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The purpose of this paper was to avaliate of the concentration of hydrocolloids (low methoxyl pectin [LMP], guar gum [GG], and carrageenan gum [CG]) in low-calorie orange jellies in order to maximize the amount of bioactive compounds and antioxidant capacity, and to study the influence on degradation these compounds. A mixture design with seven tests was used to analyze the total phenolic compounds, ascorbic acid (vitamin C) and antioxidant capacity (ABTS, DPPH and ß-carotene/linoleic acid methods). The results were analyzed by response surface methodology and the Scott-Knott mean test at a significance level of 5% (p ≤ 0.05). In general, the regions containing 0.5% GG and 0.5% GC had higher levels of the variables under study, and this combination preserved the bioactive compounds and antioxidant activity of jellies in relation to that of orange juice.

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Resumo Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.

Abstract This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist's practice.

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This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist's practice.

Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.

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Cardiac tumors are rare and myxomas are the most prevalent among them. Although it presents benign histology, they may be the cause of severe consequences due to intracardiac location. Nonspecific manifestations may hinder the diagnosis, which can lead to complications, such as changes in cardiac dynamics, thromboembolic events and death. This paper presents a case report of a patient in the emergency department of a high complexity hospital in Minas Gerais State, Brazil, with a clinical history of angina and 7 previous Transient Ischemic Attack (TIA), besides aphasia, right hemiparesis, dysarthria, and mouth deviation. Submitted to transesophageal echocardiography, she was diagnosed with left atrial myxoma. For the treatment of myxoma, a surgical approach was used to resect the myxoma in the left atrium. The standard surgical approach was through a median sternotomy. Cardiopulmonary bypass (CPB) with aortic and bicaval cannulation and moderate hypothermia was used. Myocardial protection was achieved by cold antegrade blood cardioplegia. The patient had notable characteristics for the diagnosis, especially the previous occurrence of seven episodes of TIA. The importance of correct clinical investigation (anamnesis, general and specific physical examination and imaging tests) is notable and a fundamental tool for the diagnosis and early treatment of neoplasia, providing good clinical outcomes.

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Specific inhibition of NADPH oxidases (NOX) and NO-synthases (NOS), two enzymes associated with redox stress in tumor cells, has aroused great pharmacological interest. Here, we show how these enzymes distinguish between isomeric 2'- and 3'-phosphate derivatives, a difference used to improve the specificity of inhibition by isolated 2'- and 3'-phosphate isomers of our NADPH analogue NS1. Both isomers become fluorescent upon binding to their target proteins as observed by in vitro assay and in vivo imaging. The 2'-phosphate isomer of NS1 exerted more pronounced effects on NOS and NOX-dependent physiological responses than the 3'-phosphate isomer did. Docking and molecular dynamics simulations explain this specificity at the level of the NADPH site of NOX and NOS, where conserved arginine residues distinguished between the 2'-phosphate over the 3'-phosphate group, in favor of the 2'-phosphate.

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Nonionic ethylene oxide (EO)-based surfactants are widely employed in commercial applications and normally form gel-like liquid crystalline phases at higher concentrations, rendering their handling under such conditions difficult. By incorporating CO2 units in their hydrophilic head groups, the consumption of the petrochemical EO was reduced, and the tendency to form liquid crystals was suppressed completely. This surprising behavior was characterized by rheology and studied with respect to its structural origin by means of small-angle neutron scattering (SANS). These experiments showed a strongly reduced repulsive interaction between the micellar aggregates, attributed to a reduced hydration and enhanced interpenetration of the head groups owing to the presence of the CO2 units. In addition, with increasing CO2 content the surfactants became more efficient and effective with respect to their surface activity. These findings are important because the renewable resource CO2 is used, and the CO2 -containing surfactants allow handling at very high concentrations, an aspect of enormous practical importance.

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Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic inflammatory disease that mainly affects children and young adults. The clinical signs and symptoms are nonspecific, hindering and delaying the proper diagnosis. We report a case of CRMO in a child with chronic pain in the cervical and thoracic spine. Investigations of the pain revealed a diagnosis of osteomyelitis in the biopsy, indicating a course of antibiotic treatment. After a year, there was progressive worsening of the pain, and it soon spread to the left wrist and right ankle. Magnetic resonance imaging of the left wrist and right ankle revealed morphostructural changes. A new biopsy was performed on the wrist and ankle, and osteomyelitis was pinpointed again. In view of the clinical, radiological, and histopathological findings, the patient was diagnosed with CRMO. The following treatment consisted of nonsteroidal anti-inflammatory drugs, methotrexate, and pamidronate. The strength of this case is the fact that there was extensive imaging and more than one biopsy, and the patient was followed. Magnetic resonance imaging was valuable in assessing the extent and activity of a lesion.

