Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19 : A Randomized Platform Trial.

BACKGROUND: Previous trials have demonstrated the effects of fluvoxamine alone and inhaled budesonide alone for prevention of disease progression among outpatients with COVID-19. OBJECTIVE: To determine whether the combination of fluvoxamine and inhaled budesonide would increase treatment effects in a highly vaccinated population. DESIGN: Randomized, placebo-controlled, adaptive platform trial. (ClinicalTrials.gov: NCT04727424). SETTING: 12 clinical sites in Brazil. PARTICIPANTS: Symptomatic adults with confirmed SARS-CoV-2 infection and a known risk factor for progression to severe disease. INTERVENTION: Patients were randomly assigned to either fluvoxamine (100 mg twice daily for 10 days) plus inhaled budesonide (800 mcg twice daily for 10 days) or matching placebos. MEASUREMENTS: The primary outcome was a composite of emergency setting retention for COVID-19 for more than 6 hours, hospitalization, and/or suspected complications due to clinical progression of COVID-19 within 28 days of randomization. Secondary outcomes included health care attendance (defined as hospitalization for any cause or emergency department visit lasting >6 hours), time to hospitalization, mortality, patient-reported outcomes, and adverse drug reactions. RESULTS: Randomization occurred from 15 January to 6 July 2022. A total of 738 participants were allocated to oral fluvoxamine plus inhaled budesonide, and 738 received placebo. The proportion of patients observed in an emergency setting for COVID-19 for more than 6 hours or hospitalized due to COVID-19 was lower in the treatment group than the placebo group (1.8% [95% credible interval {CrI}, 1.1% to 3.0%] vs. 3.7% [95% CrI, 2.5% to 5.3%]; relative risk, 0.50 [95% CrI, 0.25 to 0.92]), with a probability of superiority of 98.7%. No relative effects were found between groups for any of the secondary outcomes. More adverse events occurred in the intervention group than the placebo group, but no important differences between the groups were detected. LIMITATION: Low event rate overall, consistent with contemporary trials in vaccinated populations. CONCLUSION: Treatment with oral fluvoxamine plus inhaled budesonide among high-risk outpatients with early COVID-19 reduced the incidence of severe disease requiring advanced care. PRIMARY FUNDING SOURCE: Latona Foundation, FastGrants, and Rainwater Charitable Foundation.

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial.

BACKGROUND: Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19. METHODS: This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups not reported here). The trial team, site staff, and patients were masked to treatment allocation. Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19 up to 28 days post-random assignment on the basis of intention to treat. Modified intention to treat explored patients receiving at least 24 h of treatment before a primary outcome event and per-protocol analysis explored patients with a high level adherence (>80%). We used a Bayesian analytic framework to establish the effects along with probability of success of intervention compared with placebo. The trial is registered at ClinicalTrials.gov (NCT04727424) and is ongoing. FINDINGS: The study team screened 9803 potential participants for this trial. The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo. The average age of participants was 50 years (range 18-102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 [11%] of 741 vs 119 [16%] of 756); relative risk [RR] 0·68; 95% Bayesian credible interval [95% BCI]: 0·52-0·88), with a probability of superiority of 99·8% surpassing the prespecified superiority threshold of 97·6% (risk difference 5·0%). Of the composite primary outcome events, 87% were hospitalisations. Findings for the primary outcome were similar for the modified intention-to-treat analysis (RR 0·69, 95% BCI 0·53-0·90) and larger in the per-protocol analysis (RR 0·34, 95% BCI, 0·21-0·54). There were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group in the primary intention-to-treat analysis (odds ratio [OR] 0·68, 95% CI: 0·36-1·27). There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01-0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups. INTERPRETATION: Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital. FUNDING: FastGrants and The Rainwater Charitable Foundation. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Do susto à criação: a análise de crianças na pandemia

O trabalho relata experiências e questionamentos de um grupo de analistas de crianças no início do isolamento social, causado pela pandemia de Covid-19. Com o afastamento do consultório, fez-se necessário recorrer às ferramentas on-line para prosseguirem os atendimentos. Surgiram dificuldades, como o estabelecimento de um setting virtual, inexperiência com as ferramentas digitais, falta de privacidade, duração das sessões, dentre outros e o trabalho mostra como puderam ser contornadas. Surpreendeu a disposição das crianças para seguirem em análise e a possibilidade de, gradativamente, se estabelecer um ambiente favorável à criatividade e ao fortalecimento dos vínculos entre as duplas. São apresentadas vinhetas para ilustrar os desafios e as experiências clínicas vividas.(AU)

