Distribución de genotipos de virus papiloma humano de alto riesgo en mujeres y hombres atendidos en una red asistencial privada en la Región Metropolitana, Chile

Introducción: La infección persistente por genotipos de virus papiloma humano de alto riesgo (VPH-AR) es la principal causa del cáncer cérvico-uterino en todo el mundo. Los genotipos 16 y 18 están asociados a la progresión hacia el cáncer de cuello uterino; sin embargo, otros genotipos también presentan alto riesgo oncogénico. Existe escasa evidencia respecto a la distribución de genotipos VPH-AR en la población nacional, siendo un tema que debiese ser abordado en el contexto de un creciente aumento de la inmigración e implementación del programa de inmunización en Chile desde 2015. Objetivo: Dar a conocer la distribución de genotipos de VPH-AR detectados en pacientes de ambos sexos, atendidos en la red de atención privada de Clínica Dávila de Santiago, entre los años 2014 y 2021. Metodología: Se estudiaron muestras genitales y anales provenientes de 3.642 pacientes, incluyendo ambos sexos. La genotipificación fue realizada mediante reacción de la polimerasa en cadena (RPC) en tiempo real (HPV AnyplexTM II HPV28 detection, Seegene, Korea. Resultados: La distribución global de genotipos en mujeres (porcentaje) fue: 16 (14,34%) - 31 (6,20%) - 39 (5,94%) - 58 (5,94%) - 51 (5,68%) - 53 (5,64%) - 52 (5,30%) - 56 (5,27%) - 68 (5,19%) - 66 (4,97% - 18 (3,36%) - 59 (3,29%) - 73 (2,80%) - 35 (2,54%) - 45 (2,13%) - 33 (1,53%) - 82 (1,38%) - 26 (0,49%) y 69 (0,41%). En hombres fue: 16 (8,52%) - 58 (4,39%) - 51 (8,44%) - 26 (0,42%) - 18 (3,21%) - 52 (4,47%) - 39 (5,40%) - 53 (4,56%) - 33 (1,69%) - 35 (2,03%), 73 (2,19%) - 69 (0,59%) - 45 (2,11%) - 59 (4,22%) - 68 (3,04%) - 66 (5,06%) - 31 (4,64%) - 56 (4,81%) y 82 (1,10%). Conclusiones: La distribución de los genotipos de VPH fue concordante con estudios previos nacionales. Se observó una tendencia a la reducción del genotipo 16 en el tiempo, lo cual podría relacionarse a la vacunación, implementada en los últimos años en Chile. Destaca que otros genotipos de VPH-AR tuvieron una alta frecuencia en la población estudiada por lo que sería recomendable evaluar la pesquisa ampliada de genotipos de VPH-AR para valorar el riesgo oncogénico, con fines diagnósticos y terapéuticos.

Background: Persistent infection by high-risk human papillomavirus (HR-HPV) genotypes is the main cause of cervical cancer worldwide. Genotypes 16 and 18 are associated with progression to cervical cancer, however other genotypes also present high oncogenic risk. There is little evidence regarding the distribution of HR-HPV genotypes in the national population, being an issue that should be addressed in the context of a growing increase in immigration and implementation of the immunization program in Chile since 2015. Aim: To show the distribution of HR-HPV genotypes detected in women and men, attended at the private care network of Clinica Davila, Santiago City, between 2014 and 2021. Methods: Genital and anal samples from 3,642 patients were studied, including both sexes. Genotyping was performed by real-time polymerase chain reaction (PCR) (HPV AnyplexTM II HPV28 detection, Seegene, Korea). Results: The global distribution of genotypes in women (percentage) was: 16 (14.34%) - 31 (6.20%) - 39 (5.94%) - 58 (5.94%) - 51 (5.68%) - 53 (5.64%) - 52 (5.30%) - 56 (5.27%) - 68 (5.19%) - 66 (4.97%) - 18 (3.36%) - 59 (3.29%) - 73 (2.80%) - 35 (2.54%) - 45 (2.13%) - 33 (1.53%) - 82 (1.38%) - 26 (0.49%) and 69 (0.41%). In men was: 16 (8.52%) - 58 (4.39%) - 51 (8.44%) - 26 (0.42%) - 18 (3.21%) - 52 (4.47%) - 39 (5.40%) - 53 (4.56%), 33 (1.69%) - 35 (2.03%) - 73 (2.19%) - 69 (0.59%) - 45 (2.11%) - 59 (4.22%) - 68 (3.04%) - 66 (5.06%) - 31 (4.64%) - 56 (4.81%) and 82 (1.10%). Conclusions: The distribution of HPV genotypes was consistent with previous national studies. A tendency to reduce genotype 16 over the years was observed, which could be related to the vaccination, implemented in recent years in Chile. It is remarkable that other HR-HPV genotypes had a high frequency in the population studied, so it would be advisable to evaluate an expanded screening for HR-HPV genotypes to assess the oncogenic risk, for diagnostic and therapeutic purposes.

