Abstract Coffea sp. is cultivated in many tropical countries. Brazil has always adopted intensive agricultural practices, but organic coffee farming is an alternative system based on the non-use of agrochemicals and the rational management of soils. Metabarcoding 16S analysis using next-generation sequencing has been developed to identify and compare the diversity of the Coffea arabica L. rhizospheric bacterial community in two farming areas in São Paulo, Brazil. Dourado uses conventional farming, while Ribeirão Corrente uses organic. We found broad taxonomic composition, with sequences from 24 phyla, 55 classes, 61 orders, 146 families, and 337genus. The three most abundant phyla were Proteobacteria (38.27%), Actinobacteria (15.56%), and Acidobacteria (16.10%). In organic farming, the top 3 were the family Sphingomonadaceae, order Rhizobiales, genus Nocardioides, and Gp6. The genus Gp2 and the phylum Candidatus Saccharibacteria were the most abundant OTUs exclusively present in conventional farming. In the organic farming practice, Proteobacteria, Actinobacteria, and Acidobacteria were also present among the exclusive OTUs; we also found OTUs belonging to Bacteroidetes, Firmicutes, and Verrucomicrobia. Our study indicates a positive effect of organic farming on microbial communities. Fertilization may directly affect soil microbiota, suggesting that a large and active microbial community low in functional diversity might not adapt to new climatic conditions. A diverse community could provide better resilience to environmental changes, improving the productivity of this important crop.

Resumo Coffea sp. é cultivada em muitos países tropicais. O Brasil sempre adotou práticas agrícolas intensivas, mas a cafeicultura orgânica é um sistema alternativo baseado na não utilização de agrotóxicos e no manejo racional dos solos. A análise Metabarcode 16S utilizando o sequenciamento de última geração foi desenvolvida para identificar e comparar a diversidade da comunidade bacteriana rizosférica de Coffea arabica L. em duas áreas de cultivo em São Paulo, Brasil. Dourado usa agricultura convencional, enquanto Ribeirão Corrente usa agricultura orgânica. Encontramos ampla composição taxonômica, com sequências de 24 filos, 55 classes, 61 ordens, 146 famílias e 337 gêneros. Os três filos mais abundantes foram Proteobacteria (38,27%), Actinobacteria (15,56%) e Acidobacteria (16,10%). Na agricultura orgânica, os 3 primeiros foram a família Sphingomonadaceae, ordem Rhizobiales, gênero Nocardioides e Gp6. O gênero Gp2 e o filo Candidatus Saccaribacteria foram as OTUs mais abundantes exclusivamente presentes na agricultura convencional. Na prática da agricultura orgânica, Proteobacteria, Actinobacteria e Acidobacteria também estiveram presentes entre as OTUs exclusivas; também encontramos OTUs pertencentes a Bacteroidetes, Firmicutes e Verrucomicrobia. Nosso estudo indica um efeito positivo da agricultura orgânica nas comunidades microbianas. A fertilização pode afetar diretamente a microbiota do solo, sugerindo que uma grande e ativa comunidade microbiana com baixa diversidade funcional pode não se adaptar às novas condições climáticas. Uma comunidade microbiana diversificada poderia proporcionar maior resiliência às mudanças ambientais, melhorando a produtividade desta importante cultura agrícola.

Resumo A família é a base fundante da sociedade e o melhor local para a educação e o crescimento da criança. O divórcio é deletério à saúde das crianças, impactando sobretudo na saúde mental e no desempenho escolar, além ter reflexos na vida adulta. O convívio por período igualitário com pai e mãe após o divórcio – a guarda compartilhada – garante benefícios, empiricamente comprovados, ao bem-estar físico e psicológico das crianças. No entanto, muitas decisões judiciais decretam guarda compartilhada em menos de um terço das separações. Ao analisar controvérsias éticas e morais na inter-relação das ciências jurídicas com as ciências da saúde, o biodireito faz com que a bioética tenha eficácia. Por esse motivo, argumenta-se que ações judiciais de família devem seguir critérios multidisciplinares que considerem as crianças como sujeitos vulneráveis que precisam de proteção.

