Competências (não exercidas) das comissões de orçamento e finanças nas câmaras municipais / Atribuciones (no ejercidas) de los comités de presupuesto y finanzas en las cámaras municipales / The (unexerted) competencies of municipal legislative financial committees in Brazil

Resumo Este artigo analisa a atuação das comissões de orçamento e finanças das câmaras municipais no controle orçamentário. Tais comissões apoiariam os vereadores na análise, na avaliação e no controle de projetos de lei, emendas parlamentares e prestação de contas apresentados(as) pelas prefeituras ao longo de todas as fases do ciclo orçamentário. Baseado em um método indutivo de pequenas amostras, este estudo compara a atuação das comissões de orçamento e finanças de 3 câmaras municipais no mandato de 2013-2016. Constatou-se que tais comissões atuaram de modo cerimonial e passivo, emitindo pareceres superficiais. Os resultados indicam que a previsão regimental e a existência de recursos materiais e humanos não garantem o funcionamento dessas comissões. Os efeitos colaterais do governo de coalizão geram incentivos políticos para manter as comissões com atuação cerimonial. A frágil atuação das comissões legislativas no controle orçamentário se mostra um ponto crítico para qualquer pretensão de equilíbrio fiscal na Federação.

Resumen Este artículo analiza los comités legislativos que realizan la supervisión financiera y presupuestaria en los municipios de Brasil. Estos comités apoyarían a los concejales en el análisis, evaluación y control de proyectos de ley, enmiendas y prestación de cuentas presentados por las municipalidades que cubran todo el ciclo presupuestario. Basado en un método inductivo, el estudio compara el desempeño de los comités presupuestarios y de finanzas de tres cámaras municipales en el mandato de 2013-2016. Se constató que dichos comités presupuestarios solo operaron ceremonial y pasivamente, al emitir pareceres superficiales. La evidencia indica que lo previsto en ley y los recursos materiales y humanos no son suficientes para garantizar el funcionamiento de dichos comités. Los efectos colaterales del gobierno de coalición crean incentivos políticos para mantener las comisiones operando de forma ceremonial. El frágil desempeño de los comités legislativos en el control presupuestario demuestra ser un punto crítico para cualquier aspiración de lograr el equilibrio fiscal en la federación brasileña.

Abstract This article analyses the legislative committee carrying out financial and budgetary oversight at municipalities in Brazil. These committees, similar to the internationally named Public Account Committees, support parliamentarians to analyze, evaluate, and scrutinize budgetary bills, amendments and governor's accounts covering the entire budgetary cycle. Based on a small-N analysis inductive approach, the study compares budgetary legislative committees from three local parliaments for the term 2013-2016. Such budgetary committees just operate ceremonially and passively, offering superficial recommendations. The evidence indicates that the legal mandate to operate and material and human resources are not sufficient to guarantee the commissions' efficiency. The collateral undesirable effects from coalitional government create incentives to maintain ceremonial commissions. The fragile legislative committee's performance on budgetary issues is a bottleneck to any aspiration to achieve fiscal sustainability in Brazil.

Metabolic syndrome: a multifaceted risk factor for kidney stones.

Kidney stones and metabolic syndrome (MetS) are common conditions in industrialized countries. There is growing evidence of associations between kidney stone disease and MetS or some of its components. The link between uric acid stones and MetS is well understood, but the link with calcium oxalate (CaOx) stones, the most common kidney stone composition, is more complex, and MetS is frequently overlooked as a risk factor for calcium nephrolithiasis. The physiopathological mechanisms of kidney stone disease in MetS are reviewed in this article. Uric acid stones are a consequence of the excessively acidic urine that results from insulin resistance. The pathophysiology of CaOx stones may include: increased excretion of lithogenesis promoters and decreased excretion of inhibitors; increased risk of Randall's plaque development; and inflammatory damage to renal epithelia by oxidative stress, as a consequence of the insulin-resistant milieu that characterizes MetS. The last mechanism contributes to the adhesion of CaOx crystals to subepithelial calcium deposits working as anchor sites where stones can grow. The predominant MetS features could determine the chemical composition of the stones in each patient. Kidney stones may be a renal manifestation of MetS and features of this syndrome should be looked for in patients with idiopathic nephrolithiasis.