El trabajo relata experiencias e indagaciones de un grupo de psicoanalistas de niños y adolescentes en el princípio del aislamiento social provocado por la pandemia del Covid-19. Con el cierre de los consultorios se hizo necesario el uso de herramientas virtuales para continuar la atención. Surgieron dificultades, tales como el establecimiento de un setting virtual, la inexperiencia con las herramientas digitales, la falta de privacidad, la duración de las sesiones, entre otras. Este trabajo muestra como esos escollos fueron subsanados. Fué sorprendente el deseo de los niños de seguir sus analisis y la posibilidad paulatina de establecerse un ambiente propicio a la creatividad y al fortalecimiento de los vínculos entre los pares analíticos. Son presentadas viñetas que ilustran los desafíos y las experiencias clínicas vividas.(AU)

This article reports experiences and questions of a group of child analysts at the beginning of social isolation, caused by the Covid-19 pandemic. Kept away from the office, it was necessary to use online tools to continue patient consultation. Difficulties arose, such as the establishment of a virtual setting, inexperience with digital tools, lack of privacy, duration of sessions, among others, and we showed how they could be overcome. It was surprising the children’s willingness to continue in analysis and the possibility of gradually establishing an environment favorable to creativity and the strengthening of the bonds between the pairs. Vignettes are presented to illustrate the challenges and clinical experiences.(AU)

A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care.

BACKGROUND: HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients' knowledge about their condition and to overcome barriers to access treatment. METHODS: The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals' workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test. RESULTS: Overall, 504 patients with chronic hepatitis C were included: 78 % male, mean age 42.3 ± 6.6 years, 14 % school education ≤ 4 years, disease duration 11.0 ± 6.0 years and 26 % HIV co-infected. A higher baseline knowledge was independently associated with educational level ≥ 10 years (regression coefficient [B] =15.13, p < 0.001), current use of intravenous drugs (B = 7.99, p = 0.038), previous referral for treatment (B = 4.26, p = 0.008) and previous HCV treatment (B = 5.40, p = 0.003). Following HEP, mean knowledge score increased from 69 % to 79 % (p < 0.001). The rate of patient referral to a liver specialist increased from 56.2 % to 67.5 % (p < 0.001). CONCLUSIONS: An HEP conducted at STDCs improved significantly patient knowledge about hepatitis C, even among patients with a high baseline knowledge. The HEP has also increased the rate of referral to the liver specialist and showed a great potential to support healthcare professionals in managing HCV. Education programs may promote treatment access among PWID, a population that represents the majority of HCV infected patients.

Interdisciplinary therapy changes superoxide dismutase activity and adiponectin in obese adolescents: a randomised controlled trial.

The objective of this study is to evaluate the effect of interdisciplinary therapy in the parameters of the oxidative stress and the anti-inflammatory responses of obese adolescents. We selected 57 participants, who were randomly divided into 2 groups: interdisciplinary therapy group and a control group. After 6 months of intervention, 17 participants of the interdisciplinary therapy group and 8 of the control group returned for re-evaluation. The interdisciplinary therapy group participated in a treatment with 4 weekly sessions of exercise, a weekly group therapy session and a weekly nutritional education session. Blood parameters of oxidative stress and anti-inflammatory response were evaluated. The results demonstrated that there were significant increases in the interdisciplinary therapy group for superoxide dismutase activity (6.56 ± 3.22 to 11.40 ± 7.49) and ferric-reducing antioxidant potential concentration (532.91 ± 106.48 to 573.25 ± 112.57), although adiponectin levels did not reduce (40.9 ± 29.34 to 49.05 ± 41.22). A significant decrease in nitrite levels was also found (14.23 ± 8.48 to 11.45 ± 6.05). In the control group, significant reduction was found in adiponectin (31.56 ± 18.88 to 18.01 ± 11.66). This study suggests that interdisciplinary therapy for 6 months was effective in improving the anti-inflammatory responses and the antioxidant defences in obese adolescents.

