Anamnesis ambiental como parte de la consulta pediátrica: estudio piloto / Environmental history-taking as part of pediatric consultations: a pilot study

Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental history- taking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study

Eficácia e segurança de rotigotina, comparada a outros agonistas dopaminérgicos disponíveis no SUS, para o tratamento da doença de Parkinson: revisão rápida de evidências / Effectiveness and safety of rotigotine in comparison to other dopaminergic agonists available in the Brazilian Public Health System for treatment of Parkinson's disease: rapid evidence review

Rotigotina e outros medicamentos antiparkinsonianos, com ênfase em agonistas dopaminérgicos (bromocriptina e pramipexol). Indicação: Tratamento da doença de Parkinson. Pergunta: Há superioridade de eficácia e segurança da rotigotina, comparado aos agonistas dopaminérgicos disponíveis atualmente no SUS para o tratamento da doença de Parkinson? Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PubMed e utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Foram selecionadas três revisões sistemáticas que atendiam aos critérios de inclusão. A rotigotina não apresenta eficácia e segurança superiores ao pramipexol; não há quantidade de estudos suficientes para comparação com a bromocriptina

Rotigotine and other antiparkinsonians medicines, with emphasis on dopaminergic agonists (bromocriptine and pramipexole). Indication: Treatment of Parkinson disease. Question: Is rotigotine more effective and safer than other dopamine agonists available in the Brazilian Public Health System for the treatment of Parkinson's Disease? Rapid evidence review (overview) from systematic reviews, with a literature search in the PubMed database by employing a structured strategy. The methodological quality of systematic reviews was evaluated using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Three systematic reviews that met the inclusion criteria were selected. Rotigotine has not shown superior efficacy and safety when compared to pramipexole; there are insufficient studies for comparison with bromocriptine

O medo da morte e do morrer em estudantes da saúde / Fear of death and dying in health students / El miedo a la muerte y a morir en estudiantes de la salud

A morte ainda causa aversão em alunos e profissionais da saúde e é enfrentada como fracasso desde a formação acadêmica. O estudo objetivou de forma geral, avaliar o medo da morte em estudantes da área da saúde. Aplicou-se um questionário sociodemográfico e a escala do medo da morte Collet-Lester em 366 estudantes de medicina, psicologia, enfermagem e fisioterapia. Os resultados indicaram que apenas o curso de medicina e fisioterapia apresentaram diferenças significativas nas subescalas referentes ao medo da morte, nas demais análises levantou-se hipóteses. Identificou-se que houve uma tendência dos estudantes de enfermagem apresentar maior medo em relação à própria morte e os de psicologia em medo do próprio processo de morrer. Concluiu-se que o medo da morte do outro surge como característica comum entre os estudantes dos quatro cursos, apontando diferenças no medo da morte entre os diferentes períodos dos cursos analisados.

Death still causes aversion in students and health professionals and is faced as a failure since academic training. The study aimed, in general, to assess the fear of death in health students. A sociodemographic questionnaire and the Collet-Lester fear of death scale were applied to 366 students of medicine, psychology, nursing and physiotherapy. The results indicated that only the medical and physical therapy courses showed significant differences in the subscales related to fear of death, in the other analyzes, hypotheses were raised. It was identified that there was a tendency for nursing students to be more afraid of their own death and those of psychology to be afraid of their own dying process. It was concluded that the fear of death of the other emerges as a common characteristic among students of the four courses, pointing out differences in fear of death between the different periods of the analyzed courses.

