A participação da família na reabilitação psicossocial do sujeito emsofrimento psíquico / Family involvement in psychosocial rehabilitation of individuals under psychological suffering

Objetivo: conhecer a participação da família na reabilitação psicossocial do sujeito em sofrimento psíquico. Métodos: trata-se de uma pesquisa qualitativa, exploratória e descritiva, realizada em 2012. Os sujeitos do estudo foram seis familiares de usuários de um Centro de Atenção Psicossocial (CAPS). Foi utilizada a análise temática conforme Minayo, que tem como foco encontrar núcleos de sentido na comunicação apresentada pelo material estudado. Resultados: emergiram desse estudo dois eixos temáticos: A inserção do sujeito em sofrimento psíquico na sociedade sob a ótica da família e A participação da família na reabilitação psicossocial do sujeito em sofrimento psíquico. Conclusão: há um certo isolamento do usuário no serviço substitutivo. É importante que os profissionais de saúde invistam na autonomia dos sujeitos, contribuindo para o conhecimento do usuário e sua família acerca dos seus direitos e da proposta da reforma psiquiátrica. Colaborando com o aumento do compromisso da família neste processo.

Objective: to now the family's participation in psychosocial rehabilitation of the individual underpsychological distress. Methods: this is a qualitative, exploratory and descriptive study, held in2012. The study subjects were relatives of individuals with psychological distress, users of aPsychosocial Care Center (CAPS). The thematic analysis according to Minayo was used, whose focusis to find nuclei of meaning in the communication presented by material studied. Results: this studyemerged the themes: The insertion of the subject in psychological distress in society from theperspective of the family and the family's participation in psychosocial rehabilitation of the subject in psychological distress. Conclusions: there’s a certain isolation used in substitute service. It isunderstood that it is important for health professionals bet on education, increasing the user'sknowledge and his family about their rights and psychiatric reform proposal. This may collaboratewith the commitment of the family in this process.

PP156. High prevalence of pre-pregnancy overweight and obesity associated with maternal and perinatal complications.

INTRODUCTION: High prevalence of pre-pregnancy weight excess, as well as evidence of increased risk of maternal and perinatal complications associated with nutritional states have been observed lately. Considering the possible ethnic and environmental influences few studies have assessed this risk in pregnant Brazilian women. OBJECTIVES: This study aimed at determining the prevalence of pre-pregnancy weight excess (overweight and obesity) and its association with maternal and perinatal complications in a Brazilian women population. METHODS: We conducted a prospective cross-sectional study with 3,300 women who had birth care at the Asa Sul Regional Hospital of Brasília - Federal District (FD), from October 2009 to May 2010. Nutritional status was determined by body mass index (BMI), according to WHO criteria (2000): Low weight (BMI<18.5kg/m(2)), Normal weight (BMI between 18.5 and 24.9kg/m(2)), Weight excess (BMI⩾25kg/m(2)), Overweight (BMI between 25 and 29.9kg/m(2)) and obesity (BMI⩾30kg/m(2)). The outcome variables were: pre-clinical complications such as chronic hypertension and diabetes, manifestation of gestational hypertension/preeclampsia, pregnancy duration and resolution as well as perinatal outcomes. The association among these variables was assessed using chi-square (Pearson) and Fisher's exact test. Results were considered significant when p<0.05. RESULTS: In this population, weight excess before pregnancy had a prevalence of 27.2%, being 19.7% and 7.5% of pregnant women presenting, respectively, overweight and obesity. The prevalence of normal weight was 64.6% and low weight was 8.3%. Comparing the weight excess (BMI⩾25kg/m(2)) group with the normal weight group it was observed predominant hypertension (23% vs. 10%) and diabetes (10.1% vs. 3.6%), prolonged pregnancy (14.4% vs. 10.7%) and cesarean section rate (58.1% vs. 47.2%) in the weight excess group. Newborn weight equal to or greater than 4,000 g (9.5% vs. 4.5%) as well as fetal macrosomia (14.6% vs. 7.4%) also predominated in weight excess group. The comparison among the groups normal weight, overweight and obesity showed predominance of hypertension, diabetes cesarean section rate, newborns weight and fetal macrosomia in the obesity group. CONCLUSION: In the population analyzed, the prevalence of pre-pregnancy weight excess, particularly obesity, was high and associated with maternal and perinatal complications. Weight excess pre-pregnancy should be considered a risk to the pregnancy, demanding different obstetric care. Efforts should be made so that, in the pre-pregnancy period, women's weight can be as close to the normal weight as possible.