Decision Making in the Restoration of Endodontically Treated Teeth: Effect of Biomimetic Dentistry Training.

The restoration of endodontically treated teeth (ETT) is challenging as these teeth often present with structural deficiencies. Currently, there is no consensus regarding the final restoration choice. Historically, the full coverage crown was the universally selected treatment for endodontically treated teeth. With advances in adhesive and biomimetic dentistry, more minimally invasive treatment modalities have become a viable option. With this study, we aim to understand the restorative decision of the general dentist with or without additional training in biomimetic dentistry. Seventy-eight general dentists, with or without biomimetic training, were surveyed to determine their restorative preferences on five extracted posterior teeth, categorized according to volumetric loss of tooth structure, as indicated by the number of missing walls, the isthmus width, the presence or absence of marginal ridges, and cusps. CAD/CAM reconstructions were made with the teeth to analyze the volume of tooth loss and compare these with the survey results. Data were compared using the chi-squared test and Fisher's exact test. The frequency of responses recommending a crown and the volume of tooth loss were correlated using the Pearson test (p < 0.05). For all five teeth, survey responses showed a statistically significant difference in the restorative decision of full coverage versus alternative restorations, with biomimetic dentists selecting a direct restoration or inlay/onlay in lieu of a full coverage crown (n = 63, p < 0.05). The age of the participant did not have a significant impact on the restorative decision making process for these teeth. The biomimetic trained dentists showed a greater tendency to select a crown option only when the volume of tooth loss was greatest, otherwise their restorative decisions tended towards the conservative treatment options. This study also demonstrates a novel method of digitally developing a volume of tooth loss to compare against the visual interpretation of the volume of tooth loss.

Chapter 8: Risk Assessment: Considerations for Coronal Caries.

Caries risk assessment (CRA) is essential to delivering personalized/precision care in caries management. Limited formal evaluation and validation of existing CRA tools affects the ability to accurately predict new lesions. However, this should not prevent clinicians from assessing modifiable risk factors to guide preventive measures and address individual needs to personalize care. Since caries is a multifactorial and dynamic disease process, CRA is complex and impacted by multiple variables throughout the life course, demanding periodic re-assessment. Many factors can influence caries risk at the individual, family, and community level; however, unfortunately, caries experience is still considered one of the greatest indicators of future risk for caries. CRA tools that are validated, inexpensive, and easy to use should be developed and prioritized to help support decision-making to implement evidence based, and minimally invasive caries management strategies for coronal caries lesions in children, adults, and older persons. Efforts into developing CRA tools should include evaluation and reporting of internal and external validation information. In the future, approaches using big data and artificial intelligence may drive risk predictions, and cost-effectiveness analyses may help derive the selection of appropriate risk thresholds for decision-making. Because of the importance of CRA in the treatment planning and decision-making process, challenges for implementation including how to communicate risk to drive behavior change, development of tools that are quick and easy to integrate seamlessly into the busy clinical flow, and reimbursement for the time needed to implement should be considered.

Clinical Impact and Risk Factors of Mortality in Hospitalized Children and Adolescents With Hematologic Diseases and COVID-19: An Observational Retrospective Cohort Study.

