Lack of methylation changes in GJB2 and RB1 non-coding regions of cochlear implant patients with sensorineural hearing loss

Objective@#Recent advances in epigenetic studies continue to reveal novel mechanisms of gene regulation and control, however little is known on the role of epigenetics in sensorineural hearing loss (SNHL) in humans. We aimed to investigate the methylation patterns of two regions, one in RB1 and another in GJB2 in Filipino patients with SNHL compared to hearing control individuals. @*Methods@#We investigated an RB1 promoter region that was previously identified as differentially methylated in children with SNHL and lead exposure. Additionally, we investigated a sequence in an enhancer-like region within GJB2 that contains four CpGs in close proximity. Bisulfite conversion was performed on salivary DNA samples from 15 children with SNHL and 45 unrelated ethnically-matched individuals. We then performed methylation-specific real-time PCR analysis (qMSP) using TaqMan® probes to determine percentage methylation of the two regions. @*Results@#Using qMSP, both our cases and controls had zero methylation at the targeted GJB2 and RB1 regions. @*Conclusion@#Our study showed no changes in methylation at the selected CpG regions in RB1 and GJB2 in the two comparison groups with or without SNHL. This may be due to a lack of environmental exposures to these target regions. Other epigenetic marks may be present around these regions as well as those of other HL-associated genes.

¿Cómo evalúan los cardiólogos la actividad sexual de sus pacientes? / How do cardiologists assess their patients' sexual activity?

Resumen Objetivo: Los pacientes con enfermedad coronaria y sus familias, a menudo enfrentan numerosos cambios en sus vidas. Las recomendaciones sobre la actividad sexual (AS) deben incluirse en el manejo de estos pacientes. El objetivo de este estudio fue evaluar el grado de conocimiento y la actitud profesional con respecto a la AS del paciente. Método: Se realizó un estudio descriptivo y analítico de corte transversal. Los datos se obtuvieron a partir de una encuesta estructurada, virtual y anónima, realizada entre médicos cardiólogos/as. Resultados: Se analizaron 345 encuestas. El 63.8% consideró la disfunción sexual como un marcador de riesgo cardiovascular. Asimismo, el 68.1% consideró relevante o muy relevante interrogar acerca de la AS. En relación con el asesoramiento, se cree que fundamentalmente lo debería comenzar el cardiólogo/a. Se observó una actitud más activa, respecto al abordaje del reinicio de la AS luego de un evento cardiovascular, un mayor interés por capacitarse en temas relacionados con la AS y una mayor solicitud de dosaje de testosterona e indicación de inhibidores de la fosfodiesterasa tipo 5 en los profesionales > 60 años y de sexo masculino en comparación con los médicos más jóvenes o de sexo femenino, respectivamente. Conclusiones: Este estudio mostró que el grado de conocimiento sobre los aspectos relacionados con la AS de los pacientes fue deficiente. Dada la relevancia del tema, consideramos importante fortalecer la educación médica en todos los ámbitos.

Abstract Background: Patients with coronary heart disease and their families often face numerous changes in their lives. Recommendations on sexual activity (SA) should be included in the management of these patients. The objective of this study was to evaluate the degree of knowledge and professional attitude regarding the patient's SA. Objective: A descriptive and analytical cross-sectional study was carried out. The data were obtained from a structured, virtual and anonymous survey that was carried out among cardiologists. Results: Three hundred forty-five surveys were analyzed. In total, 63.8% considered sexual dysfunction as a cardiovascular risk marker. Likewise, 68.1% considered it relevant or very relevant to ask patients about SA. Regarding counseling, it is believed that it should be initiated primarily by the cardiologist. A more active attitude regarding the re-initiation of SA after a cardiovascular event, a greater interest in SA training, more testosterone orders and more indications of phosphodiesterase inhibitors were observed in professionals older than 60 years and male compared to younger or female physicians, respectively. Conclusions: This study showed that the degree of knowledge of the patients about the aspects related to SA was poor. Given the relevance of the topic, we consider it important to strengthen medical education in all areas.

