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OBJECTIVES: To define disease activity measures, muscle strength and functional assessments in new-onset juvenile dermatomyositis (JDM) patients, at disease onset and follow up. METHODS: A registry was set up in 18 hospitals, enrolling patients over 3-years (2015-2018). Clinical assessments were performed at baseline, and at 6, 12, 18 and 24 months after diagnosis. Disease Activity Score (DAS20), skin and musculoskeletal DAS sub-scales; Manual Muscle Test (MMT8); Childhood Myositis Assessment Scale (CMAS); Childhood Health Assessment Questionnaire disability index (CHAQ_DI 0-3) and 10 cm Visual Analog Scale (VAS) for overall wellbeing scores were compared by Poisson Model and Wald post-test for repeated measures. RESULTS: Ninety-six cases, being 61 (64%) females, median age 10 years had JDM diagnosis and 12 (13%) onset calcinosis. Mean ±SD scores at diagnosis and 6 months intervals for DAS20 (0-20) were 7.8±5, 6.3 ±4.8, 5±4, 4.9 ±5 and 0.5 ±2.3; with significant difference from baseline (p<0.01). Skin DAS subscales were 2.8±3.3, 1.8±2.9, 1,1±2.2, 0.6±1.8, 0.4±1.5. MMT (0-80) 62.6±20.4, 70.2±13.5, 73.3±11, 75.7±7.9 and 74.8±7.8, with significant difference from baseline up to 6 months (p=0.016); CMAS (0-53) 29.5±11.4, 33.1±8.3, 34.2±5.8, 34±6 and 33.3±5.4. CHAQ-DI (0-3) 1±0.9, 0.6±0.7, 0.8±0.8, 1±0.8 and 1±0.3; parents VAS 4.1±2.5, 2±2.1; 1.3±2.8, 4.1±3.1, 1.7±2.2. There was no significant difference for CMAS, CHAQ-DI and parents VAS from baseline up to 24-month assessment. CONCLUSIONS: DAS20 scores improved gradually during follow up, MMT8 improved significantly during the first 6 months and CMAS, CHAQ-DI and parents VAS scores had no significant improvement with persistent functional impairment over 2-years.

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BACKGROUND: F abry disease (FD) is an X-linked lysosomal storage disorder with accumulation of globotriosylceramide, causing neurologic involvement mainly as acroparesthesias and cerebrovascular disease. Aseptic meningitis has been reported in 11 patients with FD, but no prior study has correlated alpha-galactosidase (GLA) specific variants with meningitis. We present in this manuscript a family in which a novel GLA pathogenic variant was associated with aseptic meningitis in 2 of 5 family members. METHODS: This study began with identifying the proband, then screening family members for FD symptoms and evaluating symptomatic individuals for genetic and biochemical status. All patients underwent magnetic resonance imaging, and those with headache underwent cerebrospinal fluid (CSF) analysis. RESULTS: Five patients (3 females) from a single family were included in this study. Mean age at diagnosis was 20.6 years. Two patients (40%) had aseptic meningitis; one of them also had cerebrovascular events. C-reactive protein and erythrocyte sedimentation rate were elevated during aseptic meningitis episodes. Both patients responded to intravenous methylprednisolone with resolution of fever, headache, and vomiting. One of them recurred and needed chronic immunosuppression with azathioprine. CONCLUSION: We described aseptic meningitis in a family with a novel GLA variant. Meningitis might be a common phenomenon in FD and not a particularity of this variant. Understanding the mechanisms underlying meningitis and its association with cerebrovascular events may lead to a new paradigm of treatment for stroke in these patients. Further prospective studies with CSF collection in patients with FD and recurrent headache could help to elucidate this question.