La muerte todavía causa aversión en estudiantes y profesionales de la salud y es enfrentada como un fracaso desde la formación académica. El estudio tuvo como objetivo, en general, evaluar el miedo a la muerte en estudiantes del área de la salud. Se aplicó un cuestionario sociodemográfico y la escala de miedo a la muerte de Collet-Lester a 366 estudiantes de medicina, psicología, enfermería y fisioterapia. Los resultados indicaron que sólo el curso de medicina y fisioterapia presentaron diferencias significativas en las subescalas relacionadas con el miedo a la muerte, en los otros análisis se plantearon hipótesis. Se identificó que los estudiantes de enfermería tenían una tendencia a tener más miedo a su propia muerte y que los estudiantes de psicología tenían miedo del proceso mismo de morir. Se concluyó que el miedo a la muerte del otro surge como una característica común entre los estudiantes de los cuatro cursos, señalando diferencias en el miedo a la muerte entre los diferentes períodos de los cursos analizados.

Venomous animals in Pernambuco: children at risk / Animais peçonhentos em Pernambuco: crianças em risco

Abstract Objectives: to analyze the epidemiological and clinical aspects of accidents caused by venomous animals in children under 15 years old. Methods: a cross-sectional study with an analytical component using secondary data from Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), (Poison Center in Pernambuco)), in 2017 to 2019. Notifications of accidents caused were included in the studied age group and evaluated the characteristics of poisoning (animal classification, exposure zone, place and time of the occurrence and specific use of serum therapy), and of the patient (sociodemographic variables, clinical condition and evolution). The analysis performed in STATA® 13.1 presents frequency distribution tables and Pearson's chi-square for comparison. Results: of the 2678 notifications, 82,8% were scorpionism and 10, 8% snakebite. The age group of1 to 9 years old (70.5%) and being male (54.1%) were predominant. Most of the cases occurred in urban area (80.9%), in Recife (67.3%), inside the victim's residence (83.9%) and at night (47.3%). The majority (87.1%) were classified as 'mild severity', 10% received antivenom therapy and one died (by scorpionism). Two cases of snakebite in the workplace were registered. Conclusion: there was a high frequency of accidents caused in the urban area, which may be related to the lack of urban planning and sanitary education. The accidents caused among children in the household environment and the suspicion of child labor in the age group of 10 to 14 years old were also highlighted which favors the development and habits of the venomous animal.

Resumo Objetivos: analisar aspectos epidemiológicos e clínicos dos acidentes por animais peçonhentos em menores de 15 anos. Métodos: estudo transversal com componente analítico utilizando dados secundários do Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), no período de 2017 a 2019. Foram incluídas as notificações dos acidentes na faixa etária estudada e avaliadas características do envenenamento (classe do animal, zona de exposição, local/turno da ocorrência e uso soroterapia específica) e do paciente (variáveis sociodemográficas, gravidade clínica e evolução). A análise realizada no STATA® 13.1 apresenta tabelas de distribuição de frequência e qui-quadrado de Pearson para comparação. Resultados: das 2678 notificações, 82,8% foram de escorpionismo e 10,8% de ofidismo. Predominaram na faixa etária de 1a 9 anos (70,5%) e sexo masculino (54,1%);ocorreram principalmente na zona urbana (80,9%),no Recife(67,3%), na residência da vítima (83,9%), durante horário noturno (47,3%). A maioria (87,1%) foi classificada como de gravidade leve, 10% receberam soroterapia e ocorreu um óbito (escorpionismo). Registraram-se dois casos de ofidismo em ambiente de trabalho. Conclusão: ressaltam-se os acidentes intradomiciliares entre crianças e a suspeita de trabalho infantil na faixa etária de 10 a 14anos.Os acidentes ocorreram sobretudo na zona urbana provavelmente associado à falta de planejamento e educação sanitária que favorece o desenvolvimento e hábitos do animal peçonhento.