Abstract Family is the founding basis of society and the best place for the education and growth of children. Divorce is deleterious to children’s health, mainly impacting their mental health and school performance, in addition to having impacts on adulthood. Living both with the father and the mother for an equal period of time after divorce – joint custody – guarantees empirically proven benefits to the physical and psychological well-being of children. However, judicial decisions decree joint custody in less than a third of separations. By analyzing ethical and moral controversies in the interrelation of legal sciences and health sciences, biolaw makes bioethics effective. Thus, it is discussed that family lawsuits should follow multidisciplinary criteria that consider children as vulnerable subjects who need protection.

Resumen La familia es la base de la sociedad y es el mejor lugar para la educación y el crecimiento del niño. El divorcio es perjudicial para la salud de los niños, especialmente afecta la salud mental y escolar, con repercusiones en la vida adulta. Vivir juntos por un período igual con el padre y la madre después del divorcio, la custodia compartida, es un elemento con una relación causal estadística para proteger la salud de los niños. Sin embargo, las decisiones judiciales han decretado la custodia compartida en menos de un tercio de las separaciones. Bioderecho es una forma de hacer que la bioética sea efectiva, mediante el análisis de controversias éticas y morales en la interrelación entre las ciencias jurídicas y las ciencias de la salud. Las acciones legales familiares deben llevarse a cabo de manera multidisciplinaria, considerando al niño como el sujeto más vulnerable a proteger.

The objective of the present experiment was to compare the performance, egg quality and organ morphometrics of commercial layers submitted to alternative forced molting methods using dietary fibers. The experimental period included the phases of molting, rest, and second laying cycle (six periods of 28 days each). In the trial, 320 commercial Isa Brown layers with 72 weeks of age were distributed, according to a completely randomized experimental design into five treatments with eight replicates of eight birds each, totaling 40 experimental units. Molting was induced by feeding diets with the inclusion of alfalfa or soybean husks at 80% and 60% or feed fasting. Treatments were applied for 14 days. Performance and egg quality parameters were evaluated for the second laying cycle and organ morphometrics (liver, gizzard, proventriculus, reproductive apparatus) in two different slaughter dates. The obtained data were submitted to analysis of variance using the General Linear Model (GLM) procedure of SAS statistical package (SAS Institute, 2002). Alternative molting methods promoted similar performance and egg quality results after molting were similar to those obtained by the conventional fasting method. Feeding fiber produced the expected effects in terms of organ weight regression and recovery and may be used to induce molting in commercial layers.

An experiment was conducted to evaluate the biometrics of organs (ovary, oviduct, liver, proventriculus and gizzard) of laying hens submitted to different forced-molting methods of molt and maintained at three different temperature. Organs were evaluated after molting and resting period. Six hundred birds were distributed according to a completely randomized experimental design in a 5x3 factorial arrangement (forced-molting methods x environmental temperatures) into 15 treatments with 5 replicates of 8 birds each. The molting methods applied were the dietary inclusion of 90%, 70%, 50% of alfalfa, 2,800 ppm zinc oxide, or total feed restriction. Birds were kept at ±20 ºC, ±27 ºC, or ±35 ºC. Data were submitted to analysis of variance and means were compared by orthogonal and polynomial contrasts. The traditional forced-molting method (feed fasting) resulted in adequate performance. However, as the aim of the present study was to find an alternative method to feed fasting, the highest dietary alfafa inclusion level (90%) was shown to be efficient compared with other methods, particularly when hens were kept at high temperature. Therefore, this alternative forced-molting may be applied, especially when bird welfare is taken into consideration.