This study aimed to evaluate the risk factors for COVID-19-related death in a large cohort of hospitalized children with hematological disorders. We performed an analysis of all pediatric patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using the cumulative incidence function. Among 21,591 hospitalized pediatric patients with COVID-19, 596 cases (2.8%) had hematological diseases. Sixty-one children (27.4%) with malignant hematological diseases had a fatal outcome as compared with 4.2% and 7.4% of nonmalignant hematological and nonhematological cohorts, respectively ( P <0.0001). Children with hematological diseases had a significant increased hazard of death compared with those without these conditions (hazard ratio [HR],=2.40, 95% confidence interval, 1.98 - 2.91). In multivariable analysis, the factors associated with death were the presence of malignant hematological disease (HR, 2.22, 95% CI 1.47 - 3.36), age >10 years (HR 2.19, 95% CI 1.46 - 3.19), male (HR 1.52, 95% CI 1.02 - 2.27), oxygen saturation <95% (HR 2.02, 95% CI 1.38 - 2.96), and abdominal pain at admission (HR 2.75, 95% CI 1.76 - 4.27). Children with malignant hematological diseases had a higher risk of death compared with those without these disorders.

Biomimetics and the restoration of the endodontically treated tooth / Biomimética e a restauração do dente tratado endodonticamente

Although much progress has been obtained in terms of the Endodontic treatment, the literature shows that true success can be only achieved with adequate coronal seal to avoid bacterial contamination, and protect the tooth structure from fracture. There are many options available to the clinician to restore the endodontically treated tooth; however, there is not much evidence available on what alternative is better than another. This review will critically present the current knowledge on restorative choices, including posts and endocrowns, showing advantages and disadvantages of different treatment forms. With this knowledge, we will also introduce the concept of biomimetics to endodontically treated teeth, and how the nature of their remaining tooth structure can benefit from this approach. This concept entails the use of mechanisms and biologically produced materials to restore a tooth in a way that would mimic its natural structure, with the purpose of achieving better long-term prognosis (AU)

Embora tenha se obtido progresso em relação ao tratamento endodôntico, a literatura mostra que o sucesso real só pode ser atingido com o selamento coronal adequado, para evitar-se a contaminação bacteriana e proteger-se a estrutura dental de fraturas. Há muitas opções disponíveis para o clínico para a restauração do dente tratado endodonticamente; entretanto, não há muita evidência disponível sobre qual alternativa é melhor que a outra. Esta revisão apresentará criticamente o conhecimento atual sobre opções restauradoras, incluindo retentores intraradiculares e endocrowns, mostrando vantagens e desvantagens das diferentes formas de tratamento. Com esse conhecimento, também introduziremos o conceito de biomimética, uma vez que dentes tratados endodonticamente, devido a natureza de sua estrutura dental remanescente, podem se beneficiar desta abordagem. Esse conceito envolve o uso de mecanismos e materiais produzidos biologicamente para restaurar um dente de forma a imitar a estrutura natural, com o objetivo de alcançar melhor prognóstico de longo-prazo.(AU)

Caries Management in Special Care Dentistry.

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Radon Concentrations in a Nuclear Reactor Center in Brazil.

ABSTRACT: Radiation workers are normally exposed to doses resulting from their day-to-day activities. Besides that, background radiation, such as radon, can contribute to the exposure rates. The radionuclide 222Rn is a noble gas belonging to the uranium series, and its indoor concentration in the air depends on the exhalation from surrounding soil and the exhalation from building materials. Radon exhaling from porous building materials containing high uranium concentrations can become a significant exposure factor in areas with limited ventilation. The objective of this study was to evaluate the 222Rn concentrations in the radiochemistry and radiometric laboratories in the nuclear reactor building of the Nuclear Reactor Center (CERPq) located in the Institute of Nuclear and Energy Research (IPEN), São Paulo, Brazil. Measurements were done using a Radon Gas Monitor, model RAD7, equipped with a solid-state alpha detector. A passive method (SSNTD) was also used, consisting of square pieces of C-39 foils (2.5 cm × 2.5 cm) placed within small diffusion chambers. The CR-39 detectors were etched in KOH 30% solution at 80 °C for 5.5 h in a constant-temperature bath. After etching, the detectors were washed, dried, and scanned using a microscope to obtain the track density measurements. The activity concentrations measured with both techniques varied from 52 to 103 Bq m-3 in the studied areas of the CERPq. These values may be compared to the reference level of 100 Bq m-3 established by the World Health Organization to ensure safety environments.

