Contribuições da psicanálise no manejo de crianças com transtornos do espectro autista / Contributions of psychoanalysis in the management of children with autistic spectrum disorders / Aportaciones del psicoanálisis en el tratamiento de niños con trastornos del espectro autista

Em todo o mundo, as pessoas com Transtorno do Espectro Autista são discriminadas e têm seus direitos violados. Estima-se que uma em cada 160 crianças possuem o distúrbio e os estudos indicam o aumento globalizado da prevalência do Espectro. A psicanálise é conhecida por ser uma clínica do sujeito, e em crianças com TEA, se coloca no lugar de respeito ao jeito de ser de cada indivíduo, independentemente de sua patologia. As intervenções psicossociais com base nas teorias psicanalíticas são uma forma de reduzir as angústias vividas pelo sujeito, às dificuldades de comunicação e convívio social, melhorando a qualidade de vida. Desse modo, a presente pesquisa buscou compreender como a técnica psicanalítica pode contribuir no manejo de crianças com TEA. Para isto foi realizado um estudo de caráter descritivo e qualitativo com 12 psicanalistas que atendem crianças com o espectro. As entrevistas e dados sociodemográficos foram analisados com auxílio do IRAMUTEQ e do SPSS 21.0, respectivamente. Após a análise, as palavras puderam ser agrupadas em dois grandes eixos. O primeiro caracterizando o processo de evolução, onde a importância da família é ponto chave, e o segundo, relacionado ao lugar do psicanalista na direção da análise, caracterizando as especificidades do tratamento, do manejo e linguagem desta demanda. Pode- se perceber que as entrevistas explanaram as vivências da prática clínica, além de um tratamento possível e que mostra resultados no atendimento psicanalítico de crianças diagnosticadas ou em processo de diagnóstico do TEA.

All over the world, people with Autistic Spectrum Disorder are discriminated against and have their rights violated. It is estimated that one in every 160 children has the disorder and studies indicate the global increase in the prevalence of the Spectrum. Psychoanalysis is known to be a clinic of the subject, and in children with ASD, it takes the place of respect for the way of being of each individual, regardless of their pathology. Psychosocial interventions based on psychoanalytic theories are a way to reduce the anxieties experienced by the subject, the difficulties in communication and social interaction, improving the quality of life. Thus, this research sought to understand how the psychoanalytic technique can contribute to the management of children with ASD. For this, a descriptive and qualitative study was carried out with 12 psychoanalysts who assist children with the spectrum. The interviews and sociodemographic data were analyzed using IRAMUTEQ and SPSS 21.0, respectively. After analysis, the words could be grouped into two major axes. The first characterizing the process of evolution, where the importance of the family is a key point, and the second, related to the place of the psychoanalyst in the direction of the analysis, characterizing the specificities of the treatment, handling and language of this demand. It can be seen that the interviews explained the experiences of clinical practice, in addition to a possible treatment that shows results in the psychoanalytic care of children diagnosed or in the process of being diagnosed with ASD.

En todo el mundo, las personas con Trastorno del Espectro Autista son discriminadas y se violan sus derechos. Se estima que uno de cada 160 niños tiene el trastorno y los estudios indican el aumento global de la prevalencia del Espectro. El psicoanálisis se sabe que es una clínica del sujeto, y en los niños con TEA, toma el lugar del respeto por la forma de ser de cada individuo, independientemente de su patología. Las intervenciones psicosociales basadas en las teorías psicoanalíticas son una forma de reducir las ansiedades que experimenta el sujeto, las dificultades en la comunicación y la interacción social, mejorando la calidad de vida. Así, esta investigación buscó comprender cómo la técnica psicoanalítica puede contribuir al manejo de niños con TEA. Para ello, se realizó un estudio descriptivo y cualitativo con 12 psicoanalistas que asisten a niños con el espectro. Las entrevistas y los datos sociodemográficos se analizaron con IRAMUTEQ y SPSS 21.0, respectivamente. Después del análisis, las palabras podrían agruparse en dos grandes ejes. La primera caracterizando el proceso de evolución, donde la importancia de la familia es un punto clave, y la segunda, relacionada con el lugar del psicoanalista en la dirección del análisis, caracterizando las especificidades del tratamiento, manejo y lenguaje de esta demanda. . Se puede apreciar que las entrevistas explicaron las experiencias de la práctica clínica, además de un posible tratamiento que muestra resultados en la atención psicoanalítica de niños diagnosticados o en proceso de ser diagnosticados con TEA. PALABRAS CLAVE: Psicoanálisis; Niños; Trastorno del Espectro Autista.

ß-caryophyllene and docosahexaenoic acid, isolated or associated, have potential antinociceptive and anti-inflammatory effects in vitro and in vivo.