This study aimed to analyze the effects of metabolizable energy levels and the age at slaughter on growth performance, carcass yield and cuts broilers Caipira French Barré. The experiment was conducted in Parauapebas, PA. We used 192 one day chicks reared in intensive system. The experimental design was completely randomized with three treatments. Each treatment consisted of four replications, the experimental unit being a box of 16 birds. The treatments were defined according to the levels of metabolizable energy diets (1 to 28 days) and late (29 to 90 days),respectively: T1 - 3000 and 3100 kcal of ME/kg, T2 - 3100 and 3200 kcal/kg, T3 - 3200 and 3300 kcal of ME/kg. The variables studied were initial weight, final weight, feed intake and feed conversion, protein consumed, metabolized protein consumed, energy efficiency and protein efficiency. The characteristics of carcasses of birds, analyzed with 77, 84 and 91 days of age were the carcass, breast, thigh, drumstick, wing, back, wings, feet, head and neck. The statistical analysis was performed using the ANOVA procedure for a completely randomized model with the System for statistical analysis and genetics (SAEG, 2007). Differences between means of variables were performed by Tukey's test at a level of 5%. The energy levels in the diets did not affect on the performance and carcass yield, breast, thighs, drumsticks, wings, feet and head + neck in birds. The level of 3200 kcal/kg provided better yield back. The protein and metabolic energy consumed by the birds improved with higher energy content of feed during the fattening stage. Age at slaughter did not affect carcass yield, however the birds slaughtered at 90 days of age showed higher breast yield.

Objetivou-se analisar os efeitos dos níveis de energia metabolizável e da idade de abate sobre o desempenho zootécnico, rendimento de carcaça e cortes de frangos da linhagem Caipira Francês Barré. O experimento foi conduzido em galpão experimental localizado em Parauapebas, PA. Foram utilizados 192 pintos, mistos, de 1 dia, criados em sistema intensivo. O delineamento experimental utilizado foi inteiramente casualizado, com 3 tratamentos. Cada tratamento foi formado de 4 repetições, sendo a unidade experimental 1 box de 16 aves. Os tratamentos foram definidos de acordo com os níveis de energia metabolizável das rações inicial (1 a 28 dias) e final (29 a 90 dias), respectivamente: T1 - 3000 e 3100 kcal de EM/kg; T2 - 3100 e 3200 kcal de EM/kg; T3 - 3200 e 3300 kcal de EM/kg. As variáveis estudadas foram peso inicial, peso final, consumo de ração e conversão alimentar, proteína bruta consumida, proteína metabolizada consumida, eficiência energética e eficiência protéica. As características de carcaças das aves, analisadas com 77, 84 e 91 dias de idade, foram o rendimento de carcaça, peito, coxas, sobrecoxas, asa, dorso, asas, pés, cabeça e pescoço. A análise estatística dos dados foi realizada utilizando o procedimento ANOVA, para um modelo inteiramente casualizado, com o programa Sistema para análise estatística e genética (SAEG, 2007). As diferenças entre as médias das variáveis estudadas foram realizadas pelo Teste de Tukey a um nível de 5%. Os níveis de energia nas dietas não interferiram no desempenho zootécnico e no rendimento de carcaça, peito, coxas, sobrecoxas, asas, pés e cabeça + pescoço das aves. O nível de 3200 kcal de EM/kg proporcionou melhor rendimento de dorso. A proteína bruta e a energia metabolizada consumida pelas aves melhoraram com o incremento energético da ração, durante a fase de engorda. A idade de abate não influenciou no rendimento de carcaça, entretanto as aves abatidas aos 90 dias de idade apresentaram maior rendimento de peito.

This study was carried out to evaluate the performance and egg quality of laying hens, in their second laying cycle submitted to different forced-molting methods and three environmental temperatures. Six hundred layers were distributed in a completely randomized experimental design with 15 treatments with five replicates of eight birds each, according to 5x3 factorial arrangement (molting methods vs. temperatures). The following forced-molting methods were applied: 90%, 70%, 50% dietary alfalfa inclusion, addition of 2,800 ppm zinc, and feed fasting. Temperatures were: 20 ºC, 27 ºC and 35 ºC. At the end of each period of the second laying cycle, bird performance and egg quality were evaluated. Data were submitted to analysis of variance and means were compared by orthogonal and polynomial contrasts. The highest alfalfa inclusion level (90% alfalfa and 10% basal diet) proved to be efficient as compared to the other methods, independently of temperature.