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Com base no esquema óptico, proposto por Lacan para identificar a formação do eu na constituição do sujeito, esta pesquisa teórico-clínica levanta a seguinte hipótese: a rotação do espelho plano desvela a fragilidade do eu. O espelho plano introduz, na formação do eu, a alteridade que parte da concepção do Outro em Lacan. Como Freud já havia conceituado, o eu é uma superfície advinda do investimento libidinal a partir da relação do infans com o Outro, substituindo-se à experiência original do corpo despedaçado. Todavia, tal despedaçamento não desaparece no engodo produzido nessa substituição, e quando se desvela, pode lançar o sujeito na angústia. Nossa vinheta clínica visa provocar a discussão que o percurso teórico advindo dessa questão suscita: quando a angústia — como sensação do desejo do Outro —, emerge para, o sujeito espatifando a imagem; ou melho, como diz nosso jovem sujeito, "espaguetificando" o eu.

Resumos Based on Lacan's optical scheme, proposed to identify the formation of the I in the constitution of the subject, this theoretical-clinical research posits that by rotating the plane mirror one reveals the fragility of the I. The plane mirror introduces, in the formation of the self, the alterity emerging from Lacan's conception of the Other. As already conceptualized by Freud, the I is a surface that emerges from the libidinal investment in the infans' relation with the Other, replacing the original experience of the fragmented body. However, such fragmentation does not disappear in this illusional substitution, which, when unveiled, can cast the subject into anguish. Our clinical vignette aims to discuss the theoretical path arising from this question: when anguish — as a sensation of the Other's desire — emerges for the subject, shattering the image; or better, as our young subject puts it, "spaghettifying" the I.

S'appuyant sur le schéma optique de Lacan, proposé pour identifier la formation du Je dans la constitution du sujet, cette recherche théorico-clinique postule qu'en faisant tourner le miroir plan on révèle la fragilité du Je. Le miroir plan introduit, dans la formation du Je, l'altérité issue de la conception de l'Autre chez Lacan. Comme déjà conceptualisé par Freud, le Je est une surface qui émerge de l'investissement libidinal de la relation du nourrisson avec l'Autre, remplaçant l'expérience originelle du corps fragmenté. Cependant, cette fragmentation ne disparaît pas dans cette substitution illusoire qui, lorsqu'elle est dévoilé, peut plonger le sujet dans l'angoisse. Notre vignette clinique vise à discuter la piste théorique qui en découle: lorsque l'angoisse — en tant que sensation du désir de l'Autre — surgit pour le sujet, faisant éclater l'image ; ou plutôt, comme le dit notre jeune sujet, en « spaghettifiant ¼ le Jr.

A partir del esquema óptico, propuesto por Lacan para identificar la formación del yo en la constitución del sujeto, esta investigación teórico-clínica plantea la siguiente hipótesis: la rotación del espejo plano revela la fragilidad del yo. El espejo plano introduce, en la formación del yo, la alteridad que proviene de la concepción del Otro en Lacan. Como ya lo había conceptualizado Freud, el yo es una superficie que surge de la investidura libidinal de la relación del infans con el Otro, sustituyendo la experiencia original del cuerpo despedazado. Sin embargo, este despedazamiento no desaparece en el engaño producido en esta sustitución, y, cuando se desvela, puede lanzar el sujeto en la angustia. Nuestra viñeta clínica pretende provocar la discusión que el camino teórico que surge de esta cuestión suscita: cuando la angustia —como sensación del deseo del Otro — emerge para el sujeto despedazando la imagen; o más bien, como dice nuestro joven sujeto, "espaguetizando" el yo.

