Teoria dos limites dos limites e as restrições de liberdades individuais na pandemia de COVID-19 no Brasil / Theory of limits of limits and the restrictions of individual rights in the COVID-19 pandemic in Brazil / Teoría de los límites de los límites y las restricciones de las libertades individuales en la pandemia de COVID-19 en Brasil

Objetivo: analisar a teoria dos limites dos limites como argumento adequado para solucionar a eventual colisão de direitos fundamentais no contexto da pandemia, partindo-se da premissa de sua relatividade. Metodologia: utilizou-se o método dedutivo, por meio da pesquisa bibliográfica de artigos científicos nas bases de dados Google Acadêmico e Scielo, no período de 2021 e 2022,sobre a teoria dos limites dos limites, e da pesquisa documental, de caráter exploratório, de normativas geradoras de restrição de direitos individuais, implementadas no município de Araraquara. Resultados: o questionamento sobre a fundamentação de atos normativos e decisões judiciais que propiciaram a aplicação de restrições a direitos fundamentais perde consistência argumentativa se os atos reclamados apresentarem construção a partir da teoria dos limites dos limites. Conclusão: verificou-se que os direitos fundamentais não são direitos absolutos, sendo, portanto, factível a sua relativização, observando-se os parâmetros da teoria dos limites dos limites, de forma a possibilitara restrição durante a pandemia da COVID-19, por meio do sopesamento de valores em um Estado Democrático e Social de Direito.

Objective: to analyze the theory of limits of limitsas a suitable argument tosolve the possible collision of fundamental rights in the context of the pandemic, starting from the premise of their relativity. Methods: the deductive method was applied through a bibliographic search of scientific articles in the Google Scholarand Scielodatabases in 2021 and 2022 on the theory of limits of limitsand anexploratory documentary research on the regulations implemented in the municipality of Araraquara that lead to a limitation of individual rights. Results: question of the basis of normative acts and judicial decisions that have led to the application of restrictions on fundamental rights loses argumentative consistency when the alleged acts are a construction from the theory oflimits oflimitsboundaries. Conclusion: it has been established that fundamental rights are not absolute rights and therefore their relativization is possible by observing the parameters of the theory of limits of limitsto allow the restriction during the pandemic COVID -19 by balancing the values in a Democratic and Social State of Law.

Objetivo: analizar la teoría de los límites de los límitescomo argumento adecuado para resolver la posible colisión de derechos fundamentales en el contexto de la pandemia, partiendo de la premisa de su relatividad. Metodología: se utilizó el método deductivo, a través de lainvestigación bibliográfica de artículos científicossobre la teoría de los límites de los límitesen las bases de datos Google Academicy Scielo, en el periodo 2021 y 2022 y también se realizó investigación documental exploratoriade normas que generan restricción de derechos individuales enel municipio de Araraquara. Resultados: el cuestionamiento sobre el fundamento de los actos normativos y decisiones judiciales que dieron lugar a la aplicación de restricciones a derechos fundamentales pierde consistencia argumentativa si los actos reclamados presentan construcción desde la teoría de los límites de los límites. Conclusión: se constató que los derechos fundamentales no son derechos absolutos, por lo que es factible su relativización, observando los parámetros de la teoría de los límites de los límites, permitiendo la restricción durante la pandemia de la COVID-19, a través de la ponderación de valores en un Estado Democrático y Social de Derecho.

Behavioural effects of noise on Linnaeus's two-toed sloth (Choloepus didactylus) in a walk-through enclosure.

Anthropogenic noise has been related to stress in captive animals; despite this there have been few studies on animal welfare assessment in walk-through zoo enclosures. We aimed to investigate the behavioural effects of noise on a male-female pair of two-toed sloths (Choloepus didactylus), housed in a walk-through enclosure in a zoo in the UK. The animals were filmed for 24 h per day, during three days per week, including days with potential low and high flow of visitors, for three weeks. Sound pressure measurement was performed four times each collection day (twice in the morning, once at noon and once in the afternoon), for 15 min per session, using a sound level meter. The number of visitors passing the enclosure during each session was also recorded. The videos were analysed using focal sampling, with continuous recording of behaviour. Correlations between noise and the behaviours expressed during, and in the 24 h after the acoustic recording, were investigated. The number of visitors correlated with the acoustic parameters. At the moment of exposure, higher levels of noise correlated with decreased inactivity, and longer expression of locomotion and maintenance behaviours for the male; the female spent more time inside a box in these moments. During the 24 h hours after exposure to loud noise, the female showed no behavioural changes while the male tended to reduce foraging. The behavioural changes observed in both individuals have already been reported in other species, in response to stressful events. Our study indicates the need for a good acoustic management in walk-through zoo enclosures where sloths are housed.