Esteatose hepática não alcoólica: relação com a síndrome metabólica e os fatores de risco cardiovascular em adolescentes obesos / Esteatosis hepática no alcohólica: relación con el síndrome metabólico y los factores de riesgo cardiovascular em adolescentes obesos / Nonalcoholic hepatic steatosis: association with metabolic syndrome and cardiovascular risk factors in obese adolescents

Avaliar a associação entre esteatose hepática não alcoólica (EHNA), síndrome metabólica (SM) e fatores de risco cardiovascular (FRCs) em adolescentes obesos. Métodos: Estudo observacional do tipo transversal com abordagem quantitativa, realizado de junho a agosto de 2011. Os voluntários foram aleatoriamente selecionados e encaminhados para avaliação clínica no setor de endocrinologia e cardiologia do hospital de clínicas da Universidade Federal de Uberlândia. Participaram 34 adolescentes de 14 a 19 anos, acima do percentil 95 da curva de crescimento. A EHNA foi analisada por ultrassonografia. A SM e os FRCs foram identificados pelos critérios da International Diabetes Federation. Resultados: A amostra foi composta de 14 indivíduos do sexo masculino e 20 do sexo feminino, com idade (16,8±1,6) e índice de massa corporal (IMC) (35,7±3,9). A ocorrência de EHNA e SM foi de 76,5% (n=26) e 50% (n=17), respectivamente. O sexo masculino apresentou maior ocorrência de EHNA (78,6%, n=11), SM (64,3%, n=09) e associação de EHNA com SM (50%, n=07). Em relação aos FRCs 100% (n=34), 61,8% (n=21) e 52,9% (n=18) dos adolescentes apresentaram valores aumentados da circunferência da cintura (CC), da lowdensity- lipoprotein cholesterol (LDL-C) e pressão arterial sistólica (PAS), respectivamente, e 52,9% (n=18) apresentaram baixos valores de high-density lipoprotein cholesterol (HDL-C). Houve correlações entre SM e triglicerídeos, PAS e diastólica e HDL-C, e entre EHNA, IMC e CC. Conclusão: Observou-se uma alta ocorrência de EHNA, SM e FRCs em adolescentes obesos. Uma forte correlação foi observada entre EHNA e SM, e entre FRCs com EHNA e SM...

To evaluate the association between nonalcoholic hepatic steatosis (NAHS),metabolic syndrome (MS) and cardiovascular risk factors (CRF) in obese adolescents.Methods: Cross-sectional observational study with a quantitative approach, carried out from June to August 2011. The volunteers were randomly selected and referred to clinical evaluation in the endocrinology and cardiology units at the clinics hospital of the Federal University of Uberlândia, being included 34 adolescents of 14-19 years above the 95th percentile of the growth curve. NAHS was assessed by ultrasonography. The MS and CRF were diagnosed by the International Diabetes Federation criteria. Results: The sample consisted of 14 male and 20 female patients aged 16.8 ± 1.6 and body mass index (BMI) of 35.7 ± 3.9. The occurrence of NAHS and MS was 76.5% and 50%, respectively. Males had a higher incidence of NAHS (78.6%), SM (64.3%) and association of NAHS with MS (50%). Regarding the CRF, 100% (n=34), 61.8% (n=21) and 52.9% (n=18) of the adolescents had elevated values of waist circumference (WC), low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP), respectively, and 52.9% (n=18) showed low levels of high-density lipoprotein cholesterol (HDL-C). There were correlations between MS and triglycerides; systolic and diastolic blood pressure and HDL-C; and between NAHS and BMI and WC. Conclusion: A high occurrence of NAHS, SM and CRF was observed in obese adolescents. A strong correlation was observed between MS and NAHS, and between FRC and NAHS and SM...