COVID-19 in the perioperative period of cardiovascular surgery: the brazilian experience

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

Modelagem da vegetação aquática em estudos de dinâmica dos fluidos computacional / Modeling aquatic vegetation in computational fluid dynamics studies

RESUMO O objetivo deste trabalho foi apresentar, por meio da técnica dinâmica dos fluidos computacional (CFD), dois métodos utilizados nas representações conceitual e física da vegetação em meio aquático: meio poroso e elementos geométricos simplificados. Três estudos de caso, que incluem um wetland flutuante e manchas de vegetação, exemplificam a aplicação dos métodos, mostrando suas vantagens e desvantagens. Nas etapas da geometria e da malha, a representação da vegetação como meio poroso é mais simples, prática e rápida do que a da vegetação como elementos geométricos simplificados. Porém, na parte da modelagem das equações, o método do meio poroso não consegue capturar os processos de mistura no interior da vegetação, enquanto o método dos elementos geométricos simplificados consegue.

ABSTRACT The goal of this work was to present, through computation fluid dynamics (CFD), two methods used in the conceptual and physical representation of vegetation in aquatic environments: the porous media approach and the simplified geometric elements. Three case studies, including a floating wetland and patches of vegetation, exemplify how the methods are applied, showing their advantages and disadvantages. At the geometry and meshing stage, the porous media approach shows to be simpler, faster, and more practical than the simplified geometric elements. However, in the equation modeling, the porous media approach is not able to capture the mixing processes inside the vegetation, while the simplified geometric elements method can capture those processes.

Genetic diversity and structure in natural populations of Cajui from Brazilian Cerrado

Cajui (Anacardium spp.) is a native fruit tree (small cashew) of the Brazilian Cerrado and possesses the potential for commercialization. However, cajui exploitation occurs exclusively through extractivism in the absence of conservation strategies. The lack of conservation strategies may lead to a decrease in genetic diversity of Anacardium. In this work, the genetic diversity and population structure of three natural populations in Sete Cidades National Park (PNSC; PI, Brazil) were assessed using ISSR analysis of 56 cajui accessions and two A. occidentale accessions (outgroup) from Pacajus (CE, Brazil). A total of 112 markers were obtained, 93 (83.04%) of which were polymorphic. The diversity indices of these populations indicated moderate levels of genetic diversity. According to AMOVA, 96.17% of the genetic variability lay within populations, with low genetic differentiation among populations (ΦST = 0.03828). Furthermore, STRUCTURE analysis indicated the existence of four connected genetic groups. The findings show that the individuals from the three collection sites did not represent different subpopulations, likely due to the high gene flow (Nm = 6.7) favored by the floral biology of Anacardium, pollinators and small-animal seed dispersers. This research identifies genetically divergent individuals (C-03, C-05, C-22, C-26, C-34 and C-39), which should be considered priority individuals for conservation and can inform conservation programs for Anacardium spp.

Diretriz Técnica da ANAMT (DT 07): mapeamento epidemiológico e intervenção preventiva para violência no trabalho / ANAMT Technical Guideline (DT 07): epidemiological mapping and preventive interventions against workplace violence

Violência em ambiente de trabalho potencialmente ocorre em prevalência importante, com associação de risco positiva para adoecimento físico e mental, absenteísmo, aumento de rotatividade, diminuição da produtividade e piora do clima organizacional. A expressão da violência no trabalho é incrustada no cotidiano profissional e heterogênea na cultura, atividade e organização de trabalho locais. Há insuficiência de evidências científicas que atestem a eficácia das intervenções em reduzir a prevalência dos eventos de violência de forma a permitir recomendações generalizáveis para qualquer atividade de trabalho. A natureza subjetiva e cultural do problema torna necessária a criação de um consenso com os membros da empresa quanto aos conceitos, importância, prevalência e fatores de risco da violência ocupacional a partir da apresentação do mapeamento epidemiológico. O desenho conjunto de soluções piloto pelos membros da empresa surge após esse consenso. Essa abordagem segue a metodologia dos estudos experimentais sobre o tema e busca promover maior aderência a mudanças