Las isotermas de sorción describen la relación entre el contenido de humedad y la actividad de agua de un alimento. Este trabajo presenta los conceptos básicos relacionados con la termodinámica de la sorción de agua, clasificación de las isotermas, ''usos y limitaciones de los modelos'', y la medición de las isotermas de sorción de materiales alimenticios. Los modelos más utilizados en los alimentos son los de Brunauer-Emmett-Teller y Guggenheim-Anderson-de Boer. El éxito del modelo de Brunauer-Emmett-Teller es más bien cualitativo, considerando que en la mayoría de casos sólo es lineal en un rango limitado de actividad de agua de 0,05 a 0,45, por lo que su aplicabilidad principal es la estimación de áreas de superficies y el modelo de Guggenheim-Anderson-de Boer su uso es generalizado por su bases teóricas, simplicidad matemática y fácil interpretación, pero se desvía a actividad de agua superior a 0,93.

Moisture sorption isotherms describe the relationship between moisture content and water activity in food. This work presents basic concepts related to the sorption thermodynamics of water, the classification of isotherms, ''uses and limitations of the models'', and measurement of sorption isotherms for food materials. The most commonly used models in food are Brunauer-Emmett-Teller and Guggenheim-Anderson-de Boer. The success of the Brunauer-Emmett-Teller model is rather qualitative, considering that almost all cases are linear only in a limited rank of water activity from 0.05 to 0.45, as its main applicability is the estimation of surface areas. And, the use of the Guggenheim-Anderson-de Boer model is generalized by its theoretical bases, mathematical simplicity, and ease to interpret; but it is not frequently used when the water activity greater than 0.93.

En este artículo hemos realizado una amplia revisión de los linfomas primarios gástricos, su clasificación y aspectos clínico-patológicos más importantes, haciendo énfasis especial en los linfomas MALT o asociados a las mucosas y su relación con la infección por Helicobacter pylori.

In this review we describe various aspects of the primary gastric lymphomas, the classification, and the most important clinico-pathological aspects, with emphasis in mucosa associated lymphoma (MALT) and the Helicobacter pylori infection.

La leche de búfala, debido a su composición, especialmente en carbohidratos, presenta una aptitud favorable para la elaboración de arequipe. Su rendimiento en productos lácteos es 40% superior al de la leche bovina. Esta investigación evalúa la variación de dos niveles de neutralización (0.09 y 0.10 % ácido láctico) y tres porcentajes de edulcorantes (25% sacarosa; 22% sacarosa y 30% azúcar invertido; 20% sacarosa y 30% azúcar invertido), en la elaboración del arequipe de leche de búfala. Al tratamiento seleccionado por los jueces mediante la prueba de medición de grado de satisfacción se le determina: contenidos de sólidos totales, humedad, cenizas, proteína, grasa, viscosidad, color, mesófilos, coliformes totales, coliformes fecales, mohos y levaduras y Staphylococcus coagulasa positivo. Se almacena a temperatura ambiente y se le practica análisis microbiológico (mohos y levaduras), organoléptico (arenosidad) y fisicoquímico (sólidos totales y humedad) en intervalos de diez días durante sesenta días. El tratamiento seleccionado, con un nivel de confianza del 95%, es el de 0.10% acido láctico, 20% sacarosa y 30% azúcar invertido. El arequipe presenta contenidos de sólidos totales, humedad, cenizas, proteína y grasa de 77.90 ± 0.04%; 22.10 ± 0.04%; 1.76 ± 0.09%; 9.85 ± 0.37% y 7.95 ± 0.41% respectivamente; un comportamiento seudoplástico y tixotrópico. El arequipe elaborado, de acuerdo con los análisis microbiológicos, cumple la Norma Técnica Colombiana NTC 3757 de 1996 y conserva sus características microbiológicas, organolépticas y fisicoquímicas hasta el día cincuenta.