O valor da marca das equipes esportivas profissionais na perspectiva do consumidor: uma revisão integrativa / Brand equity of professional sports teams from consumers' perspective: an integrative review / El valor de la marca de los equipos deportivos profesionales desde la perspectiva del consumidor: una revisión integrativa

Resumo O presente estudo teve como objetivo descrever e revisar criticamente a literatura acerca do valor da marca das equipes esportivas profissionais na ótica do consumidor. Utilizou-se de uma revisão integrativa, com buscas entre outubro e novembro de 2019 por artigos empíricos e conceituais publicados até setembro de 2019, nas seguintes bases de dados: SCOPUS, Web of Science, Academic Search Ultimate e Business Source Ultimate. Após a aplicação dos critérios de inclusão e exclusão, uma busca paralela nas principais revistas da área da gestão e marketing do esporte e o processo de cross-manual reference, 16 artigos foram incluídos na revisão. Observou-se uma predominância de publicações na Europa, no futebol, inicialmente com uma abordagem qualitativa, transitando nas últimas publicações para uma análise quantitativa. Várias dimensões são utilizadas para a análise da temática e sua importância é justificada pelo impacto na lealdade dos fãs, no sucesso econômico e esportivo das equipes.

Abstract The present study aimed to describe and critically review literature about the brand equity of professional sports teams from consumers' perspective. An integrative review was used, with searches conducted between October and November 2019 for empirical and conceptual articles published until September 2019, in the following databases: SCOPUS, Web of Science, Academic Search Ultimate, and Business Source Ultimate. After applying inclusion and exclusion criteria, a parallel search in the main sports management and marketing journals, and the cross-manual reference process, 16 articles were included in the review. Publications in the European context and in football prevailed, initially with a qualitative approach moving from the latest publications to quantitative analysis. Several dimensions are used to analyze the theme, and its importance is justified by the impact on fans' loyalty and on teams' economic and sporting success.

Resumen El presente estudio tuvo como objetivo describir y revisar críticamente la literatura sobre el valor de la marca de los equipos deportivos profesionales desde la perspectiva del consumidor. Se utilizó una revisión integrativa, buscando, entre octubre y noviembre de 2019, artículos empíricos y conceptuales publicados hasta septiembre de 2019 en las siguientes bases de datos: SCOPUS, Web of Science, Academic Search Ultimate y Business Source Ultimate. Después de aplicar los criterios de inclusión y exclusión y de realizar una búsqueda paralela en las principales revistas del área de gestión deportiva y marketing del deporte y del proceso de cross-manual reference, se incluyeron 16 artículos en la revisión. Se observó una predominancia de publicaciones en Europa, en el fútbol, inicialmente con un enfoque cualitativo, pasando, en las últimas publicaciones, al análisis cuantitativo. Se utilizan varias dimensiones para analizar la temática y su importancia se justifica por el impacto en la lealtad de los aficionados y en el éxito económico y deportivo de los equipos.

Interstitial mycosis fungoides / Micose fungoide intersticial

ABSTRACT Interstitial mycosis fungoides (IMF) is a rare variant of mycosis fungoides, a cutaneous T-cell non-Hodgkin's lymphoma. It is characterized by an interstitial dermal infiltrate of lymphocytes and histiocytes between collagen bundles. We report the case of a 54-year-old patient with pruritic hypochromic macules on the arms and forearms diagnosed with IMF. Special attention was given to the anatomopathological features that differentiate this entity from its differential diagnoses, such as inflammatory morphea, interstitial annular granuloma, and other variants of the mycosis fungoides itself. We also present a review of the literature on the classification of the IMF.

RESUMEN La micosis fungoide intersticial (MFI) es una variante poco común de la micosis fungoide, un linfoma cutáneo de células T no Hodgkin. Se caracteriza por un infiltrado dérmico intersticial de linfocitos e histiocitos entre haces de colágeno. Presentamos el caso de un paciente de 54 años con máculas hipocrómicas pruriginosas en brazos y antebrazos diagnosticado de MFI. Se prestó especial atención a las características anatomopatológicas que diferencian a esta entidad de sus diagnósticos diferenciales, como morfea inflamatoria, granuloma anular intersticial y otras variantes de la propia micosis fungoide. También presentamos una revisión de la literatura sobre la clasificación de la MFI.

RESUMO A micose fungoide intersticial (MFI) é uma variante rara da micose fungoide, um linfoma cutâneo de células T não Hodgkin. É caracterizada por um infiltrado dérmico intersticial de linfócitos e histiócitos entre feixes de colágeno. Relatamos o caso de um paciente de 54 anos com máculas hipocrômicas pruriginosas nos braços e antebraços com diagnóstico de MFI. Atenção especial foi dada às características anatomopatológicas que diferenciam essa entidade de seus diagnósticos diferenciais, como morfeia inflamatória, granuloma anular intersticial e outras variantes da própria micose fungoide. Apresentamos também uma revisão da literatura sobre a classificação da MFI.