Educação em saúde no esporte com crianças e jovens em condição de vulnerabilidade social / Sports health education of socially vulnerable children and youth / Educación en salud en el deporte con niños y jóvenes en condiciones sociales vulnerables

Objetivo: Relatar a experiência de universitários com atividades de educação em saúde no esporte com crianças e jovens em condições de vulnerabilidade social. Síntese dos dados: Trata-se de um relato de experiência que teve como base o desenvolvimento de atividades de educação em saúde realizada por universitários, para crianças e jovens na faixa etária de 7 a 23 anos, integrantes do projeto Areninha, localizado em um bairro periférico da cidade de Fortaleza, Ceará, Brasil. As atividades tiveram início em maio de 2018 e fim em novembro de 2019, com a realização de 11 encontros, sendo três atividades executadas pela preceptora e os acadêmicos da disciplina do estágio em saúde pública de um curso de nutrição de uma universidade privada. Os temas abordados foram: Bullying: uma partida de todos; Alimentação saudável; O açúcar por trás dos alimentos industrializados. Conclusão: Diante do que foi apresentado, conclui-se que a forma lúdica de abordar temas de educação em saúde fez alcançar de uma maneira ampla os objetivos das atividades, havendo uma excelente interação com os participantes, facilitando o entendimento deles pela simplicidade da explanação.

Objective: To report the experience of university students in conducting sports health education activities with socially vulnerable children and youth. Data Synthesis: This is an experience report based on health education activities carried out by university students with children and youth aged 7 to 23 years participating in the Areninha project, located in a peripheral neighborhood in the city of Fortaleza, Ceará, Brazil. The activities began in May 2018 and ended in November 2019. A total of 11 meetings were held, three of which were carried out by the preceptor and students of the public health internship of a nutrition school of a private university. The subjects addressed were: Bullying: a game for everyone; Healthy eating; The sugar in processed foods. Conclusion: In view of what has been presented herein, it is concluded that the playful way of addressing health education themes allowed achieving the goals of the activities in a broad way, with an excellent interaction with the participants, which facilitated understanding due to the simple nature of the explanation.

Objetivo: Relatar la experiencia de universitarios con actividades de educación en salud en el deporte con niños y jóvenes en condiciones sociales vulnerables. Síntesis de los datos: Se trata de un relato de experiencia basado en el desarrollo de actividades de educación en salud realizada por universitarios para niños y jóvenes de la franja de edad entre 7 y 23 años integrantes del proyecto Areniña localizado en un barrio de la periferia de Fortaleza, Ceará, Brasil. Las actividades se iniciaron en mayo de 2018 hasta noviembre de 2019 con la realización de 11 encuentros con tres actividades realizadas por la tutora y los académicos de la disciplina de práctica en salud pública de un curso de nutrición de una universidad privada. Los temas abordados fueron: Bullying: un partido de todos; Alimentación saludable; El azúcar por detrás de los alimentos industrializados. Conclusión: Ante lo presentado se concluye que la forma lúdica de hablar de temas de educación en salud ha permitido el amplio alcance de los objetivos de las actividades con una interacción excelente de los participantes lo que ha facilitado su comprensión a partir de la simplicidad de la explanación.

A elaboração imaginativa na origem da vida psíquica e suas implicações clínicas / The imaginative elaboration at the origin of psychic life and its clinical implications / La elaboración imaginativa en el origen de la vida psíquica y sus implicaciones clínicas

Este artigo pretende identificar o surgimento e o desenvolvimento da noção de elaboração imaginativa na obra de Winnicott, analisando o seu significado e suas possíveis implicações clínicas. Complexa e pouco explorada, a noção de elaboração imaginativa é uma das contribuições específicas à psicanálise, feitas por D.W. Winnicott, que permite a formulação de uma hipótese teórica sobre a inclusão do corpo como um elemento fundamental na origem da vida psíquica. Considerando o campo sensorial como ponto de partida para a atribuição de sentido às sensações corporais nos primórdios da existência, a capacidade de elaborar imaginativamente inaugura o processo de apreensão da integração psicossomática, assim como a possibilidade de manter viva e presente na vida adulta a conexão entre o campo da sensorialidade, o campo afetivo e a vida de representação. Nesta perspectiva, a elaboração imaginativa está na origem da possibilidade de criar, sonhar, fantasiar, devanear, brincar e simbolizar, constituindo um elemento importante no tratamento psicanalítico (AU)