Muscular force is reduced in neurofibromatosis type 1.

OBJECTIVES: To measure muscular force in neurofibromatosis type 1 (NF1) patients. METHODS: The maximal voluntary muscular force (F(max)) was measured in the first 21 volunteer patients without acute health problems at the routine annual examination in the Neurofibromatosis Outpatient Reference Center during October-November (2007). The NF1 individuals were 9 males and 12 females, aged from 7 to 60 years and physically sedentary. The healthy control group was 21 healthy subjects matched to NF1 group by age, sex and physical activity. A handgrip test instrument was used to measure maximal force. To allow comparisons between physically different patients, forearm circumference (cm) was measured with a tape and forearm cross sectional area was derived to express the force per unit of forearm area. Data were compared using a t Student test (P<0.05). RESULTS: The mean F(max) of NF1 male (260-/+136 N) and NF1 female (217-/+76 N) were lower than expected for their sex and age. Healthy men showed greater F(area) (9.8-/+3.2 N x cm(-2)) than NF1 men (5.7-/+2.6 N x cm(-2)) and healthy women (6.7-/+1.6 N x cm(-2)) showed greater F(area) than NF1 females (5.7-/+1.9 N x cm(-2)). CONCLUSION: Maximal voluntary muscle force was reduced in NF1 patients.

p16(INK4a) Expression does not predict the outcome of cervical intraepithelial neoplasia grade 2.

Spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN2) lesions has been recognized since 1955, but predictors of this are poorly understood. Among the predictive markers studied, p16(INK4a) has been suggested to be of some value in monitoring the diagnosis of CIN2. In this clinical trial, 90 Brazilian women, diagnosed to CIN2 and high-risk human papillomavirus infection, were randomized into two groups of equal size: 45 women whose lesions were excised and 45 women subjected to prospective follow-up at 3-month intervals at least for 1 year (mean 6.8 months). p16(INK4a) expression was analyzed in paraffin-embedded sections using immunohistochemical staining. Among the 45 women in the follow-up group, 42% experienced spontaneous regression, 11% showed persistence, 22% progressed to CIN3, and 20% had partial regression to CIN1 or ASCUS (atypical squamous cell undetermined signifiance). p16(INK4a) expression was detected in 68.9% of the patients. In univariate survival (Cox) analysis, no significant difference in regression was obtained between p16(INK4a)-negative and -positive CIN2 lesions (adjusted HR = 1.1; 95% CI 0.6-2.0). In conclusion, p16(INK4a) expression could be useful in the diagnosis of CIN2. However, it failed to predict the outcome of CIN2. Because of its high spontaneous regression rate, follow-up could be considered as a management option of CIN2 in young and compliant women.

Influence of narrow-band UVB phototherapy on cutaneous microbiota of children with atopic dermatitis.

OBJECTIVE: In the present work, the effect of narrow-band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo). METHODS: Count, isolation and identification of cutaneous microbiota from anticubital fossa were performed in 10 controls and 10 AD patients, both submitted to similar levels (P > 0.05) of UVB phototherapy (4.3 +/- 0.9 and 4.3 +/- 0.8 accumulated joules, respectively). Additionally, Staphylococcus aureus isolates were screened for the production of exotoxins. RESULTS: The total and staphylococcal cutaneous microbial population levels were higher (P < 0.05) in AD patients than in the controls. All these population levels decreased (P < 0.05) for both AD and control patients after UVB phototherapy, which also decreased the SCORAD for AD patients. All patients with AD and 50% of controls were carriers of S. aureus, and harboured the bacteria simultaneously on skin and anterior nares. All of the S. aureus strains recovered from AD patient skin produced toxin and the B type was the most frequently detected (70%), followed by C (20%) and A (10%) toxins. Only 40% of the S. aureus isolates from control patients produced toxin. After UVB treatment, microbial population levels of AD patients were similar (P > 0.05) to the ones found in control patients before phototherapy, and toxin production ability of S. aureus isolates decreased drastically. CONCLUSION: The results of the present study show the beneficial effect of UVB phototherapy on AD and suggest that this may be attributable not only to reduction of skin surface bacteria but also to the suppression of superantigen production from S. aureus.