Evaluar la asociación entre la esteatosis hepática no alcohólica (EHNA), síndrome metabólico (SM) y factores de riesgo cardiovascular (FRCs) en adolescentes obesos. Métodos: Estudio observacional del tipo trasversal com abordaje cuantitativo realizado entre junio y agosto de 2011. Los voluntarios fueron seleccionados al azar y encaminados para evaluación clínica en el sector de endocrinología y cardiología delhospital de la Universidad Federal de Uberlandia. Participaron 34 adolescentes entre 14 y 19 años que estaban por encima Del percentil 95 de la curva de crecimiento. La EHNA fue analizada con la ultrasonografía. La SM y los FRCs fueron identificados a través de criterios de la International Diabetes Federtion. Resultados: La muestra fue constituida de 14 individuos del sexo masculino y 20 del sexo femenino con media de edad de 16,8±1,6años y media del índice de masa corporal (IMC) de 35,7±3,9. La ocurrencia de EHNA y SM fue del 76,5% (n=26) y 50% (n=17), respectivamente. El sexo masculino presentó mayor ocurrencia de EHNA (78,6%, n=11), SM (64,3%, n=09) y asociación de EHNA y SM (50%, n=07). Respecto a los FRCs, el 100% (n=34), 61,8% (n=21) y el 52,9% (n=18) de los adolescentes presentaron valores mayores de la circunferencia de cintura (CC), de la low-densitylipoprotein cholesterol (LDL-C) y tensión arterial sistólica (TAS), respectivamente, y el 52,9% (n=18) presentó bajos niveles de high-density lipoprotein cholesterol (HDL-C). Hubieron correlaciones entre SM y triglicérides, TAS y diastólica y HDL-C, y entre EHNA, IMC y CC. Conclusión: Se observó una elevada ocurrencia de EHNA, SM y FRCs en adolescentes obesos. Uma fuerte correlación fue observada entre EHNA y SM, y entre FRCs y EHNA y SM...

O terceiro cavaleiro / The third knight / El tercero caballero

Este trabalho traz questões a respeito do tratamento psicanalítico de uma menina de sete anos, que apresentava sintomas fóbicos. A autora busca uma compreensão analítica sobre o sofrimento psíquico desta criança abordando desdobramentos do caso, através de algumas vinhetas clínicas.(AU)

This paper raises questions about the psychoanalytic treatment of a seven years old girl, with phobic symptoms. The author seeks an analytical comprehension of this child's psychical suffering, considering the developments of the case, as seen in a few vignettes.(AU)

El trabajo trae cuestiones acerca del tratamiento psicoanalítico de uma niña de siete anos que apresentaba síntomas fóbicos. A autora busca una compresión analítica sobre el sufrimiento psíquico de esta niña abordando desdoblamiento del caso, a través de algunas viñetas clínicas.(AU)

Knowledge-attitude-practice survey among Portuguese gynaecologists regarding combined hormonal contraceptives methods.

ABSTRACT Objectives To evaluate knowledge, attitude and practices of Portuguese gynaecologists regarding combined hormonal contraceptives. Methods A cross-sectional survey was conducted among 303 gynaecologists. Results Ninety percent of the gynaecologists considered that deciding on contraceptive methods is a process wherein the woman has her say. Efficacy, safety and the woman's preference were the major factors influencing gynaecologists, while efficacy, tolerability and ease of use were the major factors perceived by the specialists to influence the women's choice. Gynaecologists believed that only 2% of women taking the pill were 100% compliant compared to 48% of those using the patch and 75% of those using the ring. The lower risk of omission was the strong point for the latter methods. Side effects were the main reason to change to another method. Vaginal manipulation was the most difficult topic to discuss. Conclusions Most gynaecologists decided with the woman on the contraceptive method. The main reasons for the gynaecologist's recommendation of a given contraceptive method and the women's choice were different. Counselling implies an open discussion and topics related to sexuality were considered difficult to discuss. Improving communication skills and understanding women's requirements are critical for contraceptive counselling.

Avaliação do broncoespasmo induzido pelo exercício avaliado pelo Peak Flow Meter em adolescentes obesos / Evaluation of exercise-induced bronchospasm assessed by Peak Flow Meter in obese adolescents