This paper aims to identify the emergence and development of the imaginative elaboration concept in Winnicott's work, by analyzing its significance and potential clinical implications. Complex and little explored, the notion of imaginative elaboration is one of the specific contributions to psychoanalysis, made by D.W. Winnicott, which allows for the formulation of a theoretical hypothesis about the inclusion of the body as a key element in the origin of psychic life. Considering the sensory field as a starting point for assigning meaning to bodily sensations in the early days of existence, the ability to imaginatively elaborate unveils the process of apprehension related to psychosomatic integration, as well as the possibility of keeping the connection between field of sensoriality, field of affection, and life representation alive and present in the adult life. In this perspective, the imaginative elaboration is at the origin of the power to create, dream, fantasize, daydream, play, and symbolize, setting it up as an important element in psychoanalytic treatment (AU)

Este artículo pretende identificar la aparición y el desarrollo de la noción de elaboración imaginativa en la obra de Winnicott, analizando su significado y sus posibles implicaciones clínicas. Compleja y poco explorada, la noción de elaboración imaginativa es una de las contribuciones específicas al psicoanálisis, echa por D.W. Winnicott, que permite la formulación de una hipótesis teórica sobre la inclusión del cuerpo como un elemento clave en el origen de la vida psíquica. Teniendo en cuenta el campo sensorial como punto de partida para la asignación de sentido a las sensaciones corporales en los primordios de la existencia, la capacidad de elaborar imaginativamente inaugura el proceso de aprehensión de la integración psicosomática, así como la posibilidad de mantener viva y presente en la vida adulta la conexión entre el campo de la sensorialidad, el campo afectivo y la vida de representación. En esta perspectiva, la elaboración imaginativa está en el origen de la posibilidad de crear, soñar, fantasear, devanear, jugar y simbolizar, constituyendo un elemento importante en el tratamiento psicoanalítico (AU)

30 Years of Experience with Non-Hodgkin Lymphoma in Children and Adolescents: a retrospective cohort study.

OBJECTIVE: Describe the clinical and demographic characteristics of pediatric patients with non-Hodgkin's lymphoma (NHL) enrolled in a tertiary unit of Pediatric Hematology between 1982-2015. PATIENTS AND METHODS: A retrospective cohort study of 140 patients aged 16 years or less with NHL. Demographic characteristics, data on diagnosis, and outcomes were analyzed. The overall survival (OS) analysis and stratification by the most frequent histological subtypes were performed using the Kaplan-Meier method. RESULTS: One hundred and thirty-six patients with de novo NHL and four with NHL as a second malignancy were analyzed. The median age at diagnosis was 6.4 years (interquartile range, 4.2 to 11.1 years); 101 patients were males. Four patients had primary immunodeficiency, four had human immunodeficiency virus, two post-liver transplantation, and one had autoimmune lymphoproliferative syndrome. The most frequent histological type was NHL of mature B- cell (B-NHL-B; 67.1%), with Burkitt's lymphoma being the most frequent subtype, and lymphoblastic lymphoma (LBL, 21.4%). The main clinical manifestation at the diagnosis was abdominal tumors (41.4%). During the follow-up time, 13 patients relapsed, but five of them reached a second remission. Thirty-five patients died, and 103 remained alive in clinical remission. No contact was possible for two patients. The OS at 5 years was 74.5% (± 3.8%). The OS estimated for patients with LBL, NHL-B, and the remaining was 80.4%±7.9%, 72.8%±4.7%, and 74.5%±11%, respectively (P = 0.58). CONCLUSION: Our results are comparable with cohorts from other middle-income countries.