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Objetivo: verificar a ocorrência de Hipertensão Arterial Sistêmica em professores. Método: estudo descritivo exploratório,com abordagem quantitativa. A população constituiu-se por professores da rede pública de ensino, formada por 15 docentes. O instrumento utilizado na coleta de dados foi um formulário para a caracterização dos professores quanto à Hipertensão Arterial Sistêmica. O processo de análise contou com a construção de um banco de dados, alimentado pelos valores aferidos. No processamento da estatística descritiva, utilizou-se a planilha eletrônica Excel e os resultados foram apresentados em tabelas. Resultados:os professores que antes da aula apresentavam a PA em situação limítrofe, ao final de sua prática educativa,passaram a apresentar valores de hipertensos em Estágio I com valores de (140/159x90/99 mmHg), p-valor<0,05.Conclusão: constatou-se um significativo aumento da pressão arterial em docentes logo após seu desempenho profissional em sala de aula.

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Total concentrations of Ni, Cr, Cu, Pb and Zn were determined in surface sediments from 30 stations in Guanabara Bay in 1999 and 2008. An approach using various environmental indices was used to assess contamination status of metals. This approach allowed the comparison with different coastal areas. Background Enrichment Index, Contamination index and Ecological Risk index (Pollution Load Index; Sediment Quality Guideline Quotient and Ecological Risk Index) were calculated for the metals. Results revealed a great load of organic matter and significant increases in Cu and Pb levels between 1999 and 2008. The concentrations of Cr and Zn were of great concern, surpassing the values of Probable Effect Level reference values. In spite of the differences of each index, results effectively revealed the striking contamination in Guanabara Bay concerning trace metals, and also suggested potential risk to local biota. The contamination of the northwest area was notably higher than the rest of the bay. In comparison with some other coastal bays around the world, Guanabara Bay stood out as a remarkably contaminated environment.

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Trabectedin (Yondelis®, ecteinascidin-743, ET-743) is a marine-derived natural product approved for treatment of advanced soft tissue sarcoma and relapsed platinum-sensitive ovarian cancer. Lurbinectedin is a novel anticancer agent structurally related to trabectedin. Both ecteinascidins generate DNA double-strand breaks that are processed through homologous recombination repair (HRR), thereby rendering HRR-deficient cells particularly sensitive. We here characterize the DNA damage response (DDR) to trabectedin and lurbinectedin in HeLa cells. Our results show that both compounds activate the ATM/Chk2 (ataxia-telangiectasia mutated/checkpoint kinase 2) and ATR/Chk1 (ATM and RAD3-related/checkpoint kinase 1) pathways. Interestingly, pharmacological inhibition of Chk1/2, ATR or ATM is not accompanied by any significant improvement of the cytotoxic activity of the ecteinascidins while dual inhibition of ATM and ATR strongly potentiates it. Accordingly, concomitant inhibition of both ATR and ATM is an absolute requirement to efficiently block the formation of γ-H2AX, MDC1, BRCA1 and Rad51 foci following exposure to the ecteinascidins. These results are not restricted to HeLa cells, but are shared by cisplatin-sensitive and -resistant ovarian carcinoma cells. Together, our data identify ATR and ATM as central coordinators of the DDR to ecteinascidins and provide a mechanistic rationale for combining these compounds with ATR and ATM inhibitors.

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PURPOSE: A growing literature reports the benefits and challenges of patient and public involvement (PPI) in research; nevertheless, understanding PPI in research design remains under-developed. The purpose of this paper is to report learning experiences from involving service users as research partners in two projects that developed and evaluated guidelines for good practice in this regard. The main objective was to evaluate these guidelines. DESIGN/METHODOLOGY/APPROACH: PPI research guidelines were developed through five workshops involving service users/patients, carers, health and social care professionals/managers and academics. Using a participatory qualitative approach, these guidelines were evaluated through mapping them against the two service user research partners' experience within another project. FINDINGS: The guidelines were found to be fit for purpose, as they allowed problems to be easily identified and reassurance that required standards were being met. Both academic and service user research partners learned and gained relevant skills. Two service user research partners also found their daily living skills unexpectedly enhanced by project participation. ORIGINALITY/VALUE: The PPI guidelines, the authors developed were produced by consensus involving several stakeholders. Service users involved as research partners in the project experienced unanticipated personal benefits.