Hand-foot syndrome caused by capecitabine: incidence, risk factors and the role of dermatological evaluation.

Hand-foot syndrome (HFS), or palmar-plantar erythrodysesthesia, is characterised by erythema, oedema and dysesthesia, which can progress to blistering and ulceration. This condition is described as a common adverse effect of the chemotherapeutic agent capecitabine. The study set out to evaluate real-world incidences; assess severity based on clinical criteria, such as local symptoms, dyschromia, erythema, oedema and ulcerations; and associated factors, such as type of solid tumour, chemotherapy regimen, number of cycles, sex, age and Eastern Cooperative Oncology Group Performance Scale of HFS, related to the use of capecitabine. This is a single-centre prospective cohort study carried out jointly by the departments of clinical oncology and dermatology of a university hospital in the southeast of Brazil. The study showed a 34% incidence of HFS, with most cases classified as mild. There was statistical significance in the correlation of the syndrome with sex and performance scores. HFS is the most common and limiting adverse reaction to capecitabine, and causes significant functional and quality impairments in patients with cancer. With this study, we have reinforced the importance of multidisciplinary assessment for early diagnosis and adequate follow-up.

Milium cysts on hands; hypertrichosis on face.

The patient's dermatologic symptoms and his history of a particular chronic condition pointed toward the diagnosis.

Fibrohistiocitoma maligno de face: uma apresentação rara / Malignant fibrohistiocytoma of face: a rare presentation

Contexto: O fibrohistiocitoma maligno é um sarcoma de tecidos moles muito agressivo, com rara apresentação limitada à pele e tecido subcutâneo em face. O diagnóstico é anatomopatológico com auxílio da imuno-histoquímica. Descrição do caso: Este artigo relata o caso de um paciente com diagnóstico de fibrohistiocitoma maligno restrito à face com boa resposta terapêutica após exérese cirúrgica. Discussão: Tendo em vista a raridade dessa afecção, dificuldade diagnóstica devido ao quadro inespecífico e com rápida evolução, é importante lembrar desse possível diagnóstico e atuar precocemente. Conclusões: O diagnóstico precoce interfere de forma significativa na evolução do quadro, sendo necessária a manutenção do acompanhamento oncológico e dermatológico com o intuito de detectar precocemente recidivas locais e metástases a distância.

Perfil clínico, histopatológico e tricoscópico da alopecia frontal fibrosante: estudo retrospectivo de casos de um serviço de referência de dermatologia / Clinical, histopathological and trichoscopic of frontal alopecia fibrosing: retrospective study of cases of a service of dermatology reference

Contexto: Alopecia frontal fibrosante (AFF) é uma alopecia cicatricial que acomete a região frontotemporal, e predomina em mulheres pós-menopausadas. Objetivo: Descrever o perfil clínico, histopatológico e tricoscópico de pacientes com diagnóstico de AFF. Desenho e local: Estudo de coorte retrospectivo observacional que foi desenvolvido no ambulatório de tricologia do departamento de dermatologia do Hospital Santa Casa de Misericórdia de Vitória, Vitória (ES), Brasil. Métodos: O estudo foi realizado por meio da análise de prontuários e de revisão histopatológica de pacientes com diagnóstico de AFF atendidos entre 1 de março de 2019 a 29 de fevereiro de 2020. Resultados: No período, 17 pacientes do sexo feminino foram diagnosticadas com AFF, 76,5% delas na pós-menopausa. Todas apresentavam alopecia frontotemporal e madarose. À tricoscopia, ausência de pelos velus, aberturas foliculares reduzidas, hiperceratose folicular e eritema perifolicular foram encontrados na maioria dos casos. Todas as biópsias mostraram aspectos microscópicos compatíveis com AFF. O tratamento mais utilizado foi tacrolimo 0,1%. Discussão: A patogênese da AFF ainda não é compreendida. A associação com doenças autoimunes sugere a influência da imunidade no quadro. A tricoscopia é uma ferramenta de fácil acesso e não invasiva que pode auxiliar no diagnóstico. Histopatologicamente a AFF é indistinguível do líquen plano pilar. O tratamento objetiva reduzir a inflamação e retardar a progressão da doença. Conclusões: Embora apresentações clínicas e tricoscópicas tenham sido descritas ao longo dos anos, a patogênese, a histologia e os tratamentos eficazes para AFF ainda são debatidos. O reconhecimento e o tratamento precoce da doença permitiriam a redução da progressão da doença.