Workplace violence has potentially high prevalence, in addition to positive correlation with risk of physical and mental disorders, absenteeism, high turnover rates, impaired productivity and poorer organizational climate. Workplace violence is embedded in the work routine, while its manifestations are heterogeneous and vary according to the local culture, work activities and organization. The scientific evidence for the efficacy of interventions to reduce the prevalence of violent incidents is insufficient to ground general recommendations applicable to any occupational activity. Consensus among organizational actors about notions, relevance, prevalence and risk factors associated with workplace violence, based on epidemiological mappings, is necessary, given the subjective and cultural nature of this problem, and also to enable organizational actors to jointly design pilot solutions. This approach is based on methods used in experimental studies and seeks to promote greater adherence to changes

Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during cabg: a double-blind controlled randomized trial

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Ação, atuação e formação profissional: uma revisão sobre animação sociocultural na Educação Física / Action, performance and professional training: a review on sociocultural animation in physical education

Este trabalho visa apresentar a "animação sociocultural" como aprimoramento da formação do profissional de Educação Física. Assim, este estudo de natureza qualitativa tem por objetivo aprofundar teoricamente sua concepção, com a finalidade de ampliar o leque de possibilidades de ação e atuação no mercado de trabalho para profissionais de Educação Física no Brasil. A metodologia utilizada foi uma revisão de literatura a partir da base de dados Parthenon/UNESP. Os resultados apontam diferentes perspectivas sobre a "animação sociocultural", como a polissemia de conceitos existentes no Brasil, as ações pontuais, a atuação voltada à transformação social, o perfil profissional, a formação e o mercado de trabalho. Como considerações finais esta formação profissional desenvolve sujeitos transformadores, capazes de significar e/ou ressignificar a realidade e, desse modo, permitir o desenvolvimento do ser humano.

This work aims to present the "sociocultural animation" as an improvement of the training of the Physical Education professional. Thus, this qualitative study has the objective of theoretically deepening its conception, with the purpose of expanding the range of possibilities of action and performance in the labor market for Physical Education professionals in Brazil. The methodology used was a literature review from the Parthenon /UNESP database. The results point to different perspectives on "sociocultural animation", such as the polysemy of existing concepts in Brazil, specific actions, action aimed at social transformation, professional profile, training and the labor market. As final considerations this professional formation develops transforming subjects, capable of meaning and / or re-signification of reality and, thus, allow the development of the human being.

Depression in the workplace: screening and treatment

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.

Diretriz Técnica da ANAMT (DT 05): prevenção de lombalgia ocupacional por uso de cinta, suporte ou órtese lombar / ANAMT Technical Guideline (DT 05): prevention of occupational low back pain through back belts, lumbar support or braces

Introdução: Lombalgia é um problema internacional importante de saúde pública. O uso de cinta lombar no meio ocupacional emerge da expectativa de inúmeros benefícios biomecânicos que, em conjunto, promoveriam a prevenção desse problema. Objetivo: Orientar estudantes, médicos e estabelecimentos de saúde sobre o uso de cinta lombar, suporte ou órtese lombar como prevenção da lombalgia ou de lesões lombares em trabalhadores sem sintomatologia atual. Método: Ela foi desenvolvida a partir da revisão sistemática da literatura: da base de dados MEDLINE, foram recuperados 809 trabalhos e das bases EMBASE e Central Cochrane, 571. Avaliar a cinta lombar como intervenção preventiva de lombalgia envolve a quantificação de benefícios, malefícios e facilidade de sua implementação, assim como a qualidade metodológica dos estudos primários. Conclusão: Apesar do benefício demonstrado fracamente em resultados individuais, parciais e isolados em poucos estudos, não há evidência consistente que sustente a utilização de cinta lombar, suporte ou órtese lombar na prevenção primária da lombalgia ou de lesões lombares ocupacionais em trabalhadores. As evidências, agrupadas, apontam para ausência de redução de absenteísmo com o uso da cinta lombar.