The buffalo milk due to its composition, especially in carbohydrates, present a favorable aptitude for the elaboration of arequipe. Its milky product yield is 40% superior to bovine milk. This investigation evaluates the variation of two neutralization levels (0.09 and 0.10% lactic acid) and three sweeteners percentage (25% sucrose; 22% sucrose and 30% inverted sugar; 20% sucrose and 30% sugar inverted) in the elaboration of buffalo milk arequipe. The panel selected treatment was to test the satisfaction degree by measurement total solid contents, humidity, ashes, protein, fat, viscosity, colour, mesophiles, fecal coliforms, mushrooms and yeasts and Staphylococcus coagulase positives. It is stored to room temperature, and microbiological analyses are carried for mushrooms and yeasts, organoleptic (sandiness) and physicochemical (solid totals and humidity) by ten days intervals during sixty days. The selected treatment, with a confidence level of 95% is of 0.10% lactic acid, 20% sucrose and 30% inverted sugar. Arequipe presents total solid contents, humidity, ashes, protein and fat of 77.90 ± 0.04%; 22.10 ± 0.04%; 1.76 ± 0.09%; 9.85 ± 0.37% and 7.95 ± 0.41% respectively; a pseudoplastic and thixotropic behavior. Arequipe elaborated, in agreement with the microbiological analyses, comply with practical standards Colombian NTC 3757 of 1996 and conserves its microbiological, organoleptic and physicochemical characteristics until day fifty.

Os portugueses são dos maiores apreciadores mundiais de brássicas. A couve Tronchuda é cultivada em Portugal em área superior a 1000 ha. O seu consumo é sobretudo apreciado na quadra natalícia. Neste trabalho reportam-se resultados da fertilização com azoto e boro, na forma de adubos convencionais, e da utilização de Dix10 (com ˜10 % N total), um fertilizante orgânico autorizado em agricultura biológica. Plantas de raiz protegida foram transplantadas a 29 de Agosto de 2005 num compasso 0,8x0,5 m. O solo, de textura franca, continha 0,83 % matéria orgânica, 5,2 pH(H2O) e teores em P e K médios e altos, respectivamente. Foram estabelecidas seis modalidades: sem adubação (SAd); Dix10, em dose equivalente a 80 kg N/ha; modalidades com 80 (NB) e 160 (N+) kg N/ha, na forma de ureia; e modalidades sem B (B-) e com aplicação de 2,2 (NB) e 4,4 (B+) kg B/ha. Todas as modalidades de B foram fertilizadas com 80 kg N/ha e as de N com 2,2 kg B/ha, coincidindo na modalidade NB as doses médias de N e B. As plantas SAd produziram 13,7 Mg biomassa/ha e exportaram 33,9 kg N/ha e 40,9 g B/ha, valores significativamente inferiores às modalidades fertilizadas. Dix10 produziu 18,0 Mg de biomassa/ha e exportou 45,1 kg N/ha e 51,3 g B/ha. A modalidade NB originou maior produção de biomassa (38,6 Mg/ha) e N exportado (107,9 kg/ha) que as modalidades SAd e Dix10. A modalidade N+ não registou aumento de produção nem de N exportado comparativamente com NB. B+ não influenciou a produção de biomassa mas aumentou a concentração de B nos tecidos e o B exportado. N+ reduziu significativamente a concentração de B nos tecidos e o B exportado, sugerindo um efeito de antagonismo da aplicação de N sobre a absorção de B. As produções obtidas e a recuperação aparente de nutrientes mostraram que a redução de produção de biomassa nas modalidades SAd e Dix10 se deveu à reduzida disponibilidade de N no solo durante a estação de crescimento.