Single-blind and comparative clinical study of the efficacy and safety of benzoyl peroxide 4% gel (BID) and adapalene 0.1% Gel (QD) in the treatment of acne vulgaris for 11 weeks.

objectives: To compare the efficacy and tolerability of a gel containing benzoyl peroxide 4%, used twice daily, with a gel containing adapalene 0.1% used once daily, in the treatment of acne vulgaris for 11 weeks. methods: 178 patients bearing acne vulgaris, aged between 13 and 30 years, were studied in a comparative and single-blind clinical study. The 178 patients were divided into two groups: 89 patients treated with benzoyl peroxide 4% and 89 patients treated with adapalene 0.1%. The treatment duration was 11 weeks. The efficacy assessment was conducted through an accounting of both the inflammatory and non-inflammatory lesions in all visits. The safety assessment was conducted through reports regarding adverse reactions and local tolerance in all visits and an overall tolerance at the end of the study. conclusions: The results showed that both treatments were efficient in the reduction of acne lesions after 11 weeks treatment and were well tolerated, without any serious adverse event report. The benzoyl peroxide 4% was superior in the reduction of the number of inflammatory and non-inflammatory lesions at weeks 2 and 5, when compared to adapalene 0.1%.

HTLV-I associated infective dermatitis may be an indolent HTLV-I associated lymphoma.

When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The biopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocytes. Eleven months later, the patient had an infiltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient had indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommend that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis.

Abortion in Brazil: legislation, reality and options.

Abortion is illegal in Brazil except when performed to save the woman's life or in cases of rape. This paper gives a brief history of parliamentary and extra-parliamentary efforts to change abortion-related legislation in Brazil in the past 60 years, the contents of some of the 53 bills that have been tabled in that time, the non-governmental stakeholders involved and the debate itself in recent decades. The authorities in Brazil have never assumed full public responsibility for reproductive health care or family planning, let alone legal abortion; the ambivalence of the medical profession is an important obstacle. Most politicians avoid getting involved in the abortion debate, but the majority of bills in the 1990s have favoured less restrictive legislation. Incremental legislative and health service changes could help to improve the situation for women. Advocacy is probably the most important action, to promote an environment conducive to change. Clandestine abortion is a serious public health problem in Brazil, and the inadequacy of family planning services is one of the causes of this problem. The solutions should be made a priority for the Brazilian public health system.

[Eating patterns among the elderly of different socioeconomic groups living in a urban area of southeastern Brazil]. / Padrão alimentar de idosos de diferentes estratos socioeconômicos residentes em localidade urbana da região sudeste, Brasil.

Two hundred and eight three male and female elderly subjects were studied. They participated in the Multicentric project: "Health assessment of elderly people living in the urban area of S. Paulo", Brazil, and were stratified by socio-economic level in three areas of S. Paulo city. The food frequency questionnaire was applied in order to discover their food pattern. The results show that for the energy-producing foods more than 90% of the total sample eat tubers, rice, bread and pasta; however, only the rice and bread are consumed daily. As for protein, 70% or more of the elderly people eat beans, beef, poultry, milk and eggs but for the daily consumption there are differences between the 3 regions. More than 85% of the subjects eat fruits, leafy and other vegetables; nevertheless, the frequency of their daily consumption is bigger in the wealthier area. The dietetic information shows that the group analysed has the same food pattern as other population groups as far the energy-producing foods are concerned; there are, however, some difference as regards the protein foods and fruit and vegetables.