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BACKGROUND: Fabry disease (FD) is a rare, X-linked, multisystemic lysosomal storage disorder (LSD) that results from a deficiency in the hydrolase alpha-galactosidase A (⍺-GalA). During childhood, classic FD symptomatology is rare. The majority of children may show non-specific symptoms, including in the musculoskeletal system. The prevalence of FD among juvenile idiopathic arthritis (JIA) patients is unknown. OBJECTIVE: This study aimed to identify the frequency of FD in a JIA cohort, characterizing early clinical symptoms, enzyme titers, and GLA genotyping. METHODS: Children with JIA followed in a tertiary Children Hospital cohort were selected. Clinical, laboratory and familiar information were recorded. Molecular genetic testing to detect GLA gene mutations was performed in girls and enzymatic analysis in boys. RESULTS: In 89 patients (56.2% female, age at disease onset: 8.93 ± 4.35 years), one male (1.12%) patient presented pathogenic mutation in GLA gene, c.1244 T > C p.L415P, one female patient had a variant of uncertain significance c.38C > T (p.Ala13Val). Three additional (3.4%) patients had the enzymatic activity of alpha-galactosidase slightly decreased. We observed the presence of intronic variants in 44.44% of patients in our cohort: c.1000-22C > T; c.370-81_-77del; c.640-16A > G; c.10C > T; c.548-125C > G and c.-12G > A. These variants and their combination were associated with clinical symptoms in our cohort. CONCLUSIONS: The incidence of FD in our cohort was 1.12%. Intronic variants were associated with symptoms previously described in the literature. Screening for FD in JIA may be a reasonable strategy for those with an atypical pattern of pain.

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Cryopyrin-associated periodic syndromes (CAPS) are a group of autoinflammatory diseases associated with NLRP3 gain of function mutations. CAPS associated mutations are found predominantly in exon 3. The objective of this study is to describe a new variant on NRLP3 gene and its phenotype. Case report description of a new NRLP3 pathogenic variant and literature case-based search through INFEVERS database. A 21-year old male who presented multiple tonic-clonic seizures on his 3rd day of life. At age 2, he had recurrent central facial palsy, high fever (40 °C), painful and persistent oral ulcers, abdominal pain, nausea and vomiting, and delayed neuropsychomotor development, with polyarthritis in wrists and knees. Over the years, several symptoms were observed: livedo reticularis, Raynaud's phenomenon, positive pathergy test, heat allodynia, extremely painful genital ulcers, and sporadic conjunctivitis. Laboratory studies revealed persistently elevated inflammatory markers and serum amyloid protein A (30 µg/l). The genetic panel for autoinflammatory diseases revealed heterozygous mutation in the NLRP3, (c.2068G > C, p.E690Q) with 0% of frequency in the general population. The patient denies rash and did not have frontal bossing or patellar overgrowth. We found a positive familial history on mother and brother, who carried the same mutation. The patient was started on canakinumab which controlled his symptoms. Currently, 241 missense variants in the NLRP3 have been described. We presented a new mutation in exon 3 of the NRLP3 gene in a patient that fulfills clinical criteria for CAPS who had complete clinical response to Canakinumab, supporting the idea that this mutation is pathogenic.

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BACKGROUND: Concerns about the safety and efficacy of vaccines in patients with autoimmune diseases (AID) have led to contradictions and low vaccination coverage in this population, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccines have been recommended for immunocompromised patients, there is still a lack of data to support its use for AID patients, such as juvenile dermatomyositis (JDM) patients. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV (qHPV) vaccine in a cohort of JDM patients. METHODS: JDM patients aged from 9 to 20 years and healthy controls (HC) were enrolled to receive a 3-dose schedule of qHPV vaccine from March/2014 to March/2016. Study visits were performed before the first dose, 1 month after the second and third doses, and 6 months after the third dose. Participants completed a diary of possible adverse events for 14 days following each dose of vaccination (AEFV). Disease activity and current therapy were analyzed at each visit for JDM patients. In addition, serum samples from all participants were collected to test antibody concentrations against HPV16 and 18 at each visit. Participant recruitment was conducted in ten Brazilian centres. From 47 eligible JDM patients and 41 HC, 42 and 35, respectively, completed the 3-dose schedule of the vaccine, given that five JDM patients and two HC had received doses prior to their inclusion in the study. RESULTS: The AEFVs presented by the participants were mild and in general did not differ between JDM and HC groups. No severe AEFVs were related to the vaccination. Disease activity was stable, or even improved during the follow-up. One month after the third dose of the vaccine the JDM group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the HC group, who presented 100% for both serotypes (p = 1.000). Six months after the third dose the seropositivity for the patient group was 94% for both HPV types. CONCLUSIONS: The HPV vaccination in this cohort of JDM patients was safe and immunogenic. Since the seropositivity against HPV16 and 18 was very high after the 3-dose schedule, this regimen should be recommended for JDM patients. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, number: RBR-9ypbtf . Registered 20 March 2018 - Retrospectively registered.