The Portuguese are one of the greatest brassica consumers in the entire world. Tall cabbage is grown in Portugal over an area greater than 1000 ha. Tall cabbage consumption is very popular at Christmas time. In this work, results from nitrogen and boron application, as conventional fertilisers, and from the use of Dix10, an organic amendment (˜ 10 % total N) permitted in organic farming, are reported. Young cabbage plants were prepared in a greenhouse in micro-pots and transplanted with protected roots on August 29, 2005, spaced at 0.8x0.5 m between and within rows. The soil was loamy textured with 0.83 % organic matter, pH(H2O) 5.2, and with median P and high K content levels. Six treatments were established: SAd treatment, without any fertilization; Dix10, applied in a rate equivalent to 80 kg N/ha; NB and N+, with 80 and 160 kg N/ha as urea, respectively; and B-and B+ treatments, without B and with 4.4 kg B/ha as borax. Boron treatments were fertilised with 80 kg N/ha and N treatments with 2.2 kg B/ha. Thus, NB is a median treatment with 80 kg N/ha and 2.2 kg B/ha. SAd plants yielded 13.7 Mg biomass/ha and took up 33.9 kg N/ha and 40.9 g B/ha, which are values significantly lower than that obtained on fertilised plots. In Dix10 treatment, cabbage yielded 18 Mg biomass/ha and took up 45.1 and 51.3 g B/ha. NB treatment produced higher biomass (38.6 Mg/ha) and N uptake (107.9 kg/ha) than SAd and Dix10 treatments. N+ treatment did not increase the yield, neither N uptake if compared with NB. B+ treatment has not any influence in biomass yield but increased tissue B content and B uptake. In N+ treatment there was a significant decrease in tissue B concentration and B uptake, which suggests antagonism of N over the uptake of B. The biomass yields and the apparent N and B recoveries showed that the lower biomass yielded in SAd and Dix10 treatments were due to a shortage of soil N availability in these treatments during the growing season.

Las propiedades reológicas de los jugos de fruta dependen de su variedad, estado de madurez, concentración de jugo/pulpa y variación de temperatura; los valores de índice de comportamiento al flujo e índice de consistencia son limitados, considerando la cantidad de variedades de guayaba. En este trabajo se caracteriza reológicamente la pulpa de guayaba (Psidium guajava L.) en las variedades Híbrido de Klom Sali, Puerto Rico, D14 y Red, cultivadas en el departamento de Córdoba (Colombia); las pulpas son obtenidas mediante refinadora con malla 1.5mm de abertura. Las medidas reológicas se realizan en un viscosímetro Brookfield modelo DV-II+ Pro, utilizando la aguja Nº 5 para las variedades Klom Salí, Puerto Rico y Red, y Nº 6 para la variedad D14. Las pulpas de guayaba presentan pH entre 3.9-4.6, ºBrix entre 9-10, acidez titulable expresada como porcentaje de ácido cítrico entre 0.56-0.96%, e índice de madurez entre 9.38-17.94; su comportamiento reológico se ajusta adecuadamente al modelo de Oswald de Waele o ley de potencia (R²≥ 0.989), comportándose como un fluido seudoplástico (n ≤ 0.307) y presentando tixotropía las variedades Puerto Rico (14.16%), Red (18.54%) y D14 (18.48%).

Rheological properties of fruit juices appear to be very much dependent of their varieties, state of ripening, concentration of juice/pulp and temperature variation. Typical values of flow behaviour index and consistency index are rather limited considering the varieties of guava fruits. In this work the guava pulp (Psidium guajava L.) was rheologically characterized in the varieties Hybrid of Klom Sali, Puerto Rico, D14 and Red cultivated in the department of Córdoba (Colombia); the pulps were obtained by means of refinery with mesh 1.5mm of opening. The rheological measurements were carried out in a Brookfield viscometer DV-II+ Pro model, used the spindle Nº 5 for the varieties Klom Sali, Puerto Rico and Red, and Nº 6 for the variety D14. The pulps presented pH among 3.90 - 4.6, ºBrix among 9 - 10, acidity expressed as percentage of citric acid among 0.56 - 0.96% and maturity index among 9.38-17.94; were adjusted appropriately to Oswald-de Waele model or power law (R²≥ 0.989), behaving as a pseudoplastic fluid (n ≤ 0.307) and presenting tixotropic percentages the variety Puerto Rico (14.16%), Red (18.54%) y D14 (18.48%).