Nutritional status influences generic and disease-specific quality of life measures in haemodialysis patients.

BACKGROUND: Poor nutritional status and worse healthrelated quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. OBJECTIVE: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. METHODS: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. RESULTS: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI ≤ 18.5 kg/m² to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/ obese patients (BMI ≥ 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). CONCLUSION: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL.

Antecedentes: En pacientes en hemodiálisis (HD) se han comunicado un estado nutricional deficiente y una peor calidad de vida (CdV) relacionada con la salud. El uso de cuestionarios de CdV genéricos y específicos de la enfermedad en la misma población puede proporcionar un mejor conocimiento del significado de la nutrición en las dimensiones de CdV. Objetivo: Evaluar el estado nutricional mediante parámetros fáciles de usar y evaluar la relación potencial con la CdV medida mediante cuestionarios genéricos y específicos de la enfermedad. Métodos: Se evaluó el estado nutricional mediante evaluación global subjetiva (EGS) adaptada a pacientes renales, índice de masa corporal (IMC), la ingesta nutricional y el apetito. La CdV se evaluó mediante el cuestionario genérico EuroQoL y el específico de la enfermedad Kidney Disease Quality of Life-Short Form (KDQoL-SF). Resultados: El estudio comprendía 130 pacientes de ambos sexos, edad media 62,7 ± 14,7 años. La prevalencia de la malnutrición varió desde 3,1% por un IMC =?18,5 kg/m2 hasta el 75,4% de los pacientes por debajo de las recomendaciones de ingesta de energía y proteínas. Con la excepción de la clasificación por el IMC, los pacientes malnutridos tenían peores puntuaciones en casi todos los dominios de la CdV (EuroQoL y KDQoL-SF), un patrón que se mantenía de forma dominante cuando se ajustaba para las variables demográficas y relacionadas con la enfermedad. Los pacientes con sobrepeso/obesidad (IMC ≥?25) también mostraron peores puntuaciones en algunas dimensiones de la CdV, pero tras el ajuste el patrón sólo se mantenía en el dominio de síntomas y problemas de KDQoL-SF (p = 0,011). Conclusión: Nuestro estudio reveló que incluso en pacientes en HD malnutridos, el estado nutricional tienen un impacto significativo en diversos dominios de la CdV. Los cuestionarios empleados proporcionaron perspectivas distintas, casi complementarias, si bien para la práctica diaria el EuroQoL es más sencillo. El asegurar un buen estado nutricional podría influir positivamente en la CdV.

Nutritional status influences generic and disease-specific quality of lifemeasures in haemodialysis patients / Estado nutricional influye en la calidad de vida en pacientes en hemodiálisis aplicando cuestionarios genéricos y específicos de la enfermedad

Background: Poor nutritional status and worse health-related quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. Objective: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. Methods: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. Results: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI < 18.5 kg/m2 to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/obese patients (BMI > 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). Conclusion: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL (AU)