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OBJECTIVE: This study aimed to assess the safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccination in childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS: Volunteer cSLE patients aged 9-20 years and healthy controls (HC) were enrolled to receive a two- or three-dose qHPV vaccination schedule from March 2014 to March 2016. Study visits were performed before the first dose, one month after the second and third doses and one year after the first dose. In each study visit, disease activity and adverse events following vaccination were analyzed, and a serum sample was collected for testing antibody concentrations. Participant recruitment was conducted in 15 Brazilian paediatric rheumatology units. Of the 256 cSLE patients included, 210 completed the two- or three-dose schedules; 15 had previously received one dose, and 18 had received two doses of the vaccine. The analysis was based on intention-to-treat so that participants who did not complete the entire study protocol were also included. RESULTS: No severe adverse events were related to the vaccination. Disease activity was generally low and remained stable or even improved. The HC presented 100% seropositivity to HPV16 and HPV18, whereas the two- and three-dose cSLE groups presented 93% and 83% versus 97% and 91%, respectively. One year after the first dose, seropositivity of the three-dose cSLE group was 91% to HPV16 and 84% to HPV18. CONCLUSIONS: HPV vaccination in cSLE patients is safe and immunogenic. Since the seropositivity to HPV16 and HPV18 was higher for the three-dose schedule group, this regimen should be recommended for cSLE patients.

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OBJECTIVE: To describe the prevalence and risk factors associated with corneal vortex keratopathy in a childhood-onset systemic lupus erythematosus (c-SLE) cohort. MATERIAL AND METHODS: Consecutive outpatients with c-SLE were evaluated by a pediatric ophthalmologist and pediatric rheumatologist in an outpatient clinic setting in an urban Children's Hospital. Demographic, clinical, laboratory, and disease characteristics were documented for each patient. Cumulative drug dosage, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and Systemic Lupus Erythematosus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR-DI) scores were calculated. RESULTS: A total of 76 c-SLE patients (61 (80.26%) females; mean age = 17.9 (SD ± 3.07)) were included. Ophthalmologic abnormalities were observed in 36 (47.36%) patients of which 16 (21.10%) had corneal vortex keratopathy (p = 0.03). c-SLE patients with corneal vortex keratopathy were all female. We did not observe any additional clinical, laboratory, or treatment feature associated with corneal vortex keratopathy. DISCUSSION: We observed a high prevalence of corneal vortex keratopathy in female c-SLE. We hypothesize that this finding may be an initial, dose-related toxicity due to antimalarial use. Follow-up studies are necessary to determine if these changes are an early predictor of retinal toxicity due to antimalarial in c-SLE. KEY POINTS: • Corneal vortex keratopathy was frequently observed in female patients with c-SLE on a chloroquine medication. • Corneal vortex keratopathy may be an early marker of chloroquine retinopathy.