La harina del camarón es el desperdicio de camarón seco molido, con buenas características de conservación, que se obtiene a partir de cabezas, abdomen o el camarón entero, según las características químicas del producto. Se elabora un sazonador a base de harinas de cabezas de camarón de cultivo (Penaeus sp) mediante un proceso de mezclado a pequeña escala, realizado en el Instituto de Ciencia y Tecnología Alimentaría, Medellín, con el fin de proporcionar una alternativa para darles valor agregado a los subproductos de empresas camaroneras. Se preparan tres formulaciones con 10, 20 y 30 % p/p de harina de cabezas de camarón, adicionándoles condimentos y aditivos. De acuerdo al análisis sensorial, realizado por panelistas entrenados, la mejor formulación es la preparada con 30 % p/p de harina de cabezas de camarón.

The flour of the shrimp is the waste of dry shrimp ground with good characteristics of conservation, obtaining itself from heads, abdomen or the whole shrimp according to the chemical characteristics of the product. A Seasoning was elaborated from a crop shrimp (Penaeus sp) heads flour a mixing process in a small scale, carried out in the Institute of Science and Technology would Feed, Medellin; with the purpose of providing an alternative to give an added value to the by-products of companies shrimps. It was prepared three formulations with 10, 20 and 30% w/w of shrimp heads flour by adding those condiments and preservatives. The best formulation, according to the sensorial analysis carried out by trained panelists, was the one prepared with 30% w/w of shrimp heads flour.

La Poliangeítis Microscópica (PAM) consiste en una vasculitis necrotizante que afecta a vasos muy pequeños, principalmente arteriolas de pequeño calibre, capilares y vénulas, fundamentalmente capilares glomerulares y en ocasiones, capilares pulmonares. El tracto gastrointestinal (TGI) también puede estar comprometido en la PAM con tasas reportadas de 30%-56%. Clínicamente, el espectro de síntomas gastrointestinales es amplio, variando desde dolor abdominal leve y transitorio hasta complicaciones que amenazan la vida y requieren cirugía de urgencia, por ejemplo, peritonitis, infarto intestinal, o hemorragia. Sin embargo, el sangrado intestinal masivo es una manifestación poco frecuente en la historia natural de la PAM. En verdad, al menos para PAM, el compromiso gastrointestinal severo ha sido identificado como un factor independiente asociado con pobre pronóstico. Informamos el caso de una mujer de 22 años que desarrolló glomerulonefritis rápidamente progresiva (GNRP) y perforación intestinal por PAM.

Microscopic polyangeitis (MPA) is a necrotizing vasculitis which affects very small vessels, including small arterioles, capillaries, and venules, but principally glomerular capillaries and occasionally pulmonary capillaries. The gastrointestinal (GI) tract also may be involved in the MPA, with reported rates of 30%-56%. Clinically, the spectrum of GI symptoms is wide, ranging from mild transient abdominal pain to life-threatening complications requiring emergency surgery, for example, peritonitis, bowel infarction, or hemorrhage. However, massive intestinal bleeding is unusual in the natural history of MPA. Severe GI involvement has been identified as an independent factor associated with poor outcome for MPA. This article reports the case of a 22 year old woman who developed Rapidly Progressive Glomerulonephritis (RPGN) and intestinal perforation from MPA.