O Melanoma pode esperar o Fim da Pandemia da Covid-19? / ¿Puede el Melanoma esperar el Fin de la Pandemia de la Covid-19? / Can Melanoma wait for the End of the COVID-19 Pandemic?

Introdução: A doença pelo coronavírus 2019 (coronavirus disease 2019 - covid-19) e as orientações de isolamento social promoveram uma drástica diminuição da procura pela avaliação dermatológica e cirurgias, fundamentais para a detecção precoce e prognóstico do melanoma. Objetivo: Avaliar a redução no diagnóstico e atendimento de pacientes com melanoma decorrentes da covid-19 entre 20 de março a 30 de junho de 2019 e correlacionar com os dados adquiridos entre 20 de março a 30 de junho de 2020. Método: Estudo retrospectivo de revisão de prontuários de pacientes com diagnóstico de melanoma. Trata-se de resultado parcial obtido de um trabalho que investigou o impacto global da pandemia no ambulatório e residência de dermatologia. Resultados: No período analisado, houve uma redução de 94,1% nos atendimentos de pacientes com câncer de pele melanoma. Negligenciar o melanoma durante a pandemia pode resultar em aumento da mortalidade e morbidade, além de maiores custos de saúde. Conclusão: É importante que os serviços públicos e privados se adequem às limitações do momento e, considerando a situação atual, esforços devem ser feitos para facilitar o acesso controlado ao dermatologista, pois isso evitará atrasos que resultem em pior prognóstico

Introduction: Coronavirus 2019 disease (coronavirus disease 2019 - COVID-19) and social isolation guidelines promoted a drastic reduction of the demand for dermatological evaluation and surgeries, essential for early detection and prognosis of melanoma. Objective: To evaluate the reduced number of diagnoses and consultation of patients with melanoma resulting from COVID-19 between March 20 and June 30, 2019 and correlate with data collected between March 20 and June 30, 2020. Method: Retrospective, review study of medical charts of patients diagnosed with melanoma. It is a partial result obtained from a study that investigated the global impact of the pandemic in the dermatology outpatient clinic and residency. Results: In the period analyzed, a reduction of 94.1% of the consultation of patients with melanoma skin cancer was found. Neglecting melanoma during the pandemic can result in increased mortality and morbidity, in addition to higher healthcare costs. Conclusion: It is important that public and private services adjust to the restrictions in-force and considering the current scenario, efforts to facilitate the controlled access to the dermatologist must be made because it could avoid delays that can lead to worse prognosis

Introducción: La enfermedad del coronavirus 2019 (enfermedad del coronavirus 2019 - covid-19) y las pautas de aislamiento social promovieron una reducción drástica de la demanda, a través de la evaluación dermatológica y las cirugías, esenciales para la detección temprana y el pronóstico del melanoma. Objetivo: Evaluar la reducción en el diagnóstico y atención de pacientes con melanoma por covid-19 entre el 20 de marzo y el 30 de junio de 2019 y correlacionar con los datos adquiridos entre el 20 de marzo y el 30 de junio de 2020. Método: Estudio retrospectivo de revisión de historias clínicas. de los pacientes diagnosticados de melanoma. Este es un resultado parcial obtenido de un estudio que investigó el impacto global de la pandemia en la clínica y residencia de dermatología. Resultados: En el período analizado, hubo una reducción del 94,1% en pacientes con cáncer de piel tipo melanoma. Descuidar el melanoma durante una pandemia puede resultar en una mayor mortalidad y morbilidad, así como en mayores costos de atención médica. Conclusión: Es importante que los servicios públicos y privados se adecúen a las limitaciones del momento y considerando la situación actual, esfuerzos deben ser hechos para facilitar el acceso controlado al dermatologista para evitar retrasos que pueden llevar a peores pronósticos

Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis.