INTRODUÇÃO: Crianças e adolescentes com excesso de peso apresentam maior prevalência de broncoespasmo induzido pelo exercício (BIE), quando comparados a eutróficos. A espirometria e o peak flow meter são importantes métodos avaliativos da função pulmonar. Porém, a aplicabilidade do medidor do pico de fluxo expiratório (peak flow meter) na detecção do BIE em crianças e adolescentes com excesso de peso não é conhecida, o que justifica o desenvolvimento desta pesquisa. OBJETIVOS: Avaliar e comparar o desencadeamento de broncoespasmo induzido pelo exercício (BIE) em crianças e adolescentes não asmáticos com excesso de peso, avaliados pela espirometria e pelo peak flow meter (PFE). CASUÍSTICA E MÉTODOS: Participaram do estudo 39 voluntários acima do percentil 85º (OB) e 30 eutróficos (EU), de oito a 15 anos. A avaliação da função pulmonar pré e pós-teste de broncoprovocação foi realizada pela espirometria e peak flow meter, de acordo com o protocolo de Del Río-Navarro et al., (2000). O BIE foi considerado positivo quando o voluntário apresentou uma redução > 10 por cento do VEF1 basal ou redução > 20 por cento do PFE PFM e/ou PFE E. RESULTADOS: Na detecção do BIE, a prevalência do grupo obeso foi de 26 por cento avaliado pelo peak flow meter (PFEPFM) e 23 por cento pelo VEF1. O tempo do BIE ocorreu nos primeiros 15 minutos pós-exercício em ambos os parâmetros: (PFE PFM) e VEF1. CONCLUSÃO: Os voluntários obesos apresentaram tempo e prevalências similares de BIE, quando avaliados por ambos os métodos de avaliação pulmonar. O fácil manejo e o baixo custo facilitam a maior acessibilidade para a população geral do peak flow meter, o que demonstra sua importância como parte integrante de um programa educacional no diagnóstico inicial do BIE em vias aéreas de grande calibre.

INTRODUCTION: Children and adolescents who are overweight have a higher prevalence of exercise-induced bronchospasm (EIB), as compared to eutrophics. Spirometry and peak flow meter are important evaluation methods of lung function. However, the applicability of the peak expiratory flow (peak flow meter) in the detection of EIB in children and adolescents who are overweight is not known, hence the development of this research. OBJECTIVES: To evaluate and compare the onset of exercise-induced bronchospasm (EIB) in children and adolescents non-asthmatic who are overweight, evaluated by spirometry and the peak flow meter (PEF). METHODS: The study included 39 volunteers above the 85th percentile (OB) and 30 normal weight (EU), with the age of 8 to 15 years. The evaluation of lung function before and after bronchial provocation test was performed by spirometry and peak flow meter, according to the protocol of Del Río-Navarro et al, (2000). The EIB was considered positive when the volunteer showed a reduction > 10 percent of baseline FEV1 or > 20 percent reduction in PEF PFM and / or PEFE. RESULTS: The detection of the BIE, the prevalence of obese group was 26 percent measured by peak flow meter (PEF PFM) and 23 percent for FEV1. The time of the BIE occurred with the first 15 minutes post-exercise in both parameters: (PFE PFM) and FEV1. CONCLUSION: The obese volunteers presented similar time and prevalence of EIB, when evaluated by both methods of pulmonary assessment. The easy handling and low cost from this method created greater accessibility for the general population from the peak flow meter, which shows its importance as part of an educational program in the initial diagnosis of EIB in large airway caliber.

Impact of a women's counselling programme on combined hormonal contraception in Portugal--the IMAGINE Study.

BACKGROUND: The aim of this health education project was to measure the impact of counselling about combined hormonal contraceptive (CHC) methods on the subsequent choice of method by Portuguese women. METHOD: This was a multi-centre study with a representative population, at the national and regional levels, of 2951 Portuguese women≥16 years of age visiting the gynaecologist. Counselling on available CHC methods was provided using a single leaflet, and their CHC choice was assessed before and after counselling. RESULTS: A combined oral contraceptive (COC) was the method preferred by the majority of the women prior to counselling. After counselling, 35% of women who initially had chosen the pill, switched to either the vaginal ring or the transdermal patch, and the difference was statistically significant. Ease of use was the major reason for choosing the COC, while a lower probability of omission was the reason for choosing the vaginal ring and the patch. CONCLUSIONS: The implementation of a counselling programme significantly affected contraceptive choices leading in a number of cases to the selection of alternatives better suited to women's lifestyle. Age and educational level are socio-demographic factors which play an important role.