Human papillomavirus type 16 variants isolated from vulvar Bowenoid papulosis.

Tissues from two cases of Bowenoid papulosis of the vulva were found to contain human papillomavirus (HPV) 16 DNA by Southern blot hybridization. Analysis of the hybridization pattern revealed differences in a restriction fragment of one specimen as compared to the HPV 16 DNA prototype. To investigate if these differences could interfere with the expression of such oncogenic viral genomes, the corresponding DNA fragments were cloned and further analyzed. After amplification by PCR and DNA sequencing, a 213 base pairs duplication was mapped in the long control region (LCR) of this HPV 16 variant. One single PCR fragment was obtained from the other Bowenoid papulosis, which is identical in size with the same region in the HPV-16 prototype. The duplication in the HPV-16 LCR analyzed in this study maps upstream of a region containing several regulatory elements.

Isolation Leishmania sp from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report)

Os autores descrevem um caso raro de leishmaniose con lesoes cutaneas disseminadas, manifestacoes sistemicas e comprometimento ocular, sendo este caracterizado por iridociclite bilateral nao granulomatosa. A gravidade do quadro oftalmologico e a ausencia de resposta ao tratamento, a despeito da melhora das manifestacoes cutaneas e sistemicas, levaram a realizacao de puncao propedeutica da camada anterior ocular. A partir do humor aquoso isolou-se Leishmania sp. Os autores desconhecem na literatura qualquer outro caso onde tal achado tenha sido demonstrado

Isolation of Leishmania sp. from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report).

The authors report an uncommon case of leishmaniasis with disseminated cutaneous lesions, systemic manifestations and ocular involvement, the latter being characterized by bilateral nongranulomatous iridocyclitis. The severity of the ophthalmologic lesions and its unresponsiveness to therapy (in spite of satisfactory regression of both systemic and cutaneous manifestations) lead to a needle aspiration of the anterior eye chamber content. From this material Leishmania sp was isolated. To our knowledge this is the first time that Leishmania has been shown into the ocular globe.

[Localized xanthoma in lymphedema]. / Xantoma localizado em linfedema.

We report a case of xanthoma and lymphoedema in a patient who has aortic insufficiency. The association of lymphoedema and vascular malformations has been reported and seems to be occasional. The lymphoedema is primary and of early onset. Localized xanthomas follow the ingestion of lipoproteins by local histiocytes. We observed partial regression of xanthomas with alleviation of lymphoedema. There seems to be the ten reports of such association.

[Multiple trichoepitheliomas with genital and paragenital localization. Ultrastructural study]. / Tricoepitelioma múltiplo com localização genital e paragenital.

We report a case of trichoepithelioma papulosum multiplex in a 35 year-old woman. Genital and paragenital lesions were found for the first time. The islands of basaloid cells and horny cysts were studied by electron microscopy. Ultrastructural differences between the trichoepithelioma papulosum multiplex and the basal cell epithelioma are discussed.

Elastose perfurante serpiginosa - relato de quatro casos. / Elastosis perforans serpiginosa - report of 4 cases

Sao relatados quatro casos de elastose perfurante serpiginosa, ocorridos em jovens brancos, de 12 a 16 anos. Dois pacientes eram do sexo masculino e dois do feminino.O inicio da molestia ocorreu nas idades de tres a 12 anos A evolucao variou de dois a 13 anos. As lesoes eram eritemato-papulosas, ceratosicas e tinham disposicoes arciforme e serpiginosa.Raramente eram isoladas. Em todos os casos as lesoes se localizaram nos membros superiores.Um dos pacientes apresentava tambem lesoes nos joelhos e coxas.Em um caso havia associacao com alopecia ofiasica e monogolismo ou sindrome de Down e em outro com nevo pigmentado congenito gigante da regiao peitoral direta. Foram abordados alguns aspectos histopatologicos e patogeneticos da afeccao