Efficacy of vitamin D supplementation among persons living with HIV/AIDS in São Paulo city, Brazil

ABSTRACT Hypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p= 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil.

Pancreatic panniculitis in systemic lupus erythematosus and Crohn's disease: rare event / Paniculite pancreática no lúpus eritematoso sistêmico e na doença de Crohn: raro evento

ABSTRACT Pancreatic panniculitis (PP) is a rare manifestation of pancreatic disease, involving subcutaneous adipose tissue. We report two cases of this entity: a 37-year-old female patient with systemic lupus erythematosus (SLE) and an elderly woman with Crohn's disease. These are two chronic autoimmune inflammatory diseases that can be uncommonly related to acute pancreatitis and that culminates in PP. We also provide a brief review of the treatment, diagnosis and morphology of the lesions, as well as the pathophysiology of the disease. The importance of histopathological analysis of lesion biopsies is highlighted as an important diagnostic tool.

RESUMEN La paniculitis pancreática (PP) es una manifestación rara de enfermedad pancreática que afecta el tejido graso subcutáneo. Reportamos dos casos de esa entidad: una paciente del sexo femenino, 37 años, con lupus eritematoso sistémico (LES), y una anciana con enfermedad de Crohn. Ambas manifestaciones son enfermedades crónicas autoinmunes raramente relacionadas con el cuadro de pancreatitis aguda y que culminaron en PP. También hicimos una breve revisión acerca de tratamiento, diagnóstico y morfología de las lesiones, así como fisiopatología de la enfermedad. Se resalta la importancia de la inmunohistoquímica y del análisis histopatológico de biopsias de la lesión como herramientas diagnósticas.

RESUMO A paniculite pancreática (PP) é uma manifestação rara de doença pancreática que acomete o tecido adiposo subcutâneo. Relatamos dois casos dessa entidade: uma paciente do sexo feminino, 37 anos, portadora de lúpus eritematoso sistêmico (LES) e uma idosa com doença de Crohn. Ambas manifestações são doenças inflamatórias crônicas autoimunes raramente relacionadas com o quadro de pancreatite aguda e que culminaram em PP. Também fizemos uma breve revisão sobre tratamento, diagnóstico e morfologia das lesões, bem como da fisiopatologia da doença. Destacamos a importância da imuno-histoquímica e da análise histopatológica de biópsias da lesão como ferramentas diagnósticas.

Sarcoma fibromixoide intracraneal primario de bajo grado: reporte de caso y revisión de la literatura / Low-grade fibro-myxoid sarcoma of intracranial origin: A case report and literature review

Resumen El sarcoma fibromixoide de bajo grado (LGFMS) es un tumor de tejidos blandos de origen mesenquimal. Los sarcomas son un grupo heterogéneo, que representa el 1% de todas las neoplasias. Los sarcomas primarios del sistema nervioso central (SNC) son raros y representan solo el 0,7% del total de sarcomas, con una incidencia estimada de 3 por cada 10 millones de personas por año. En este artículo, se describe el caso de una mujer de 59 años que presentó un sarcoma fibromixoide intracraneal de bajo grado, localizado en la región parietal derecha. Se discute el curso clínico, estudios de imágenes, características histopatológicas y tratamiento de este diagnóstico infrecuente y, por lo mismo, muy poco reportado. El diagnóstico definitivo se obtiene, ciertamente, mediante estudios histo-patológicos.

Summary Low-grade fibromyxoid sarcoma (LGFMS) is a soft tissue tumor of mesenchymal origin. Sarcomas are a heterogeneous group, representing 1% of all neoplasm diagnoses. Primary sarcomas of the central nervous system (CNS) are rare, and represent only 0.7% of all sarcomas, with an estimated incidence of 3 per 10 million people per year. The case of a 59-year-old woman who developed a low-grade intracranial fibromyxoid sarcoma in the right parietal region, is described. The clinical course, imaging studies, histopathological features, and treatment approach of this unusual diagnosis, are discussed. Low-grade intracranial fibromyxoid sarcoma is a rare and probably under- reported condition. The definitive diagnosis is usually made through histo-pathological studies.