The accuracy of estimated glomerular filtration rate (eGFR) equations in diabetes mellitus (DM) patients has been extensively questioned. We evaluated the performance of cystatin C-based equations alone or in combination with creatinine to estimate GFR in DM patients. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with "diabetes mellitus" and "cystatin C" as search terms. Studies comparing cystatin C-based eGFR equations with measured GFR (mGFR) in DM patients were eligible. Accuracies P10, P15, P20, and P30 indicated the proportion of eGFR results within 10, 15, 20, and 30% of mGFR. Single-arm meta-analyses were conducted, and the Quality of Diagnostic Accuracy Studies-II tool (QUADAS-2) was applied. Twenty-three studies comprising 7065 participants were included, and 24 equations were analyzed in a broad range of GFRs. Meta-analyses were completed for 10 equations. The mean P30 accuracies of the equations ranged from 41% to 87%, with the highest values found with both CKD-EPI equations. Mean P10-P15 achieved 35% in the best scenario. A sensitivity analysis to evaluate different mGFR methods did not change results. In conclusion, cystatin C-based eGFR equations represent measured GFR fairly at best in DM patients, with high variability among the several proposed equations.

The Different Physical and Behavioural Characteristics of Zoo Mammals That Influence Their Response to Visitors.

The factors underlying the 'zoo visit effect' (changes in animal behaviour/physiology in response to visitor presence) are still poorly understood, despite it being widely investigated. The present study examined the effect of zoo visitors on the behaviour of 17 different species of mammals at the Belo Horizonte Zoo, Minas Gerais, Brazil. The behaviour of the animals was recorded using scan (focal in one case) sampling with instantaneous recording of behaviour, during 12 continuous months. Data were analysed using a comparative method examining five different factors: diet, body weight, stratum occupied, activity cycle, and habitat, as well as three different visitor categories: small and quiet audience, medium size audience and medium noise, and large size and loud audience. Significant changes in the behaviour for each factor, especially increases in locomotor and resting behaviour, were observed in response to different visitor categories. The factors that most explained responses to visitor categories were habitat and activity cycle. Species from closed habitats compared to open habitats were significantly more impacted (more behaviour affected), probably, because they are, evolutionarily, less accustomed to visual contact with people. Diurnal species showed more behavioural changes than nocturnal ones, possibly, because they were being observed during their normal activity cycle. These results may help zoos identify which mammal species are most susceptible to the zoo visitor effect, and consequently, be more pro-active in the use of mitigating strategies.

Update in diagnosis and management of primary aldosteronism.

Primary aldosteronism (PA) is a group of disorders in which aldosterone is excessively produced. These disorders can lead to hypertension, hypokalemia, hypervolemia and metabolic alkalosis. The prevalence of PA ranges from 5% to 12% around the globe, and the most common causes are adrenal adenoma and adrenal hyperplasia. The importance of PA recognition arises from the fact that it can have a remarkably adverse cardiovascular and renal impact, which can even result in death. The aldosterone-to-renin ratio (ARR) is the election test for screening PA, and one of the confirmatory tests, such as oral sodium loading (OSL) or saline infusion test (SIT), is in general necessary to confirm the diagnosis. The distinction between adrenal hyperplasia (AH) or aldosterone-producing adenoma (APA) is essential to select the appropriate treatment. Therefore, in order to identify the subtype of PA, imaging exams such as computed tomography or magnetic ressonance imaging, and/or invasive investigation such as adrenal catheterization must be performed. According to the subtype of PA, optimal treatment - surgical for APA or pharmacological for AH, with drugs like spironolactone and amiloride - must be offered.

[Breastfeeding for at least thirty days is a protective factor against overweight in preschool children from the semiarid region of Alagoas]. / Aleitamento materno por trinta ou mais dias é fator de proteção contra sobrepeso em pré-escolares da região semiárida de Alagoas.

OBJECTIVE: To assess the impact of breastfeeding on the occurrence of anthropometric deviations among preschool children of the semiarid region of Alagoas (Brazil) and possible associated factors. METHODS: In probability sample of 716 children 1-3 years of age, anthropometric, socioeconomic, demographic and health data were collected. The dependent variables were stunting (height-for-age < -2 SD) and overweight (weight-for-height > 2 SD) relative to WHO-2006 standard. Children were categorized into 'breastfed' (breastfeeding > 30 days) and 'not breastfed' (breastfeeding <30 days). Data were submitted to bivariate (x(2)) and multivariate (logistic regression) analyses. RESULTS: Prevalence of overweight and stunting were 11.5% and 6.3% respectively. Although 87.3% belonged to the lower economic classes (D and E), 44.3% of mothers had a BMI > 25 kg/m(2). Among the 716 children, 489 (68.3%) were breastfed, 65 (9.0%) were not breastfed and 162 (22.7%) were still breastfeeding. Among those of the breastfed group, 213 (43.5%) received breast milk for more than 12 months. In bivariate analysis the prevalence of overweight was higher among the not breastfed group (12.7% vs. 6.0%; 95% CI = 1.0 to 5.5). Factors independently associated with stunting were lower birth weight, living in rural areas and mother not living with a companion. Overweight was associated with no breastfeeding, maternal smoking during pregnancy and birth weight > 4.0 kg. CONCLUSION: Breastfeeding for a minimum period of thirty days had a protective effect against overweight in preschool children of the semiarid region of Alagoas.