Antecedentes: En pacientes en hemodiálisis (HD) se han comunicado un estado nutricional deficiente y una peor calidad de vida (CdV) relacionada con la salud. El uso de cuestionarios de CdV genéricos y específicos de la enfermedad en la misma población puede proporcionar un mejor conocimiento del significado de la nutrición en las dimensiones de CdV. Objetivo: Evaluar el estado nutricional mediante parámetros fáciles de usar y evaluar la relación potencial con la CdV medida mediante cuestionarios genéricos y específicos de la enfermedad. Métodos: Se evaluó el estado nutricional mediante evaluación global subjetiva (EGS) adaptada a pacientes renales, índice de masa corporal (IMC), la ingesta nutricional y el apetito. La CdV se evaluó mediante el cuestionario genérico EuroQoL y el específico de la enfermedad Kidney Disease Quality of Life-Short Form (KDQoL-SF). Resultados: El estudio comprendía 130 pacientes de ambos sexos, edad media 62,7 ± 14,7 años. La prevalencia de la malnutrición varió desde 3,1% por un IMC < 18,5 kg/m2 hasta el 75,4% de los pacientes por debajo de las recomendaciones de ingesta de energía y proteínas. Con la excepción de la clasificación por el IMC, los pacientes malnutridos tenían peores puntuaciones en casi todos los dominios de la CdV (EuroQoL y KDQoL-SF), un patrón que se mantenía de forma dominante cuando se ajustaba para las variables demográficas y relacionadas con la enfermedad. Los pacientes con sobrepeso/obesidad (IMC > 25) también mostraron peores puntuaciones en algunas dimensiones de la CdV, pero tras el ajuste el patrón sólo se mantenía en el dominio de síntomas y problemas de KDQoL-SF (p = 0,011). Conclusión: Nuestro estudio reveló que incluso en pacientes en HD malnutridos, el estado nutricional tienen un impacto significativo en diversos dominios de la CdV. Los cuestionarios empleados proporcionaron perspectivas distintas, casi complementarias, si bien para la práctica diaria el EuroQoL es más sencillo. El asegurar un buen estado nutricional podría influir positivamente en la CdV (AU)

Causes of autonomic dysfunction in idiopathic recurrent kidney stone formers.

BACKGROUND: A higher prevalence of hypertension and adverse cardiovascular outcomes has been reported in kidney stone formers (KSF). We performed this study with the purpose of evaluating the autonomic nervous system (ANS) activity in KSF. METHODS: We performed a 70° head-up tilt test in 30 idiopathic recurrent KSF aged 45.6 ± 12.1 years old (17 men: 13 women) and 30 healthy controls aged 42.0 ± 12.4 years old (17 women: 13 men). Thirteen KSF were hypertensive, and 17 were normotensive. Blood pressure (BP) and heart rate variability (HRV) were used for the non-invasive assessment of the efferent activity of the ANS. Discrete wavelet transform (DWT) was used to quantify the low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: 0.15-0.4 Hz) components during several periods of tilt. RESULTS: The results showed significantly higher HR and BP in KSF, in both supine and tilt positions. DWT revealed diminished HRV in the kidney stone patients during head-up tilt, with no increase in the LF and greater decrease in the HF components. The differences in the HF component of HRV were associated with obesity and hyperuricosuria, but the abnormalities of the LF component were independent of the explanatory variables. The LF component of systolic BP was significantly higher in KSF and was associated with hypertension. CONCLUSIONS: Several factors may contribute to the presence of autonomic dysfunction in patients with recurrent nephrolithiasis. This abnormality has significant implications in cardiovascular risk assessment and treatment planning.

Nephrolithiasis is associated with an increased prevalence of cardiovascular disease.

BACKGROUND: Nephrolithiasis has been associated with hypertension, obesity and diabetes mellitus. The prevalence of adverse cardiovascular outcomes among kidney stone formers (KSF) is unknown. METHODS: We examined the IV Portuguese National Health Survey for documenting possible associations between nephrolithiasis, cardiovascular diseases, diabetes and obesity in the Portuguese adult population. RESULTS: We obtained 23 349 questionnaires from individuals ≥ 15 years old. The prevalence of kidney stone disease (KSD) was 7.3%. The prevalence of hypertension was higher among KSF when compared with the general population (50.4 vs 30.2%; P < 0.001). Age and obesity significantly increase the risk for nephrolithiasis. After adjusting for age and body mass index, KSF have higher prevalence of hypertension [odds ratio (OR), 1.841; 95% CI, 1.651-2.053], diabetes mellitus (OR, 1.475; 95% CI, 1.283-1.696; P < 0.001), myocardial infarction (OR, 1.338; 95% CI, 1.003-1.786; P < 0.05) and stroke (OR, 1.330; 95% CI, 1.015-1.743; P < 0.05) compared with non-stone formers. CONCLUSIONS: KSD is associated with a higher prevalence of chronic diseases and adverse cardiovascular outcomes when compared with the general population.