O Psíquico e o Corporal da Sexualidade nas Origens da Psicanálise freudiana / The Psychic and the Corporal of Sexuality in the Origins of Freudian Psychoanalysis

Resumo O artigo tem por objetivo explorar, em uma perspectiva teórica conceitual, a presença corporal da sexualidade na compreensão da psicanálise, não se esgotando ela no psiquismo. Argumenta-se que as vivências primitivas da sexualidade (a sexualidade infantil) não somente determinam formas da fantasia e dos sintomas, mas vigem como vivências corporais de estímulo e excitação, satisfação, prazer de órgão e dor. Para isso, percorre-se os diversos modos da presença da sexualidade nas neuroses e nas perversões, tais como compreendidas a partir dos primeiros textos de Freud, mostrando suas raízes no corpo e seus traços originários como permanentemente corporais. Conclui-se com a irredutibilidade entre psiquismo, sexualidade e corpo.

Abstract The article aims to explore, from a conceptual and theoretical perspective, the corporeal presence of sexuality in the comprehension of psychoanalysis, not exhausting it in the psyche. It is argued that the primitive experiences of sexuality (infantile sexuality) not only determine forms of fantasy and symptoms, but also act as bodily experiences of stimulation and arousal, organ satisfaction and pleasure and pain. In order to do so, one goes through the various modes of the presence of sexuality in neuroses and perversions, as understood from Freud's early texts, showing their roots in the body and their original features as permanently bodily. It is concluded with irreducibility between psyche, sexuality and body.

First report of hemosiderotic adenodermatofibroma in Brazil / Primeiro relato de adenodermatofibroma hemossiderótico no Brasil

ABSTRACT Hemosiderotic adenodermatofibroma is a recently recognized lesion, characterized by a dermal nodule with cystic structures of an apocrine gland, surrounded by a dermatofibroma-like stroma with hemosiderotic macrophages. We present the first case report of this entity in Brazil together with representative images, in addition to a review on the subject and discussion about the apocrine origin of this lesion.

RESUMEN El dermatoadenofibroma hemosiderótico es una lesión recientemente descrita, caracterizada por un nódulo dérmico con estructuras quísticas de una glándula apocrina, rodeado por un estroma del tipo dermatofibroma con macrófagos hemosideróticos. Presentamos el primer reporte de caso de esa entidad en Brasil, junto a imágenes representativas, además de una revisión del tema y discusiones acerca del origen apocrina de esa lesión.

RESUMO Adenodermatofibroma hemossiderótico é uma lesão recentemente conhecida, caracterizada por um nódulo dérmico com estruturas císticas de uma glândula apócrina, circundado por um estroma do tipo dermatofibroma com macrófagos hemossideróticos. Apresentamos o primeiro relato de caso dessa entidade no Brasil junto a imagens representativas, além de uma revisão do assunto e discussões sobre a origem apócrina dessa lesão.

Memory impairment: an intermediate clinical syndrome symptom in HTLV-1-infected patients? / Comprometimento da memória: um sintoma de síndrome clínica intermediária em pacientes infectados pelo HTLV-1?

Background Although classical human T-cell lymphocyte virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis syndrome is the most frequent HTLV-1-associated neurological disorder, some "minor" neurological disorders can be seen in "asymptomatic" carriers. These disorders, including cognitive alterations already described in clinical cases and studies, may constitute an intermediate syndrome (IMS) between the asymptomatic state and myelopathy. The aim of this study was to investigate the presence of cognitive deficits in patients with HTLV-1 virus, who usually are diagnosed as asymptomatic. Methods A total of 54 HTLV-1-infected patients were evaluated, 35 asymptomatic and 19 with minor neurological alterations (evaluated by a neurologist); 25 HTLV-1-seronegative individuals served as controls. The instruments used were: Beck's Depression Inventory, Lawton's Daily Life Activity Scale, and a complete neuropsychological battery. The application of these evaluation instruments was performed blindly, with the evaluator neuropsychologist not knowing the clinical condition of the patient. Results Most of the participants in this cohort, including seronegative controls, were female (n = 57, 72.21%), their mean age was 52.34 years (SD = 14.29) and their average schooling was 9.70 years (SD = 4.11). Discussion Participants classified with IMS had lower gross scores when compared with both the patients classified as asymptomatic and with the control group, and when tested for auditory episodic memory of immediate (p < 0.01), and late (p = 0.01), recall. Conclusion Patients with IMS presented with memory impairment when compared with asymptomatic patients and seronegative individuals; this is one of the symptoms that aids in the classification of the syndrome.