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Many alkylating agents are used as chemotherapeutic drugs and have a long history of clinical application. These agents inflict a wide range of DNA damage resulting in a complex cellular response. After DNA damage, cells trigger a series of signaling cascades promoting cellular survival and cell cycle blockage which enables time for DNA repair to occur. More recently, induction of autophagy has been observed in cancer cells after treatment with different DNA-targeted anticancer drugs, including alkylating agents. Several studies have demonstrated that induction of autophagy after DNA damage delays apoptotic cell death and may therefore lead to chemoresistance, which is the limiting factor for successful chemotherapy. On the other hand, depending on the extent of damage and the cellular context, the induction of autophagy may also contribute to cell death. Given these conflicting results, many studies have been conducted to better define the role of autophagy in cancer cells in response to chemotherapy. In this review, we describe the main alkylating agents used in clinical oncology as well as the cellular response they evoke with emphasis on autophagy.

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Sampling was conducted monthly during a transition period between the dry and rainy seasons in order to evaluate the effectiveness of a municipal sewage treatment plant (STP) in eutrophication control. STP effluent and fluvial input data were also estimated. In the dry period, high concentrations of nutrients, chlorophyll a (up to 360 µg L(-1)), and anoxia in bottom waters were observed in the upper portion of the estuary. Nitrate was scarce during the dry months, although high concentrations were observed at the river sources and the upper estuary. The N:P and Si:P molar ratios were usually below 16:1, and the Si:N ratio was higher than 1:1. The fluvial inputs were a greater source of nutrients to the estuary than the STP, but nutrient loading by these effluents were also important in contributing to the eutrophication of the upper estuarine zone, especially in the dry season when symptoms were more intense.

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O termo sarcoma granulocítico (SG) designa um raro tumor sólido composto de agregados de precursores granulocíticos imaturos em sítios extramedulares. A lesão geralmente ocorre durante o curso natural da leucemia mieloide aguda (LMA) ou após sua remissão. O SG primário manifesta-se mais comumente na pele e linfonodos, portanto, quando se apresenta na mama, o erro diagnóstico de linfoma não Hodgkin, carcinoma lobular, sarcoma e melanoma maligno é um problema comum. A mama tem sido relatada como um local incomum de SG. Relata-se um caso raro de SG bilateral em mamas concomitante com LMA numa mulher de 47 anos. A paciente foi admitida em nosso hospital devido a manifestações neurológicas e descobrimos, durante a investigação, tumorações nas mamas. A histopatologia das lesões sugeriu linfoma não Hodgkin, sendo iniciada quimioterapia esquema CHOP. No entanto, o mielograma mostrou hiperplasia das séries granulocíticas, e a imuno-histoquímica revelou mieloperoxidase e CD68 positivos, confirmando o diagnóstico de SG primário em mamas. A citogenética não detectou anomalias. A revisão da microscopia e a análise do líquor confirmaram a presença de infiltração no parênquima mamário e no sistema nervoso central por leucemia monoblástica aguda (LMA-M5a). O protocolo de indução da remissão foi iniciado com daunorrubicina, arabinosídeo-C e quimioterapia intratecal com metotrexate, arabinosídeo-C e dexametasona (MADIT). Um mês depois, a paciente recusou a continuação do tratamento, depois de ter feito pedido de alta.

Granulocytic sarcoma (GS) is an uncommon solid tumor composed of aggregates of immature granulocytic precursors in extramedullary sites. The lesion generally occurs during the natural course of acute myelogenous leukemia or after remission has been achieved. Primary GS manifests most commonly in skin and lymph nodes, therefore when it presents in the breast, misdiagnosis of non-Hodgkin's lymphoma, lobular carcinoma, sarcoma and malignant melanoma is a common problem. The breast has been reported to be an uncommon site for GS. We report on a rare case of granulocytic sarcoma presenting as bilateral breast masses concomitant with acute myeloid leukemia in a 47-year-old woman. The patient was admitted to our hospital due to neurological manifestations, at which time we discovered lesions in the breasts. The histopathology suggested non-Hodgkin lymphoma, and chemotherapy using the CHOP regimen was performed. However, a myelogram showed hyperplasia of the granulocyte cells and immunohistochemistry tests were positive for myeloperoxidase and CD68, confirming the diagnosis of primary granulocytic sarcoma of the breasts. Cytogenetic examinations did not detect anomalies. The review of microscopy and the analysis of cerebrospinal fluid confirmed the presence of infiltration in the breast and in the central nervous system by acute monoblastic leukemia (AML M5a). AML M5a protocols had been started with daunorubicin, arabinoside-C and intrathecal chemotherapy using methotrexate, arabinoside-C and dexamethasone (MADIT). One month later, the patient refused further treatment.