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Freud, em 1915, no texto As pulsões e seus destinos, demarca o estímulo pulsional como uma força constante que não provém do mundo exterior, mas do interior do próprio organismo, sem que haja fuga eficaz a ela. Jacques Lacan, em seu retorno à obra freudiana, esclarece, em 1964, em “O Seminário, livro 11: os quatro conceitos fundamentais da psicanálise”, a gramática pulsional em suas três vozes - ativa, passiva e reflexiva -, reiterando que a satisfação pulsional se encontra justamente em seu caráter repetitivo, circular, contínuo e insistente, por onde pulsão e fantasia se entrelaçam. Desse modo, a partir do método descritivo, alicerçado em pesquisa bibliográfica, o artigo apresenta um fragmento do caso clínico de Mariana, uma adolescente de 12 anos que chega à análise através de uma demanda terceirizada do abrigo no qual se encontra. Sua história é marcada por abandonos, tendo como cerne o abandono da família de origem, no qual o pai falece e a mãe desaparece, deixando Mariana e seus dois irmãos na rua. Já no abrigo surge a possibilidade de adoção conjunta dos três irmãos, a qual Mariana rejeita, mas seus irmãos escolhem dar prosseguimento. É nesse momento que ela chega à clínica. Angustiada, sentindo-se abandonada pelos irmãos, sofre e queixa-se da posição em que se encontra. De fato, ela se faz ser abandonada, posição que corrobora com sua construção fantasística diante do enigma do desejo do Outro.(AU).

Freud, in 1915, in the text Instincts and their vicissitudes, defines the drive stimulus as a constant force that does not come from the outside world, but from inside the organism itself, without any effective escape from it. Jacques Lacan, in his return to Freud's work, clarifies, in 1964, in “The Seminar, book 11: the four fundamental concepts of psychoanalysis”, the circuit of the Drive with three grammatical voices - active, passive and reflexive -, reaffirming that the drive satisfaction is found precisely in its repetitive, circular, continuous and insistent character, where drive and fantasy are intertwined. Thus, based on the descriptive method, based on bibliographic research, the article below presents a fragment of the clinical case of Mariana, a 12-year-old teenager who arrives at the clinic through an outsourced demand from the shelter in which she lives. Her history is marked by abandonments, having as its core, the abandonment of the original family, in which the father dies and the mother disappears, leaving Mariana and her two brothers on the street. At the shelter, there is the possibility for the three brothers to be adopted together, which Mariana rejects, but her brothers choose to continue. That's when she arrives at the clinic. Anguished, feeling abandoned by her brothers, she suffers and complains about her position: the abandoned one. In fact, it is made to be abandoned, a position that corroborates with her fantasy construction in face of the enigma of the desire of the Other.(AU).

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O presente trabalho visa a apresentar alguns fragmentos do documentário pro-duzido a partir da pesquisa de Iniciação Científica “A transexualidade e o estra-nhamento do corpo”, que conta com o apoio do Programa Institucional de Bolsas de Iniciação Científica, e as possíveis articulações com a psicanálise no que tange aos discursos sobre o estranhamento do corpo, aos recursos à mudança de sexo, à escolha do parceiro e à representação do que é ser homem e do que é ser mulher.(AU)

This work aims to present some fragments of the documentary produced from the Undergraduate Research “Transsexuality and body strangeness” — which counts on the support of the Institutional Program of Undergraduate Research Scholar-ships — and the possible correlations with psychoanalysis, in reference to sex chan-ge, choice of partners and representation of what it means to be a man or a woman.(AU)

El presente trabajo pretende presentar algunos fragmentos del documental pro-ducido a partir de la Investigación de la Iniciación Científica de la transexualidad y el alejamiento del cuerpo — que cuenta con el apoyo del Programa Institucional de Becas de Iniciación Científica — y las posibles articulaciones con el psicoanáli-sis, en cuanto a los discursos sobre el extrañamiento del cuerpo, los recursos para el cambio de sexo, la elección del compañero y la representación de lo que es ser un hombre y lo que es ser una mujer.(AU)

Le présent travail vise à présenter certains fragments du documentaire pro-duit à partir de la Recherche de l’Initiation Scientifique de la transsexualité et l’éloignement du corps — qui compte avec le soutien du Programme Institu-tionnel de Bourses d’Initiation Scientifique — et le possible articulations avec la psychanalyse, en ce qui concerne les discours sur l’éloignement du corps, les ressources pour le changement de sexe, le choix du partenaire et la repré-sentation de ce qui est d’être un homme et de ce qui est d’être une femme.(AU)