30 Years of Experience with Non-Hodgkin Lymphoma in Children and Adolescents: a retrospective cohort study

SUMMARY OBJECTIVE Describe the clinical and demographic characteristics of pediatric patients with non-Hodgkin's lymphoma (NHL) enrolled in a tertiary unit of Pediatric Hematology between 1982-2015. PATIENTS AND METHODS A retrospective cohort study of 140 patients aged 16 years or less with NHL. Demographic characteristics, data on diagnosis, and outcomes were analyzed. The overall survival (OS) analysis and stratification by the most frequent histological subtypes were performed using the Kaplan-Meier method. RESULTS One hundred and thirty-six patients with de novo NHL and four with NHL as a second malignancy were analyzed. The median age at diagnosis was 6.4 years (interquartile range, 4.2 to 11.1 years); 101 patients were males. Four patients had primary immunodeficiency, four had human immunodeficiency virus, two post-liver transplantation, and one had autoimmune lymphoproliferative syndrome. The most frequent histological type was NHL of mature B- cell (B-NHL-B; 67.1%), with Burkitt's lymphoma being the most frequent subtype, and lymphoblastic lymphoma (LBL, 21.4%). The main clinical manifestation at the diagnosis was abdominal tumors (41.4%). During the follow-up time, 13 patients relapsed, but five of them reached a second remission. Thirty-five patients died, and 103 remained alive in clinical remission. No contact was possible for two patients. The OS at 5 years was 74.5% (± 3.8%). The OS estimated for patients with LBL, NHL-B, and the remaining was 80.4%±7.9%, 72.8%±4.7%, and 74.5%±11%, respectively (P = 0.58). CONCLUSION Our results are comparable with cohorts from other middle-income countries.

RESUMO OBJETIVO Descrever as características clínicas e demográficas de pacientes pediátricos com linfoma não Hodgkin (LNH) em uma unidade terciária de Hematologia Pediátrica entre 1982-2015. PACIENTES E MÉTODOS Estudo de coorte retrospectivo de dados de prontuários de 140 pacientes com idade até 16 anos com LNH. Características demográficas e dados relativos ao diagnóstico e evolução foram analisados. A sobrevida global (SG) e estratificada pelos subtipos histológicos mais frequentes foi analisada pelo método de Kaplan-Meier. RESULTADOS Dados de 136 pacientes com LNH de novo e quatro com LNH como segunda neoplasia foram analisados. A mediana de idade ao diagnóstico foi 6,4 anos (intervalo interquartil: 4,2 a 11,1 anos); 101 pacientes eram meninos. Onze pacientes apresentavam imunodeficiência (quatro primária, quatro secundária ao vírus da imunodeficiência humana adquirida, dois pós-transplante hepático e um com síndrome linfoproliferativa autoimune). Os tipos histológicos mais frequentes foram o LNH de células B madura (LNH-B, 67,1% dos pacientes), sendo o linfoma de Burkitt o subtipo mais frequente, e o linfoma linfoblástico (LL, 21,4%). A principal manifestação clínica ao diagnóstico foi massa abdominal (41,4%). A mediana de seguimento dos sobreviventes foi 7,7 anos (intervalo interquartil: 3,3 a 10,9 anos). Treze pacientes recidivaram (cinco alcançaram segunda remissão clínica), 35 faleceram, 103 permanecem vivos em remissão completa e dois perderam o seguimento. A probabilidade de SG em cinco anos foi 74,5%±3,8%. Para os pacientes com LL, LNH-B e os demais, a SG foi 80,4%±7,9%, 72,8%±4,7% e 74,5%±11%, respectivamente (P=0,58). CONCLUSÃO Nossos resultados são comparáveis aos de outros países de renda média.

Uma vida que não vale a pena ser vivida: relações entre submissão e suicídio segundo o pensamento de D. W. Winnicott / A life that is not worth living: relationships between submission and suicide according to the thought of D. W. Winnicott / Una vida que no vale la pena vivir: relaciones entre sumisión y suicidio según el pensamiento de D. W. Winnicott / Une vie qui ne vaut pas la peine d'être vécue: des relations entre la soumission et le suicide selon la pensée de D. W. Winnicott

O pensamento teórico-clínico de D. W. Winnicott traz importantes contribuições para a ampliação da compreensão do suicídio, apontando perspectivas clínicas no tratamento psicanalítico. A partir do conceito de submissão, decorrente do estabelecimento de um falso self patológico, é possível ao analista identificar a vulnerabilidade oculta sob a aparente normalidade. Quando o indivíduo se encontra totalmente dominado por um falso self submisso, vivendo num estado de adaptabilidade e racionalidade constantes, a morte pode vir a representar um último recurso contra a ameaça de aniquilamento. Identificar esse tipo de sofrimento psíquico é fundamental para um manejo clínico que possibilite ao paciente reencontrar algum sentido em sua vida, a partir da possibilidade de se sentir real na relação com o analista. A apresentação de um exemplo clínico tem o objetivo de auxiliar na reflexão sobre o recorte teórico apresentado, criando imagens que introduzam o leitor no universo abstrato dos conceitos.