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O linfoma primário do osso (LPO) é uma condição extremamente rara, habitualmente confundida com outras lesões ósseas primárias. É responsável por cerca de 3 por cento-5 por cento de todos os tumores malignos no osso e 4 por cento-7 por cento de todos os linfomas nãoHodgkin extranodais. Caracteriza-se pelo envolvimento de um ou vários locais ósseos, com ou sem comprometimento de linfonodos regionais e vísceras. Histopatologicamente, o linfoma non Hodgkin de grandes células B representa a maioria dos casos de LPO. Ossos longos são mais frequentemente comprometidos, e o fêmur é o sítio mais acometido. Osso ilíaco e da coluna vertebral também podem ser atingidos. Relatamos um caso raro de linfoma não Hodgkin da vértebra em mulher de 41 anos. A imuno-histoquímica revelou CD20 e CD45 positivos. Ela foi diagnosticada com linfoma primário difuso de grandes células B da coluna vertebral. O estudo histopatológico da medula óssea não detectou infiltração por hemopatia linfoide. A paciente foi tratada com quimioterapia CHOP juntamente com etoposide, seguida de radioterapia (dose total = 3600cGy) na região tóraco-lombar. Não houve evidência de recidiva em um período de vinte meses de acompanhamento.

Primary bone lymphoma (PBL) is an extremely rare condition, commonly confused with other primary bone injuries. It accounts for approximately 3-5 percent of all malignant bone tumors and 4-7 percent of all extranodal non-Hodgkin's lymphomas. It is characterized by the involvement of one or multiple bone locations, with or without the involvement of regional lymph nodes and viscera. Histopathologically, diffuse large-B-cell lymphomas account for the majority of cases of PBL. Long bones are usually involved, with the femur being the most commonly affected site. Pelvic bones and the vertebral column can also be involved. We report on a rare case of PLB of the vertebra in a 41-year-old woman. Immunohistochemistry examinations revealed CD20 and CD45 positive cells. She was diagnosed with primary diffuse large B-cell lymphoma presenting as a vertebral column tumor. The histopathologic analysis of the bone marrow did not show lymphoproliferative disorders. The patient was treated with a CHOP plus etoposide regimen. Systemic chemotherapy was followed by radiotherapy (total dose = 3600 cGy) in the thoracolumbar region. There was no evidence of recurrence in the 20-month follow up.

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Capillary thyroid carcinoma (PTC) is the most common neoplasm of thyroid. It usually grows slowly and is clinically indolent, although rare, its aggressive forms with local invasion or distant metastases can occur. Metastatic thyroid carcinoma rarely involves the orbit. We reported an uncommon case of orbital metastasis of PTC. A 66-years-old woman presented proptosis of the right eye. The biopsy of the tumor in orbit revealed metastatic thyroid carcinoma. The ultrasensitive TSH level was 1,34 mUI/L and free T4 level was 1,65 ng/dL. A total thyroidectomy was performed and histopathological analysis of the nodule revealed follicular variant of papillary thyroid carcinoma. Currently, the patient has been receiving palliative chemotherapy with Clodronate Disodium. The importance of the case is due to its unusual presentation, which emerged as a primary clinical manifestation. Although rare, thyroid carcinoma should be suspected in orbit metastasis.

Carcinoma papilífero da tiróide (PTC) é a neoplasia mais comum da tiróide. Geralmente cresce lentamente e é clinicamente indolente, embora raras, as formas agressivas com invasão local ou metástases distantes podem ocorrer. Carcinoma metastático da tiróide raramente envolve a órbita. Relatamos um caso raro de metástase orbital de PTC. Uma mulher de 66 anos apresentou proptose no olho direito. A biópsia do tumor em órbita revelou carcinoma metastático da tiróide. O nível ultra-sensível do TSH foi de 1,34 mUI/L e T4 livre foi de 1,65 ng/dL. A tireoidectomia total foi realizada e a análise histopatológica do nódulo revelou carcinoma papilífero variante folicular da tiróide. Atualmente, a paciente recebe quimioterapia paliativa com clodronato dissódico. A importância do caso é devido à sua apresentação incomum que surgiu como principal manifestação clínica. Embora raro, o carcinoma da tiróide deve ser pensado em metástase orbitária.