Levantamento de seio maxilar com enxerto de osso homólogo particulado em áreas com remanescente ósseo inferior a três milímetros de altura

Os homoenxertos são enxertos de tecidos nos quais o doador e o receptor são da mesma espécie e podem ser encontrados como enxerto fresco congelado (criopreservado), congelado e desidratado (FDBA) e desminiralizado, congelado e desidratado (DFDBA). O osso autógeno fresco é o melhor material para aumento ósseo disponível...

Mutant fibrinogen A-alpha-chain associated with hereditary renal amyloidosis and peripheral neuropathy.

A middle age Portuguese woman was investigated for renal amyloidosis. She presented with progressive renal failure, proteinuria, hypertension, and sensory symptoms in the feet. Clinical and neurophysiological evaluation disclosed sensory-autonomic neuropathy. Cardiovascular tests and 123-MIBG investigation showed parasympathetic dysfunction and decrease of myocardial innervation, in accordance with small fiber neuropathy, as usually observed in amyloidosis. Immunohistochemical studies revealed AFib amyloidosis and genetic studies the amino acid exchange Glu526Val of the fibrinogen Aalpha-chain mutation, which was also present in one of her sons. The mutant gene in this patient was associated with the same haplotype as all other reported cases of Glu526Val mutations. This is the first reported AFibamyloidosis in Portugal, and the first case of AFib in which sensory and autonomic nerve fiber dysfunction is described, indicating that small nerve fiber lesion can occur in the fibrinogen Aalpha chain mutation. This can be important for prognosis, in particular when liver transplantation is considered for treatment.

[Metabolic evaluation of recurrent idiopathic calcium stone disease in Portugal]. / Avaliação metabólica da litíase cálcica idiopática recorrente em Portugal.

BACKGROUND: Idiopathic calcium stone disease is the most frequent type of nephrolithiasis in industrialised countries. Several metabolic, environmental and genetic factors have described and may be involved in its pathogenesis. This study was designed to evaluate the factors that contribute to idiopathic calcium stone disease in Portugal. METHODS: To characterise the Portuguese population with idiopathic recurrent calcium stone disease, a population of 87 consecutive idiopathic recurrent calcium stone formers (IRCSF) was evaluated over a 5-year period. The results were compared with a control group of 45 healthy subjects (HS) from the same population, with similar age and gender distribution. RESULTS: No difference was observed in the distribution of affected individual according to gender (47 females and 40 males). A familial history of nephrolithiasis was present in 35.6%. Significantly higher urinary calcium and lower urinary citrate were observed in IRCSF group when compared with HS group. Individual analysis revealed urinary abnormalities in 78 of 87 IRCSF (89.7%). Hyperoxaluria was the most frequent abnormality, observed in 40.2% of the patients, hyperuricosuria in 33.3%, hypercalciuria in 24.1%, hypocitraturia in 23.0%, low urine volume in 19.5% and hypomagnesiuria in 8%. No difference was observed in the distribution of urinary risk factors according to gender or presence of familial antecedents of nephrolithiasis. A positive correlation was observed between urinary sodium and calcium in hypercalciuric patients. CONCLUSIONS: Among the studied population, idiopathic calcium nephrolithiasis affected both genders equally. Metabolic evaluation permits the identification of urine abnormalities in most of these patients. Hyperoxaluria, hypercalciuria, hypocitraturia and hyperuricosuria appeared as important pathogenic factors in IRCSF. Urine volume was not different between groups. Dietary factors may be involved in the observed urine abnormalities and need to be further evaluated.

[Paraquat intoxication]. / Intoxicação por paraquat.

Paraquat, widely used as a contact herbicide is, in some environments (meanly rural), the principal mean of suicide. Commercially known as Gramoxone, it was sintetyzed for the first time in 1882 and its herbicide properties were not discovered until 1955. The authors made a literature review and describe the historic perspective, physicochemical properties, clinic aspects, prognosis factors and treatment and, finally, propose a therapeutic approach having always in mind the capital importance of the early beginning of general treatment of intoxication cases.