Background: Low back pain is a considerable global public health problem. Use of back belts in occupational settings arises from the expectation of countless biomechanical benefits, which together would contribute to the prevention of this problem. Objective: To orient students, physicians and health institutions on the use of back belts, lumbar support or braces for prevention of low back pain or injury among asymptomatic workers. Method: The present guideline was developed based on a systematic literature review; 809 studies were located in database MEDLINE and 571 in EMBASE and Cochrane CENTRAL. Evaluating back-belt use as preventive intervention against low back pain demands quantifying benefits, harms and difficulties to implementation, as well as the methodological quality of primary studies. Conclusion: Despite the weak benefits reflected in the individual, partial and isolated results of a few studies, there is no consistent evidence for the use of back belts, lumbar supports or braces for primary prevention of low back pain or occupational low back injury among workers. According to the available evidence, back-belt use is not associated with reduction of absenteeism

Extended-time of noninvasive positive pressure ventilation improves tissue perfusion after coronary artery bypass surgery: a randomized clinical trial

Abstract Objective: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05). Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function. Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br

O quarto de Jack: tecendo símbolos da relação primal à luz da teoria de Erich Neumann / "Room": forging symbols from the primal relationship according to the Erich Neumann's Theory / "La Habitación": tejiendo símbolos de la relación primal a la luz de la teoría de Erich Neumann

Este ensaio propõe a análise simbólica da obra cinematográfica "O quarto de Jack", entendendo-a como uma alegoria para explicitar a relação primal entre mãe e bebê, descrita por Neumann. Elementos dessa história, tais como a inconsciência do mundo externo pela criança e o período de isolamento em que se mantém circunscrito a seu mundo privado, semelhante a um útero psíquico, característico desta fase, levaram-nos a concluir que ela pode ser considerada um excelente representante simbólico desta teoria, tanto pelos aspectos visuais e linguísticos quanto pelo desenvolvimento cronológico.

This essay suggests the symbolic analysis of the cinematographic work "Room", as an allegory to explain the primal relationship between mother and baby, described by Neumann. Features of this novel - as the child's unconsciousness of the external world and the confinement in which his world is circumscribed, similar to a psychic uterus of this phase - led us to the conclusion that "Room" can be considered an excellent symbolic nominee of this theory, as much by its visual and linguistic aspects as by the chronological development.

Este ensayo propone un análisis simbólico de la obra cinematográfica "La habitación", entendiéndola como una alegoría para explicitar la relación primal entre madre y bebé, descrita por Neumann. Características - tales como la inconsciencia del niño en relación al mundo externo y el período de aislamiento en que se mantiene circunscrito en su mundo privado, semejante al útero psíquico característico de esa fase -, nos han llevado a concluir que esta obra puede ser considerada una excelente representante simbólica de esa importante teoría, tanto por los aspectos visuales y lingüísticos, como por el desarrollo cronológico.

Allium sativum compared to cilostazol as an inhibitor of myointimal hyperplasia

Abstract Objective: Intimal hyperplasia is associated with graft failure and vascular sutures in the first year after surgery and in postangioplasty restenosis. Allium sativum (common garlic) lowers cholesterol and has antioxidant effects; it also has antiplatelet and antitumor properties and, therefore, has great potential to reduce or inhibit intimal hyperplasia of the arteries. Our objective is to determine if the garlic has an efficacy to inhibit myointimal hyperplasia compared to cilostazol. Methods: Female New Zealand rabbits were divided into the following groups (n=10 each) according to treatment: group A, garlic, 800 µg×kg-1×day-1, orally; group C, cilostazol, 50 mg.day-1, orally; group PS, 10 ml of 0.9% physiological saline solution, orally. Our primary is the difference of the mean of myointimal hyperplasia. Statistical analysis was performed by using ANOVA and Tukey tests, as well as the Chi-square test. We calculated the 95% confidence interval for each point estimate, and the P value was set as < 0.05. Results: Group PS had a mean hyperplasia rate of 35.74% (95% CI, 31.76–39.71%); group C, 16.21% (95% CI, 13.36–19.05%); and group A, 21.12% (95% CI, 17.26–25.01%); P<0.0001. Conclusion: We conclude that Allium sativum had the same efficacy in inhibiting myointimal hyperplasia when compared to the positive control, cilostazol.