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O estudo científico das experiências religiosas/espirituais tem sido negligenciado ao longo da história da Psicologia, ocasionando uma indiferenciação destas e dos sintomas psicóticos de conteúdo religioso/espiritual. O objetivo deste artigo foi analisar e comparar duas teorias: a Psicologia Integral, de Wilber, e o Modelo Psicobiológico de Cloninger, a fim de desenvolver critérios para diferenciar saúde e doença mental em experiências religiosas/espirituais. O conceito wilberiano de "Falácia Pré-Trans" aparece enquanto chave de leitura para a diferenciação entre experiência religiosas/espirituais e transtornos mentais, aproximando-se da concepção de maturidade de caráter observada nos conceitos de autodirecionamento e de autotranscendência de Cloninger.(AU)

The scientific study of religious/spiritual experiences has been neglected throughout the history of psychology causing a lack of differentiation between them and psychotic symptoms. The objective of this study was to analyze and compare two theories: Integral Psychology, by Wilber, and the Psychobiological Model, by Cloninger, in order to distinguish health and mental illness in religious/spiritual experiences. The Wilberian concept of "Pre-Trans Fallacy" is a reading key to differ religious/spiritual experiences from mental disorders. It is similar to the conception of Maturity of Character observed in Cloninger's concepts of Self-directedness and Self-transcendence.(AU)

El estudio científico de las experiencias religiosas/espirituales ha sido descuidado a lo largo de la historia de la Psicología causando una indiferencia de éstas y de los síntomas psicóticos de contenido religioso/espiritual. El objetivo de este artículo fue analizar y comparar dos teorías: la Psicología Integral, de Wilber, y el Modelo Psicobiológico de Cloninger, con el fin de desarrollar criterios para diferenciar salud y enfermedad mental en experiencias religiosas/espirituales. El concepto Wilberiano de "Falacia Pre-Trans" aparece como clave de lectura para la diferenciación entre la experiencia religiosa/espiritual y los trastornos mentales, acercándose a la concepción de madurez de carácter observada en los conceptos de Autodirección y Autotrascendencia de Cloninger.(AU)

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BACKGROUND: Different lesions may affect the liver resulting in harmful stimuli. Some therapeutic procedures to treat those injuries depend on liver regeneration to increase functional capacity of this organ. AIM: Evaluate the effects of tranexamic acid on liver regeneration after partial hepatectomy in rats. METHOD: 40 rats (Rattus norvegicus albinus, Rodentia mammalia) of Wistar-UP lineage were randomly divided into two groups named control (CT) and tranexamic acid (ATX), with 20 rats in each. Both groups were subdivided, according to liver regeneration time of 32 h or seven days after the rats had been operated. The organ regeneration was evaluated through weight and histology, stained with HE and PCNA. RESULTS: The average animal weight of ATX and CT 7 days groups before surgery were 411.2 g and 432.7 g, and 371.3 g and 392.9 g after the regeneration time, respectively. The average number of mitotic cells stained with HE for the ATX and CT 7 days groups were 33.7 and 32.6 mitosis, and 14.5 and 14.9 for the ATX and CT 32 h groups, respectively. When stained with proliferating cell nuclear antigen, the numbers of mitotic cells counted were 849.7 for the ATX 7 days, 301.8 for the CT 7 days groups, 814.2 for the ATX 32 hand 848.1 for the CT 32 h groups. CONCLUSION: Tranexamic acid was effective in liver regeneration, but in longer period after partial hepatectomy.

