidas a 2 ou mais cesáreas. Considerando que oferecer a tentativa de parto vaginal após duas oumais cesáreas prévias é incomum, é possível que a oferta do DIU na admissão para o parto possa reduzir o risco de cesáreas repetidas e de seus riscos associados.

Abstract Objective Themoment of admission for deliverymay be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. Methods This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Results Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Conclusion Two thirds of the women who continued with IUD at 6 months had undergone 2 ormore cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

RESUMO: Este estudo avaliou a resposta do feijão-fava (Phaseolus lunatus L.) a aplicação de lodo de curtume compostado na nodulação, absorção de N e crescimento. Durante oito anos, o composto foi aplicado em doses de: 0, 2.5, 5, 10, e 20 Mg ha-1 (base seca). As plantas de feijão-fava mostraram maior nodulação nos tratamentos com o composto. Entretanto, os nódulos encontrados nestes tratamentos apresentaram menor biomassa, tamanho e diversidade do que os observados no tratamento sem composto. A acumulação de N aumentou com a aplicação da maior dose do composto (20 Mg ha-1), enquanto que houve um aumento nos teores de crômio na parte aérea com o aumento das doses do composto. Desta forma, o uso do lodo de curtume compostado, em longo prazo, aumenta a acumulação de crômio, aumentando a nodulação, enquanto diminui a diversidade de rizóbios nos nódulos.

ABSTRACT: This study evaluated the responses of lima bean (Phaseolus lunatus L.) to application of composted tannery sludge on nodulation, N uptake and plant growth. For eight years, the compost was applied at rates of: 0, 2.5, 5, 10, and 20 Mg ha-1 (dry basis). Plants of lima bean showed higher nodulation in treatments with compost; however, nodules reported in these treatments presented lower biomass, size and diversity than those reported in treatment without compost. Accumulation of N increased with the application of the highest rate (20 Mg ha-1), while there was an increase in chromium content in shoot with the increase in compost rates. Thus, the use of composted tannery sludge, in long-term, increases the accumulation of chromium in plants, increasing nodulation, while decrease rhizobia diversity in nodules.

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