Aleitamento materno por trinta ou mais dias é fator de proteção contra sobrepeso em pré-escolares da região semiárida de Alagoas / Breastfeeding for at least thirty days is a protective factor against overweight in preschool children from the semiarid region of Alagoas

OBJETIVO: Investigar os efeitos do aleitamento materno sobre a ocorrência de desvios antropométricos em pré-escolares da região semiárida de Alagoas e os possíveis fatores associados. MÉTODOS: Em amostra probabilística de 716 crianças de um a cinco anos, coletaram-se dados antropométricos, socioeconômicos, demográficos e de saúde. As variáveis dependentes foram o déficit estatural (estatura para idade <-2 dp) e o sobrepeso (peso para altura > 2 dp) em relação ao padrão da OMS-2006. As crianças foram categorizadas em "mamaram" (amamentação >30 dias) e "não mamaram" (amamentação < 30 dias). Os dados foram submetidos à análise bivariada (c2) e multivariada (análise de regressão logística). RESULTADOS: As prevalências de déficit estatural e sobrepeso foram, respectivamente, 11,5 por cento e 6,3 por cento. Embora 87,3 por cento pertencessem às classes de menor nível econômico (D e E), 44,3 por cento das mães tinham IMC >25 kg/m². Dentre as 716 crianças estudadas, 489 (68,3 por cento) mamaram, 65 (9 por cento) não mamaram e 162 (22,7 por cento) ainda estavam mamando. Entre as que mamaram, 213 (43,5 por cento) foram amamentadas por mais de um ano. Na análise bivariada, a prevalência de sobrepeso foi maior entre crianças que não mamaram (12,7 por cento vs 6 por cento; IC95 por cento = 1 a 5,5). Os fatores independentemente associados ao déficit estatural foram o menor peso ao nascer, residir em área rural e mãe não residir com companheiro. O sobrepeso associou-se à não amamentação, tabagismo materno durante a gestação e peso ao nascer > 4 kg. CONCLUSÃO: O aleitamento materno por um período mínimo de 30 dias exerce um efeito protetor contra o sobrepeso em crianças de um a cinco anos da região semiárida de Alagoas.

OBJECTIVE: To assess the impact of breastfeeding on the occurrence of anthropometric deviations among preschool children of the semiarid region of Alagoas (Brazil) and possible associated factors. METHODS: In probability sample of 716 children 1-3 years of age, anthropometric, socioeconomic, demographic and health data were collected. The dependent variables were stunting (height-for-age < -2 SD) and overweight (weight-for-height > 2 SD) relative to WHO-2006 standard. Children were categorized into "breastfed" (breastfeeding > 30 days) and "not breastfed" (breastfeeding <30 days). Data were submitted to bivariate (x²) and multivariate (logistic regression) analyses. RESULTS: Prevalence of overweight and stunting were 11.5 percent and 6.3 percent respectively. Although 87.3 percent belonged to the lower economic classes (D and E), 44.3 percent of mothers had a BMI > 25 kg/m². Among the 716 children, 489 (68.3 percent) were breastfed, 65 (9.0 percent) were not breastfed and 162 (22.7 percent) were still breastfeeding. Among those of the breastfed group, 213 (43.5 percent) received breast milk for more than 12 months. In bivariate analysis the prevalence of overweight was higher among the not breastfed group (12.7 percent vs. 6.0 percent; 95 percent CI = 1.0 to 5.5). Factors independently associated with stunting were lower birth weight, living in rural areas and mother not living with a companion. Overweight was associated with no breastfeeding, maternal smoking during pregnancy and birth weight > 4.0 kg. CONCLUSION: Breastfeeding for a minimum period of thirty days had a protective effect against overweight in preschool children of the semiarid region of Alagoas.