Qualidade de vida de pessoas com pé diabético / Quality of life of people with diabetic foot

Avaliar a qualidade de vida de pessoas com pé diabético e sua associação com idade e sexo. Métodos:estudo transversal realizado com pessoas com pé diabético atendidas na clínica vascular de um hospitalmunicipal. Foram utilizados questionários sociodemográfico, clínico, de estilo de vida e de avaliação de qualidadede vida SF-36. Resultados: amostra de 48 pessoas, maioria idosa (58,4%), sexo feminino (56,3%), não tabagista(93,7%), não etilista (83,4%), com reincidência das úlceras (50,0%), secreção presente (54,2%) e odor fétidoausente (81,3%). Quanto à qualidade de vida, o melhor resultado foi no domínio vitalidade e pior no domínioaspectos físicos. Todos os domínios, exceto a vitalidade, apresentaram escore abaixo de 50 na mensuração daqualidade de vida. Não houve diferença significante na comparação da qualidade de vida entre faixas etárias esexo. Conclusão: os participantes apresentaram domínios de qualidade de vida que tendem a um pior estadode saúde...

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe / Efeito Endotelial da Terapia com Estatina em Alta Dose versus Baixa Dose Associada à Ezetimiba

Abstract Background: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. Objective: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. Methods: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. Results: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. Conclusion: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.

Resumo Fundamento: O efeito das estatinas na função endotelial em seres humanos permanece em discussão. Particularmente, ainda carece resposta se a melhora na função endotelial deve-se à redução do LDL-colesterol ou a um efeito pleiotrópico arterial. Objetivo: Testar a hipótese de que a modulação da função endotelial promovida por estatinas é prioritariamente mediada pelo grau de redução do LDL-colesterol, independente da dose de estatina utilizada. Métodos: Ensaio clínico randomizado com dois grupos de tratamento hipolipemiante (16 pacientes/cada) e um grupo placebo (14 pacientes). Os dois grupos ativos foram desenhados para promover graus semelhantes de redução de LDL-colesterol: o primeiro utilizou estatina em alta dose (80 mg, grupo sinvastatina 80) e o segundo em baixa dose (10 mg) associada a ezetimiba (10 mg, grupo sinvastatina 10/ezetimiba) para otimizar o efeito hipolipemiante. A função endotelial foi analisada pela vasodilatação mediada por fluxo (VMF) antes e após 8 semanas de tratamento. Resultados: A redução no LDL-colesterol foi semelhante entre os grupos sinvastatina 80 e sinvastatina 10/ezetimiba (27% ± 31% e 30% ± 29%, respectivamente, p = 0,75). O grupo sinvastatina 80 apresentou incremento da VMF de 8,4% ± 4,3% no basal para 11% ± 4,2% após 8 semanas (p = 0,02). Da mesma forma, o grupo sinvastatina 10/ezetimiba apresentou melhora da VMF de 7,3% ± 3,9% para 12% ± 4,4% (p = 0,001). O grupo placebo não apresentou variação no nível de LDL-colesterol ou da função endotelial. Conclusão: A melhora da função endotelial com uso de estatina parece depender mais da redução do LDL-colesterol, independente da dose de estatina utilizada, do que de mecanismos pleiotrópicos.