A importância da avaliação otorrinolaringológica de pacientes com mucopolissacaridose / The importance of the otorhinolaryngologic evaluation in mucopolysaccharidosis patients

INTRODUÇÃO: Mucopolissacaridose (MPS) é um conjunto de doenças raras causadas pela deficiência de enzimas lisossômicas levando ao acúmulo de glicosaminoglanos (GAG) em órgãos e tecidos, responsáveis pelo quadro clínico multissistêmico, crônico e progressivo. OBJETIVO: Descrever o perfil do exame clínico otorrinolaringológico de pacientes acompanhados no submetidos à Terapia de Reposição Enzimática (TRE) e propor um algoritmo de acompanhamento otorrinolaringológico para estes pacientes. MÉTODO: Realizado estudo de série de casos incluindo 21 pacientes com MPS I, II e VI. RESULTADOS: As queixas otorrinolaringológicas mais frequentes foram obstrução nasal, roncos, respiração bucal. A presença de apneia foi relatada em 31 por cento dos casos. No exame físico a macroglossia foi a principal alteração (41 por cento) da orofaringoscopia. Na otoscopia, a retração da membrana timpânica esteve presente em 33 por cento e a queixa de hipoacusia esteve presente em 45 por cento. CONCLUSÃO: É importante avaliar as queixas, exame físico e o impacto das alterações associadas à respiração e audição produzidas pela MPS visando um melhor acompanhamento destes pacientes e a prevenção das alterações crônicas resultantes como a perda auditiva, distúrbios do sono e respiração bucal, promovendo assim uma melhor qualidade de vida destes pacientes.

INTRODUCTION: Mucopolysaccharidosis (MPS) is a group of rare diseases caused by the deficit of lysosomal enzymes, causing an accumulation of glycosaminoglycans (GAG) in organs and tissues responsible for the multi-systemic clinical, chronic and progressive status. OBJECTIVE: Describe the profile of the otorhinolaryngologic clinical evaluation in patients submitted to Enzyme Replacement Therapy (ERT) and suggest an algorithm to otorhinolaryngolgically follow up with these patients. METHOD: A study with a number of cases was performed, including 21 patients having MPS I, II and VI. RESULTS: The most common otorhinolaryngological complaints were nasal obstruction, snore, and mouth-breathing. Apnea was reported in 31 percent of the cases. In the physical examination, macroglossia was the main alteration (41 percent) of oral pharyngoscopy. At otoscopy, the retraction of the tympanic membrane was found in 33 percent and hearing loss was found in 45 percent. CONCLUSION: It is important to evaluate the complaints, physical examination and the impact of alterations associated with MPS-produced breathing and hearing, for purposes of better following up with these patients and preventing consequential chronic alterations such as hearing loss, sleep disorder, and mouth breathing, thus, enhancing these patients' quality of life.

Ricardo III: seu descomedimento, sua desmesura, sua compulsão / Richard III: his lack of moderation, his excess, his compulsion

Através da obra literária Ricardo III, de Shakespeare, a autora faz uma reflexão articulando a ficção da peça ao processo psicanalítico no tratamento da compulsão. A subjetividade de Ricardo III, em seu sentimento de excluído pela natureza, a partir de sua deformidade física, aparece no texto através da arrogância, da desmesura, que aponta para uma privação. O trabalho busca mostrar como o protagonista sentindo-se "mal acabado" e prejudicado pelo destino, cobra uma fatura numa cadeia compulsiva, sem ter a chance de experimentar um vínculo que o levasse a um viver criativo.(AU)

Through the literary work Richard III, of Shakespeare, the author makes a reflexion articulating the fiction of the play with the psychoanalytic process in the treatment of the compulsion. Richard's III subjectivity, in his feeling of being excluded by nature, due to his physical deformity, appears in the text through the arrogance, of the excess that points to a deprivation. The work tries to show how the protagonist with the feeling of "badly finished" and being less fortunate by destiny, charges an invoice in a compulsive chain, without having the chance of experimenting a bond that could take him to live a creative life.(AU)

Effects of a benzodiazepine on free recall of semantically related words.

Although it is widely known that benzodiazepines impair episodic memory, few studies have investigated their effects upon specific processes involved in free recall. This study evaluated the acute effects of flunitrazepam (1.0 mg; 1.3 mg) and placebo in healthy volunteers on immediate and delayed free recall of word lists considering serial positions as well as semantic relations between words inserted in the middle of the lists (e.g. milk-cheese-butter). Flunitrazepam promoted a global amnestic effect, impairing recall in all serial positions except the last words (recency effect). Primacy and recency effects were preserved as indexed, respectively, by larger recall of the first and last words in relation to adjacent items. Facilitation in recall of semantically related words was not impaired by the drug when compared to recall in adjacent positions, in spite of a dose-dependent diminution of the number of words recalled also in mid-list positions. Flunitrazepam-induced deficits were interpreted as impairment in the formation of new associations between items, or groups of items in the case of related words, and context.