Jovem de 15 anos portadora de doença de Crohn do cólon, não penetrante e não estenosante, com 1 ano de evolução. Trata-se de doente cortico-dependente e refractária à azatioprina, tendo a remissão sido obtida com infliximab, que foi descontinuado após reacção grave à 3ª infusão. Perante a reactivação da doença, apesar do tratamento com metotrexato e corticosteróides, obteve-se aprovação para o uso do adalimumab, conseguindo-se a redução do metotrexato, a suspensão da corticoterapia e a remissão clínica completa. Este caso ilustra os resultados promissores recentemente apresentados sobre o uso do adalimumab na doença de Crohn e, em particular, a sua segurança em doentes intolerantes ou com perda de resposta ao infliximab. A este propósito, os autores fazem uma revisão da literatura sobre esta provável nova opção no tratamento da doença de Crohn.

Fifteen-year-old female with non stenotic and non fistulizing Crohn's colitis for one year. We report a steroid dependent and refractory to azathioprine patient, in whom disease remission was obtained with infliximab, which sought to be discontinued after severe acute reaction to third infusion. Treatment with steroids and methotrexate was established, but effective control of the disease was not achieved. We then obtained permission for the use of adalimumab, which allowed methotrexate reduction, steroid postponement and complete disease remission. This case illustrates the recently presented promising results regarding the use of adalimumab on Crohn's disease, and on the particular setting of patients with intolerance or loss of response to infliximab. We briefly review the existing literature on this probable new therapeutic option for the treatment of Crohn's disease.

Objectivos: Avaliação da eficácia e segurança da terapêutica com infliximab efectuada no nosso serviço em doentes portadores de DC. Material e Métodos: Revisão dos processos dos doentes com DC seguidos no nosso serviço, submetidos a pelo menos uma infusão de infliximab até 2004. Resultados: Foram tratados 54 (18,7%) doentes com DC. Estudaram-se 52, cuja DC tinha 8,5 (1-28) anos de evolução. As indicações foram doença luminal activa em 24 (46,2%) doentes, fístulas activas em 22 (42,3%) e ambas em 6 (11,5%). Efectuaram-se 226 infusões, com 4,3 (1-24) infusões por doente. Aindução seguiu o protocolo triplo em 38 (73,1%) doentes. No início do tratamento 84,6% dos doentes estavam sob imunossupressão. Registaram-se efeitos adversos em 19 (36,5%) doentes, que foram graves em 9 (17,3%). Cerca de 2/3 dos doentes responderam à indução e 3/4 dos doentes em manutenção mantêm resposta positiva. No final do follow-up, 28 (53,0%) doentes mantinham resposta favorável, estando 13 (25,0%) em remissão completa. Conclusões: Metade dos doentes infundidos melhorou clinicamente de modo estável, metade dos quais em remissão completa. Ocorreram efeitos adversos em cerca de 1/3 dos doentes, implicando a descontinuação da droga em menos de 10%.

Aims: Evaluation of efficacy and safety of infliximab treatment in Crohn's disease (CD), performed at our department. Methods: Medical records of patients with CD followed at our department and treated with infliximab until 2004 were reviewed. Results: Fifty-four (18,7%) patients with CD were treated with infliximab. Fifty-two patients were studied, with a 8,5 (1-28) year DC on average. Indications for treatment were inflammatory luminal disease in 24 (46,2%) patients, active fistulas in 22 (42,3%) and both in 6 (11,5%). Each patient received 4,3 (1-24) infusions, on average, for a total of 226 infusions. On starting infliximab, 84,6% of patients were also on imunossupressive treatment. Adverse events occurred in 19 (36,5%), being serious in 9 (17,3%). In about 2/3 of patients responded to the induction scheme and 3/4 of patients on maintenance uphold a positive response. At the end of follow-up, 28 (53,0%) patients sustained a positive response, with 13 (25,0%) in complete remission. Conclusions: Half of the patients clinically and steadily improved, with half of these in complete remission. Adverse events occurred in about 1/3 of patients, which warranted discontinuation of treatment in less than 10%.