Giant-cell tumor: analysis on the importance of early diagnosis and the epidemiological profile / Tumor de células gigantes: análise sobre importância do diagnóstico precoce e perfil epidemiológico

This study aimed to ascertain the relationship between early diagnosis of giant-cell tumors (GCT) and their prognosis, by correlating the time of symptom onset with the staging of the injury (through the Campanacci classification at the time of diagnosis), and with the type of treatment. The secondary objective of the study was to outline the epidemiological profile of patients with GCT in the region where the data were gathered, and to compare them with data in the literature. METHODS: The authors present an evaluation on 61 patients diagnosed with bone GCT, with regard to the site of involvement, age, initial symptoms, time of symptom onset, classification and type of treatment, among patients attended between May 1994 and August 2009. RESULTS: The threshold indicated as the limit for Campanacci stage I tumors to be the commonest diagnosis, with a 98.2% chance that the treatment would be non-aggressive, was 2 months after symptom onset. This finding was statistically significant (p = 0.017). Every additional month increased the chance that a patient would be diagnosed with an advanced-stage tumor by 10.94%, in relation to the chances of having the other two stages of the tumor. CONCLUSION: The study result not only suggests that the alternative hypothesis that the earlier the diagnosis of GCT is, the less severe the lesion will be, has been confirmed; but also especially predicts the relationship between the time of symptom appearance and the severity of the tumor.

Presumir a relação entre o diagnóstico precoce do tumor de células gigantes (TCG) e o seu prognóstico, relacionar o tempo de surgimento dos sintomas com o estadiamento da lesão, por meio da classificação de Campanacci no momento do diagnóstico, e com tipo de tratamento. O objetivo secundário do estudo é traçar o perfil epidemiológico dos pacientes com TCG da região onde foram colhidos os dados e compará-lo com dados da literatura. MÉTODOS: Avaliação de 61 pacientes diagnosticados com tumor de células gigantes ósseo quanto ao local de acometimento, idade, sintomatologia inicial, tempo do surgimento dos sintomas, classificação e tipo de tratamento em pacientes atendidos entre maio de 1994 e agosto de 2009. RESULTADO: Aponta o marco de dois meses após o início da sintomatologia como data limite, quando seria mais comum o diagnóstico de tumor estágio I de Campanacci e com 98,2% de chance de ser tratado de modo não agressivo, dados com relevância estatística (p = 0,017). A cada aumento de um mês a chance de um paciente ser diagnosticado com tumor em estágio avançado é 10,94% maior do que em relação aos outros dois estágios do tumor. CONCLUSÃO: O resultado do estudo sugere não somente a confirmação da hipótese opcional de que quanto mais precoce o diagnóstico de TCG, menos grave é a lesão, mas, principalmente, prediz a relação do tempo de surgimento do sintoma com a gravidade do tumor.

Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera / Hiperplasia miointimal na artéria ilíaca em coelhos submetidos à angioplastia e tratados com Moringa oleifera

Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Objetivo: determinar a diferença da média de hiperplasia miointimal pós-angioplastia na artéria ilíaca de coelhos tratados e não tratados com extrato das folhas de Moringa oleifera. Métodos: ensaio aleatório em animais de laboratório por cinco semanas de seguimento, desenvolvido no Biotério do Laboratório de Tecnologia Farmacêutica da Universidade Federal da Paraíba. Foram utilizadas coelhas da raça Nova Zelândia, submetidas à dieta hipercolesterolêmica e angioplastia da artéria ilíaca externa, randomizadas em dois grupos: Grupo M200 (n=10), coelhas tratadas com 200mg/kg/dia de extrato de folhas de Moringa oleifera, por via oral; Grupo SF (n=10), coelhas tratadas com soro fisiológico 0,9%, por via oral. Após cinco semanas, os animais foram eutanaziados e as artérias ilíacas preparadas para histologia. Os cortes histológicos foram analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student. O nível de significância foi 0,05. Resultados: comparando as artérias ilíacas submetidas à angioplastia do grupo M200 com as do grupo SF, não houve diferença significativa da hiperplasia miointimal Conclusão: não houve diferença da hiperplasia miointimal nos grupos tratados com soro fisiológico e Moringa oleifera após angioplastia.