RESUMO Apesar da síndrome de HAM / TSP clássica ser a perturbação neurológica mais atribuída, alguns distúrbios neurológicos denominados "menores" são vistos em portadores "assintomáticos" de HTLV-1. Esses distúrbios, incluindo alterações cognitivas já observadas em descrições de casos clínicos e estudos, podendo constituir uma verdadeira síndrome clínica intermediária (SI) entre o estado assintomático e mielopatia. O objetivo deste estudo foi investigar a presença de déficits cognitivos em pacientes portadores do vírus HTLV-1 diagnosticados classicamente como assintomáticos. Métodos Foram avaliadas 54 pessoas, sendo 35 assintomáticos, 19 com alterações neurológicas menores (avaliados por um neurologista) e 25 HTLV-1 negativo. Os instrumentos utilizados foram: Inventário Beck de Depressão, Escala de Atividades de Vida Diária de Lawton e uma completa bateria neuropsicológica. A aplicação destes instrumentos de avaliação foi realizada de forma cega, ou seja, a avaliadora não sabia a condição clinica do paciente. Resultados A maioria dos participantes era do sexo feminino (n = 57, 72,21%), com idade média de 52.34 anos (DP = 14,29) e escolaridade média de 9.70 anos (DP = 4,11). Discussão Avaliando o desempenho cognitivo nos três grupos, foi possível observar que os participantes classificados com SI, apresentaram menores escores brutos, quando comparados, com os pacientes com classificação assintomática e grupo controle e, em relação à memória episódica auditiva de evocação imediata (p < 0,01) (p = 0,01) e tardia. Conclusão Diante dos resultados foi possível concluir que os pacientes com SI apresentam comprometimento de memória quando comparado com os outros grupos, sendo possível, ser este um dos sintomas para auxiliar na classificação da síndrome.

Endoscopic Ultrasound in the Diagnosis of Pancreatoduodenal Groove Pathology: Report of Three Cases and Brief Review of the Literature

The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, real-time procedures, such as fine-needle aspiration.

Prospective Analysis of Short- and Mid-term Knowledge Retention after a Brief Ultrasound Course for Undergraduate Medical Students

OBJECTIVES: The benefits of implementing point-of-care ultrasound (POCUS) in the emergency department are well established. Ideally, physicians should be taught POCUS during medical school. Several different courses have been designed for that purpose and have yielded good results. However, medical students need specifically designed courses that address the main objectives of knowledge acquisition and retention. Despite that, there is limited evidence to support knowledge retention, especially in the mid-term. The purpose of this study is to evaluate short- and mid-term knowledge retention after a student-aimed ultrasound course. METHODS: Medical students participating in a medical student trauma symposium (SIMPALT) in 2017 were included. Their profiles and baseline ultrasound knowledge were assessed by a precourse questionnaire (PRT). The same questionnaire was used one week (1POT) and three months (3POT) after the course. RESULTS: Most of the participants were 1st- to 4th- year medical students. None had prior ultrasound knowledge. They reported costs as the major barrier (65%) to enrollment in an ultrasound course. A comparison between the PRT and 1POT results showed a statistically significant difference (p<0.02), while no difference was found between 1POT and 3POT (p>0.09). CONCLUSION: Our findings support the use of a tailored ultrasound course for medical students. Knowledge acquisition and mid-term retention may be achieved by this specific population.

Waist circumference is an effect modifier of the association between bone mineral density and glucose metabolism