Inflammation is a complex biological response involving the immune, autonomic, vascular, and somatosensory systems that occurs through the synthesis of inflammatory mediators and pain induction by the activation of nociceptors. Staphylococcus aureus, the main cause of bacteremia, is one of the most common and potent causes of inflammation in public health, with worse clinical outcomes in hospitals. Antioxidant substances have been evaluated as alternative therapeutic analgesics, antioxidants, anti-inflammatory agents, antitumor agents, and bactericides. Among these, we highlight the essential oils of aromatic plants, such as ß-caryophyllene (BCP), and polyunsaturated fatty acids, such as docosahexaenoic acid (DHA). The objective of this study was to evaluate the biological activities of BCP-DHA association in in vitro and in vivo experimental models of antinociception and inflammation. To determine the anti-inflammatory effects, monocytes isolated from the peripheral blood of adult male volunteers were infected with methicillin-resistant S. aureus and incubated with treatment for cytokine dosage and gene expression analysis. Antinociceptive effects were observed in the three models when comparing the control (saline) and the BCP-DHA treatment groups. For this purpose, the antinociceptive effects were evaluated in animal models using the following tests: acetic acid-induced abdominal writhing, paw edema induced by formalin intraplantar injection, and von Frey hypernociception. There was a significant reduction in the GM-CSF, TNFα, IL-1, IL-6, and IL-12 levels and an increase in IL-10 levels in the BCP-DHA treatment groups, in addition to negative regulation of the expression of the genes involved in the intracellular inflammatory signaling cascade (IL-2, IL-6, IRF7, NLRP3, and TYK2) in all groups receiving treatment, regardless of the presence of infection. Statistically significant results (p < 0.05) were obtained in the acetic acid-induced abdominal writhing test, evaluation of paw edema, evaluation of paw flinching and licking in the formalin intraplantar injection model, and the von Frey hypernociception test. Therefore, BCP and DHA, either administered individually or combined, demonstrate potent anti-inflammatory and antinociceptive effects.

Sum of skinfolds measurement can be used in the estimation of total body fat in patients with chronic kidney disease undergoing hemodialysis / La medición de la suma de los pliegues cutáneos puede utilizarse en la estimación de la grasa corporal total en los pacientes con nefropatía crónica sometidos a hemodiálisis

INTRODUCTION: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. OBJECTIVES: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. METHODS: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. RESULTS: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. CONCLUSIONS: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA

INTRODUCCIÓN: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. OBJETIVOS: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. MÉTODOS: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. RESULTADOS: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. CONCLUSIÓN: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA

Sum of skinfolds measurement can be used in the estimation of total body fat in patients with chronic kidney disease undergoing hemodialysis.

INTRODUCTION: Introduction: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. Objectives: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. Methods: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. Results: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. Conclusions: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA.

INTRODUCCIÓN: Introducción: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. Objetivos: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. Métodos: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. Resultados: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. Conclusión: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA.

Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation

ABSTRACT Background: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. Methods: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. Results: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p = 0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. Conclusion: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation.

BACKGROUND: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. METHODS: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. RESULTS: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p=0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. CONCLUSION: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

Increased Levels of Txa2 Induced by Dengue Virus Infection in IgM Positive Individuals Is Related to the Mild Symptoms of Dengue.

The inflammatory process plays a major role in the prognosis of dengue. In this context, the eicosanoids may have considerable influence on the regulation of the Dengue virus-induced inflammatory process. To quantify the molecules involved in the cyclooxygenase and lipoxygenase pathways during Dengue virus infection, plasma levels of thromboxane A2, prostaglandin E2 and leukotriene B4; mRNA levels of thromboxane A2 synthase, prostaglandin E2 synthase, leukotriene A4 hydrolase, cyclooxygenase-2 and 5-lipoxygenase; and the levels of lipid bodies in peripheral blood leukocytes collected from IgM-positive and IgM-negative volunteers with mild dengue, and non-infected volunteers, were evaluated. Dengue virus infection increases the levels of thromboxane A2 in IgM-positive individuals as well as the amount of lipid bodies in monocytes in IgM-negative individuals. We suggest that increased levels of thromboxane A2 in IgM-positive individuals plays a protective role against the development of severe symptoms of dengue, such as vascular leakage.

Bioassay-guided fractionation and antimicrobial and cytotoxic activities of Cassia bakeriana extracts

ABSTRACT The antimicrobial potential of extracts of bark and leaves of Cassia bakeriana Craib, Fabaceae, against aerobic and anaerobic oral bacteria was evaluated by the microdilution broth method. For crude ethanol extracts and organic fractions tested, the bark dichloromethane phase showed a significant antibacterial effect, with MIC values ranging from 12.5 to 100 µg/ml for most of the microorganisms tested. Thus, a bioassay-guided fractionation of this fraction was performed. This fractionation led to isolation of the 1,8-dihydroxy-anthraquinone-3-carboxylic acid, also known as cassic acid or rhein. It is the first time that this bioactive anthraquinone has been isolated from this plant. Rhein exhibited good selectivity and high activity against anaerobic microorganisms, with MIC values ranging between 3.12 µg/ml (11.0 µM) and 25 µg/ml (88.0 µM). These results were considered very promising since the most active samples and rhein showed greater selectivity against oral microorganisms than toxicity to Vero cells.