D. W. Winnicott's theoretical and clinical thinking brings important contributions to the broadening of the understanding of suicide, pointing out clinical perspectives in psychoanalytic treatment. From the concept of submission, resulting from the establishment of a false pathological self, it is possible for the analyst to identify the hidden vulnerability under the apparent normality. When the individual is totally overwhelmed by a submissive false self, living in a state of constant adaptability and rationality, death may be a last resort against the threat of annihilation. Identifying this type of psychological distress is fundamental for a clinical management that enables patients to rediscover some meaning in their lives, based on the possibility of feeling real in their relationship with the analyst. The presentation of a clinical example aims to assist in the reflection on the theoretical framework presented, creating images that introduce the reader into the abstract universe of concepts.

El pensamiento teórico-clínico de D. W. Winnicott hace importantes contribuciones a la ampliación de la comprensión del suicidio, señalando las perspectivas clínicas en el tratamiento psicoanalítico. Desde el concepto de sumisión, resultante del establecimiento de un falso yo patológico, es posible que el analista identifique la vulnerabilidad oculta bajo aparente normalidad. Cuando el individuo está totalmente abrumado por un falso yo sumiso, que vive en un estado de constante adaptabilidad y racionalidad, la muerte puede ser el último recurso contra la amenaza de aniquilación. Identificar este tipo de angustia psicológica es fundamental para un manejo clínico que permita a los pacientes redescubrir algún significado en sus vidas, basado en la posibilidad de sentirse reales en su relación con el analista. La presentación de un ejemplo clínico tiene como objetivo ayudar en la reflexión sobre el marco teórico presentado, creando imágenes que introducen al lector en el universo abstracto de conceptos.

La réflexion théorique clinique de D. W. Winnicott apporte des contributions importantes à l'élargissement de la compréhension du suicide, tout en soulignant les perspectives cliniques dans le traitement psychanalytique. Fondé sur le concept de soumission résultant de l'établissement d'un faux soi pathologique, il est possible pour l'analyste d'identifier la vulnérabilité cachée sous la normalité apparente. Lorsque l'individu est totalement submergé par un faux soi soumis et qu'il vit dans un état permanent d'adaptation et de rationalité, la mort peut devenir un dernier recours contre la menace de l'anéantissement. Identifier ce type de détresse psychologique est fondamental pour un maniement clinique qui permet aux patients de retrouver du sens dans leur vie, en se basant sur la possibilité de se sentir réel dans leur rapport avec l'analyste. La présentation d'un exemple clinique vise à faciliter la réflexion sur le cadre théorique exposé, en créant des images qui introduisent le lecteur dans l'univers abstrait des concepts.

Educação nutricional para pais e pré-escolares em uma creche / Nutritional education for parents and preschool children in day care

Objetivo: Descrever uma experiência de educação nutricional por intermédio de uma fábula infantil trabalhada com pais e crianças em idade pré-escolar de uma creche pública. Síntese dos dados: A experiência ocorreu no dia 15 de maio de 2018, em que é comemorado o Dia Internacional da Família em uma creche pública no município de Fortaleza, Ceará. Houve a participação de 35 crianças, entre 2 a 4 anos, e de 30 adultos de ambos os sexos. A ação educativa desenvolveu-se a partir de uma apresentação adaptada da fábula infantil "Os três porquinhos". Construiu-se um cartaz de três metros com material de tecido não tecido (TNT), que continha uma imagem das três casas dos porquinhos. As casas de palha, madeira e tijolos foram associadas aos alimentos ultraprocessados, processados e in natura, ou minimamente processados, respectivamente. Os alimentos escolhidos baseavam-se no novo Guia Alimentar para a População Brasileira. Na medida em que os pais/responsáveis chegavam, eram acolhidos com panfletos explicativos e convidados a aproximarem-se do cartaz. Em decorrência do modo lúdico apresentado, percebeu-se facilidade na interação do preceptor e dos acadêmicos com o público-alvo, despertando a curiosidade na associação das casas ao corpo humano em relação à importância da escolha dos alimentos, entendendo-se o ambiente escolar como um local possível para promoção de saúde. Conclusão: A educação nutricional é fundamental no ambiente escolar para a promoção da alimentação saudável. O desenvolvimento de atividades lúdicas é importante para despertar o interesse das crianças, favorecendo o aprendizado. (AU)