ABSTRACT Objective: The role of bone markers on insulin resistance (IR) remains controversial. The objective of this study is to evaluate the association between bone mineral density (BMD) and glucose metabolism and investigate if visceral hyperadiposity, evaluated by waist circumference (WC), is an effect modifier of this association. Subjects and methods: Cross-sectional analysis with 468 young adults from the fourth follow-up of the 1978/79 Ribeirão Preto prospective birth cohort, Brazil. BMD, total osteocalcin (OC), fasting plasma glucose and insulin concentrations were assessed. IR, sensitivity (S) and secretion (β) were estimated by homeostasis model assessment (HOMA) indexes. Multiple linear regression models were constructed to estimate the association between BMD and glucose metabolism. Beta coefficient, R2 and p-values were provided. WC was tested as an effect modifier and OC as a confounder. The covariates were selected based on Direct Acyclic Graph. Results: Significant interaction between BMD (femoral neck and proximal femur areas) and WC on glucose metabolism was observed in the adjusted models. Subjects with increased WC presented a positive association between BMD and log HOMA1-IR while an inverse association was found in those with normal WC (femoral neck R2 = 0.17, p = 0.036; proximal femur R2 = 0.16, p = 0.086). BMD was negatively associated with log HOMA2-S in individuals with increased WC and positively in those with normal WC (femoral neck R2 = 0.16, p = 0.042; proximal femur R2 = 0.15, p = 0.097). No significant associations between BMD, log HOMA2-β and OC and glucose metabolism markers were observed. Conclusions: BMD was associated with glucose metabolism, independently of OC, and WC modifies this association.

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion

ABSTRACT The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

RESUMO O objetivo desse artigo é enfatizar a importância do setup ortodôntico no planejamento do tratamento da má oclusão de Classe III esquelética de uma paciente adulta com apinhamento anteroinferior moderado e mordida cruzada anterior associada à presença de dois incisivos inferiores supranumerários.

Diógenes e o corpo "fabricador de drogas": o estatuto do corpo no uso abusivo de crack e nas situações de precariedade e vulnerabilidade social / Diogenes and the "drug-making" body: the body's statute in crack abuse and social vulnerability situations / Diogène et le corps comme «producteur des drogues¼: le statut du corps dans consommation de crack et dans les situations de précarité et vulnérabilité sociale / Diógenes y el cuerpo "productor de drogas": el estatuto del cuerpo en el uso abusivo de crack y en situaciones de precariedad y vulnerabilidad social

Este artigo aborda a relação entre os modos de subjetivação resultantes das situações de vulnerabilidade social e o uso abusivo de crack. A partir de um estudo de caso clínico, examinou-se como a ação do crack sobre o corpo pulsional se liga à experiência do sujeito e à sua inscrição no laço social e na realidade sociocultural. Observou-se estreita articulação entre o estatuto do corpo engendrado pelo uso de crack e o lugar conferido ao corpo nas situações de precariedade e exclusão.

This paper addresses the relationship between the forms of subjectivation that result from situations of social vulnerability and crack abuse. Drawing from a clinical case, examine we examined how crack's action in the pulsional body is connected to the subject's experience and to his or her social embeddedness in society and sociocultural reality. We observed a strong connection between the body's statute in the use of crack and the place assigned to the body in situations of social vulnerability and exclusion.

Cet article porte sur le rapport entre les modes de subjectivation résultants de situations de vulnérabilité sociale et la consommation du crack. À partir d'un cas clinique, on examine comment l'action du crack sur le corps pulsionnel se lie à l'expérience du sujet et à son rapport à l'autre, au lien social et à la réalité socioculturelle. On observe une étroite articulation entre le statut du corps engendré par la consommation du crack et la place accordée au corps dans les contextes de précarité et d'exclusion.

Este artículo aborda la relación entre los modos de subjectivación que resultan de situaciones de vulnerabilidad social y abuso de crack. A partir de un caso clínico, se ha analizado de qué forma la acción del crack sobre el cuerpo pulsional se articula a la experiencia del sujeto y a su inscripción en el lazo social y en la realidad sociocultural. Se ha observado una estrecha articulación entre el cuerpo engendrado por el uso abusivo de crack y el lugar dado al cuerpo en situaciones de precariedad y exclusión.

Dieser Artikel analysiert die Beziehung zwischen den verschiedenen Arten der Subjektivierung welche aus Situationen sozialer Verwundbarkeit und dem Konsum von Crack entstehen. Aufgrund einer klinischen Fallstudie untersuchten wir, auf welcher Weise die Wirkung des Cracks auf den Triebkörper sich auf die Erfahrung des Subjekts auswirkt, sowie auf seine Einfügung im sozialen Netz und in der sozio-kulturellen Realität. Eine enge Verbindung wurde festgestellt zwischen dem Status des Körpers der durch den Crackkonsum erzeugt wird und der zugeordneten Stelle des Körpers in Situationen der Prekarität und der Ausgrenzung.