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Este artigo apresenta algumas das concepções acerca do processo saúde-doença e promoção da saúde que figuram na literatura brasileira recente, visando contribuir para a reflexão sobre seus diferentes modos de sua apreensão e concretização. Tem, como referência, os contextos sociohistóricos que influenciaram a construção dos conceitos em questão, analisados a partir da argumentação de autores contemporâneos representativos do campo. O trabalho estrutura-se em dois blocos: o primeiro corresponde à apresentação de diferentes conceituações sobre saúde, doença e processo saúde-doença, relacionando-os aos momentos históricos que lhes deram origem. No segundo, procura-se descrever o desenvolvimento dos conceitos e práticas de promoção da saúde e de prevenção nos últimos anos e sua incorporação ao Sistema Único de Saúde - SUS. A análise desta evolução histórica mostra que embora os conceitos talvez sejam ainda limitados para expressar a extensão e concretude das iniciativas implementadas no âmbito do SUS, têm grande utilidade operacional no sentido de orientar projetos políticos sanitários.

This article presents some of the concepts surrounding the health-illness process and the health promotion efforts that appear in recent Brazilian literature, aiming to contribute toward some reflection on the different types of concern and their manifestations. As a reference, we cite the socio-historical contexts that influenced the development of the concepts in question, based on the arguments of contemporary representative authors. The work is structured into two blocks: the first presents the different conceptualizations of health, illness and the process ?health-illness?, relating them with the historical settings from which they originated. The second describes the development of the concepts and practices of health promotion and prevention strategies in the past few years, and its incorporation into the Brazilian Public Health System - SUS. The analysis of this evolutionary process shows that although these concepts are perhaps still limited in describing the extent and concreteness of the initiatives implemented within the scope of SUS, they have great operational value in guiding health policy projects.

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Este artigo apresenta algumas das concepções acerca do processo saúde-doença e promoção da saúde que figuram na literatura brasileira recente, visando contribuir para a reflexão sobre seus diferentes modos de sua apreensão e concretização. Tem, como referência, os contextos socio-históricos que influenciaram a construção dos conceitos em questão, analisados a partir da argumentação de autores contemporâneos representativos do campo. O trabalho estrutura-se em dois blocos: o primeiro corresponde à apresentação de diferentes conceituações sobre saúde, doença e processo saúde-doença, relacionando-os aos momentos históricos que lhes deram origem. No segundo, procura-se descrever o desenvolvimento dos conceitos e práticas de promoção da saúde e de prevenção nos últimos anos e sua incorporação ao Sistema Único de Saúde - SUS. A análise desta evolução histórica mostra que embora os conceitos talvez sejam ainda limitados para expressar a extensão e concretude das iniciativas implementadas no âmbito do SUS, têm grande utilidade operacional no sentido de orientar projetos políticos sanitários. (AU)

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Este artigo apresenta algumas das concepções acerca do processo saúde-doença e promoção da saúde que figuram na literatura brasileira recente, visando contribuir para a reflexão sobre seus diferentes modos de sua apreensão e concretização. Tem, como referência, os contextos socio-históricos que influenciaram a construção dos conceitos em questão, analisados a partir da argumentação de autores contemporâneos representativos do campo. O trabalho estrutura-se em dois blocos: o primeiro corresponde à apresentação de diferentes conceituações sobre saúde, doença e processo saúde-doença, relacionando-os aos momentos históricos que lhes deram origem. No segundo, procura-se descrever o desenvolvimento dos conceitos e práticas de promoção da saúde e de prevenção nos últimos anos e sua incorporação ao Sistema Único de Saúde - SUS. A análise desta evolução histórica mostra que embora os conceitos talvez sejam limitados para expressar a extensão e concretude das iniciativas implementadas no âmbito do SUS, têm grande utilidade operacional no sentido de orientar projetos políticos sanitários. [AU]

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Capillary thyroid carcinoma (PTC) is the most common neoplasm of thyroid. It usually grows slowly and is clinically indolent; although rare, its aggressive forms with local invasion or distant metastases can occur. Metastatic thyroid carcinoma rarely involves the orbit. We reported an uncommon case of orbital metastasis of PTC. A 66-years-old woman presented proptosis of the right eye. The biopsy of the tumor in orbit revealed metastatic thyroid carcinoma. The ultrasensitive TSH level was 1,34 mUI/L and free T4 level was 1,65 ng/dL. A total thyroidectomy was performed and histopathological analysis of the nodule revealed follicular variant of papillary thyroid carcinoma. Currently, the patient has been receiving palliative chemotherapy with Clodronate Disodium. The importance of the case is due to its unusual presentation, which emerged as a primary clinical manifestation. Although rare, thyroid carcinoma should be suspected in orbit metastasis.

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