Screening methylation of DNA repair genes in the oral mucosa of chronic smokers.

OBJECTIVE: The aim of this study was to evaluate the epigenetic changes in the process of oral carcinogenesis by screening the methylation of repair genes in chronic smokers. DESIGN: Two groups were formed: Group 1: 16 smokers with consumption of 20 cigarettes/day for at least 10 years; and Group 2: 10 non-smoking. Exfoliative cytology of the tongue was performed, and the extracted DNA was treated by enzymes. The PCR Array System performed methylation screening to evaluate 22 DNA repair genes, and the results were validated by RT-qPCR for each gene with methylation levels ≥10%. RESULTS: Highest percentages of methylation were observed for MLH3 and XRCC1 genes (11-20% methylation) and in one case for MRE11A and PMS2 (>50% methylation). Statistical analysis showed significant differences in the expression of the genes MRE11A (p = 0.0002), PMS2(p = 0.0068), XRCC1 (p = 0.0080) and MLH3 (0.0057) between the two groups. CONCLUSION: The effects of chronic smoking on oral mucosa led to the methylation of genes MRE11A PMS2, XRCC1 and MLH3, but resulted in a reduction of gene expression of MRE11A and PMS2, which showed ≥50% methylation. These results provide evidence that smoking cause methylation and reduced expression of repair genes.

Recent major advances in cardiovascular pharmacotherapy.

The field of cardiovascular pharmacotherapy remains extremely active. The aim of this review is to summarize the recent major advances in cardiovascular pharmacotherapy, with a focus on (1) the new approved drug for treatment of heart failure with reduced ejection fraction-sacubitril/valsartan; (2) proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors; (3) the novel reversal agents for non-vitamin K oral anticoagulants (NOACs); and finally, (4) new evidence on pharmacological treatment of coronary artery disease.

Mucoepidermoid carcinoma mimicking a mucocele (ranula) in the floor of the mouth.

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The submandibular gland is rarely involved, about less than 10% of all other major salivary glands. We report a case of a 49-year-old female who presented with a mass on the left side of the floor of the mouth. She was complaining of neck pain for the last 2-3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. A multidetector CT scan was made. The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucocele (ranula), which was thought to be corroborated by the clinical findings. The treatment of choice was the complete excision of the mucocele and the left submandibular salivary gland. The histopathological examination surprisingly revealed a low-grade MEC. No further treatment was recommended; however, a follow up was scheduled in 4 months. This atypical location of MEC in the floor of the mouth simulated the clinical and radiographic features of a mucocele. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management, as the histopathological analysis played an important role to confirm the diagnosis.

Recordar, repetir, criar: a dança-teatro de Pina Bausch / Remember, repeat, create: the dance-theater of Pina Bausch

Pina Bausch expõe o corpo simultaneamente como origem do estímulo e veículo de expressão das pulsões, portador da sexualidade infantil, carregado de memória e de linguagem. Em seus espetáculos a coreógrafa explora o movimento em seu pleno potencial de comunicação, conferindo às imagens sensoriais a capacidade de gerar uma polissemia de significados, compondo uma narrativa fragmentada que convida à construção de múltiplos sentidos.

Pina Bausch exposes the body simultaneously as the origin of the stimulus and vehicle of expression of the drives, bearer of infantile sexuality, loaded with memory and language. In her shows the choreographer explores the movement in its full potential for communication, giving sensory images the ability to generate a polysemy of meanings, composing a fragmented narrative that invites the construction of multiple senses.