Obstrução intestinal por intussuscepção devido melanoma metastático: relato de caso / Bowel obstruction in intussusception due melanoma metastatic: case report

O envolvimento do trato gastrointestinal por metástase de melanoma é uma entidade rara, sendo o intestino delgado o sítio mais comum. Comumente esses pacientes são assintomáticos ou manifestam sintomas inespecíficos. A ressecção das metástases pode proporcionar tratamento paliativo com alivio imediato dos sintomas. É essencial o diagnóstico precoce, quando essa medida ainda é potencialmente curativa. Este estudo relata um caso de obstrução intestinal por intussuscepção secundário à metástase por melanoma em um paciente jovem...

Involvement of the gastrointestinal tract by metastatic melanoma is a rare disease, the small bowel being the most common site. Commonly these patients are asymptomatic or manifest nonspecific symptoms.The resection of the metastases can provide palliative treatment with immediate relief of symptoms. Early diagnosis is essential if the measure is still potentially curative. This study reports a case of intestinal obstruction by intussusception secondary to metastatic melanoma in by a young patient...

Aggressive angiomyxoma of the vagina: a case report / Angiomixoma agressivo de vagina: um relato de caso

ABSTRACT Aggressive angiomyxoma (AAM) is a rare infiltrative tumor of mesenchymal origin that has high rates of local recurrence. We present the case of a 42-year-old patient with a lump in the vaginal canal, treated with excisional biopsy. Histopathologic evaluation revealed myxoid spindle-cell proliferation in the subepithelial region, and immunohistochemical analysis was positive for CDK4, CD34, desmin, estrogen and progesterone receptors. The markers S100 and smooth muscle actin were negative, what corroborated the diagnosis of AAM. Because of its high recurrence rates, we opted for outpatient follow-up during the two subsequent years.

RESUMO O angiomixoma agressivo (AA) é uma neoplasia rara de origem mesenquimal, caráter infiltrativo e altas taxas de recidiva local. Apresentamos o caso de uma paciente de 42 anos com nódulo no canal vaginal, submetida à biópsia excisional. A avaliação histopatológica demonstrou proliferação fusocelular mixoide na região subepitelial, e a análise imuno-histoquímica revelou positividade para CDK4, CD34, desmina e receptores de estrogênio e progesterona. Os marcadores S100 e actina de músculo liso foram negativos, o que corroborou o diagnóstico de AA. Devido às altas taxas de recidiva, optou-se por acompanhamento ambulatorial pelos dois anos subsequentes.

Vias de acesso às experiências constitutivas na proposta freudiana de psicanálise / Access routes to constitutive experiences in Freudian psychoanalysis proposed / Vías de acceso a las experiencias constitutivas en la propuesta freudiana del psicoanálisis

O texto tem por objetivo identificar na psicanálise freudiana vias para a apreensão, a compreensão e a consideração das experiências constitutivas e arcaicas do psiquismo - das experiências de fantasias de desejo recalcadas às vivências irrepresentáveis. Para isso, adota-se uma leitura de Freud guiada pela importância que tais experiencias adquirem na psicanálise contemporânea. Para desenvolver o argumento, tomam-se em consideração três aspectos metodológicos: o método de pesquisa que tem em vista a construção da teoria psicanalítica sobre as experiências constitutivas; o método clínico que visa a construção e o entendimento da própria clínica psicanalítica, e o método de tratamento que busca alcançar tais experiências com o fim de proporcionar transformações subjetivas. Mostra-se como o interesse de Freud se voltou para a pesquisa do inconsciente através do sonho, após a crise da neurótica, e recupera-se seu retorno à clínica e ao tratamento para reafirmar e reformular aspectos de seus achados em direção às experiências as mais primitivas. Por fim, sugere-se uma compreensão da construção da psicanálise segundo uma metodologia que se guia por escalas de abstrações.

The paper aims to identify ways in Freudian psychoanalysis for the apprehension, understanding and consideration of constitutive and archaic psyche's experiences - the experiences of repressed desire fantasies to unrepresentable experiences. For this, we adopt a reading of Freud guided by the importance that such experiences acquire in contemporary psychoanalysis. To develop the argument, taking into account three methodological aspects: the search method that aims at the construction of psychoanalytic theory about the constitutive experiences; clinical method that aims at building and understanding of clinical psychoanalysis itself, and treatment method which seeks to achieve these experiments in order to provide subjective transformations. It is shown how Freud's interest turned to the research of the unconscious through dream, after the crisis of the "neurotic", and recovers his return to the clinic and treatment to reaffirm and reshape aspects of their findings towards the more primitive's experiences. Finally, it suggests an understanding of the construction of psychoanalysis according to a methodology which is guided by scales abstractions.

El objetivo del texto es identificar en el psicoanálisis freudiano vías para la aprensión, la comprensión y la consideración de las experiencias constitutivas y arcaicas de lo psíquico - desde las fantasías de deseo recalcadas hasta las vivencias irrepresentables. Para ello, se adopta una lectura de Freud guiada por la importancia que tales experiencias adquieren en el psicoanálisis contemporáneo. Para desarrollar el argumento, se tienen en cuenta tres aspectos metodológicos: el método de investigación, que considera la construcción de la teoría psicoanalítica acerca de las experiencias constitutivas; el método clínico, que tiene por objetivo la construcción y la comprensión de la clínica psicoanalítica, y el método de tratamiento, que busca alcanzar dichas experiencias con el fin de proporcionar transformaciones subjetivas. Se demuestra como el interés de Freud se ha volcado a la investigación del inconsciente a través del sueño, tras la crisis de la neurotica, y se recupera su regreso a la clínica y al tratamiento para reafirmar y formular aspectos de sus hallazgos en dirección a las experiencias las más primitivas. Por fin, se sugiere una comprensión de la construcción del psicoanálisis de acuerdo con una metodología guiada por escalas de abstracciones.

Estudo epidemiológico da evolução de neonatos com hipertireotropinemia no Estado de Minas Gerais: Brasil / Epidemiologic study of the newborns evolution with hyperthyrotropinemia in the State of Minas Gerais: Brazil

Introdução: no exame sérico os valores de TSH acima de 10 ?Ul/mL e de T4 livre (T4L) baixo confirmam o diagnóstico do hipotireoidismo congênito, e as crianças deverão ser tratadas. Contudo, se houver elevação discreta do TSH (5,6 a 10 µUI/mL) e T4L normal, o recém-nascido (RN) apresenta quadro de hipertireotropinemia (HT) neonatal, que pode ser transitório ou permanente, e deve permanecer em acompanhamento clínico rigoroso. Objetivos: verificar a evolução de crianças triadas pelo Programa de Triagem Neonatal de Minas Gerais (PTN-MG) com HT. Métodos: estudo do tipo coorte retrospectivo. Analisaram-se os dados obtidos pelo ?teste do pezinho?, disponibilizados pelo banco de dados do Núcleo deAções e Pesquisa em Apoio Diagnóstico (NUPAD). Resultados: no período de 2000 a 2010,125 RNs apresentaram HT. Desses, 48% normalizaram os níveis de TSH no período médio de 20 meses. Já os outros 52% não normalizaram o TSH no período estudado e por isso foram mantidos em acompanhamento. Conclusões: mesmo que os níveis de TSH tenham se normalizado em 48% dos casos, concedendo alta a esses RNs, o tempo para esse desfecho foi significativo (cerca de 20 meses). Nesse período, pode haver alterações nos exames, muitas vezes com necessidade de tratamento com reposição hormonal, sendo, portanto, fundamentalo seguimento por meio de consultas e dosagens hormonais periódicas.

Introduction: in the serum exam TSH values above 10 ?Ul / mL and free T4 (FT4) low confirm the diagnosis of congenital hypothyroidism, and children should be treated. However, if mild elevation of TSH (5.6 to 10 ?UI / mL), normal FT4, the newborn (NB) has a hyperthyrotropinemia (HT) frame neonatal, which can be temporary or permanent, and should remain in rigorous clinical monitoring. Objects: to check the progress of children screened by the Newborn Screening Program of Minas Gerais (LWA-MG) withHT. Methods: this is a retrospective cohort study. We analyzed the data obtained by ? heel prick test ? provided by the Core Database Action and Research in Support Diagnostics (NUPAD). Results: from 2000 to 2010, 125 newborns had HT. Of these, 48% had a normal TSH levels in an average period of 20 months. As for the other 52% did not normalizeTSH during the study period and were therefore kept in accompaniment. Conclusions: Even though TSH levels have become normal in 48% of cases providing high for these RNs, this time to endpoint was significantly (about 20 months). During this period there may be changes in the exams, often requiring treatment with hormone replacement, and is therefore essential to follow through periodic consultations and hormone levels.