RACIONAL: Muitas são as injúrias que acometem o fígado e levam a estímulo lesivo. Alguns procedimentos terapêuticos para tratamento dessas lesões dependem da regeneração hepática para aumentar a sua capacidade funcional. OBJETIVO: Avaliar o efeito do ácido tranexâmico na regeneração hepática após hepatectomia parcial em ratos. MÉTODO: Foram utilizados 40 ratos (Rattus norvegicus albinus, Rodentia mammalia) convencionais da linhagem Wistar-UP. Foram divididos aleatoriamente em dois grupos de 20: grupo controle (CT) e grupo ácido tranexâmico (ATX). Cada um deles foi divido em dois subgrupos para avaliar a regeneração hepática no tempo de 32 h e 7 dias do pós-operatório. A regeneração do órgão foi avaliada quanto ao peso e histologia, sendo esta última por hematoxilina-eosina e antígeno nuclear de proliferação celular. RESULTADOS: A média dos pesos dos animais dos grupos ATX 7 dias e CT 7 dias no pré-operatório foram de 411,2 g e 432,7 g, respectivamente, e após a regeneração foram de 371,3 g e 392,9 g. As médias das taxas de mitose coradas por HE dos dois grupos em 7 dias foram de 33,7 e 32,6 mitoses, respectivamente, e de 14,5 e 14,9 mitoses para os grupos ATX e CT 32 h. A contagem de células por antígeno nuclear de proliferação celular mostrou valores de 849,7 para o grupo ATX 7 dias e 301,8 para o CT 7 dias; 814,2 para o grupo ATX 32 h e 848,1 para o CT 32 h. CONCLUSÃO: O ácido tranexâmico mostrou-se efetivo na regeneração hepática somente em período mais longo de observação após hepatectomia parcial.

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ABSTRACT Background: Different lesions may affect the liver resulting in harmful stimuli. Some therapeutic procedures to treat those injuries depend on liver regeneration to increase functional capacity of this organ. Aim: Evaluate the effects of tranexamic acid on liver regeneration after partial hepatectomy in rats. Method: 40 rats (Rattus norvegicus albinus, Rodentia mammalia) of Wistar-UP lineage were randomly divided into two groups named control (CT) and tranexamic acid (ATX), with 20 rats in each. Both groups were subdivided, according to liver regeneration time of 32 h or seven days after the rats had been operated. The organ regeneration was evaluated through weight and histology, stained with HE and PCNA. Results: The average animal weight of ATX and CT 7 days groups before surgery were 411.2 g and 432.7 g, and 371.3 g and 392.9 g after the regeneration time, respectively. The average number of mitotic cells stained with HE for the ATX and CT 7 days groups were 33.7 and 32.6 mitosis, and 14.5 and 14.9 for the ATX and CT 32 h groups, respectively. When stained with proliferating cell nuclear antigen, the numbers of mitotic cells counted were 849.7 for the ATX 7 days, 301.8 for the CT 7 days groups, 814.2 for the ATX 32 hand 848.1 for the CT 32 h groups. Conclusion: Tranexamic acid was effective in liver regeneration, but in longer period after partial hepatectomy.

RESUMO Racional: Muitas são as injúrias que acometem o fígado e levam a estímulo lesivo. Alguns procedimentos terapêuticos para tratamento dessas lesões dependem da regeneração hepática para aumentar a sua capacidade funcional. Objetivo: Avaliar o efeito do ácido tranexâmico na regeneração hepática após hepatectomia parcial em ratos. Método: Foram utilizados 40 ratos (Rattus norvegicus albinus, Rodentia mammalia) convencionais da linhagem Wistar-UP. Foram divididos aleatoriamente em dois grupos de 20: grupo controle (CT) e grupo ácido tranexâmico (ATX). Cada um deles foi divido em dois subgrupos para avaliar a regeneração hepática no tempo de 32 h e 7 dias do pós-operatório. A regeneração do órgão foi avaliada quanto ao peso e histologia, sendo esta última por hematoxilina-eosina e antígeno nuclear de proliferação celular. Resultados: A média dos pesos dos animais dos grupos ATX 7 dias e CT 7 dias no pré-operatório foram de 411,2 g e 432,7 g, respectivamente, e após a regeneração foram de 371,3 g e 392,9 g. As médias das taxas de mitose coradas por HE dos dois grupos em 7 dias foram de 33,7 e 32,6 mitoses, respectivamente, e de 14,5 e 14,9 mitoses para os grupos ATX e CT 32 h. A contagem de células por antígeno nuclear de proliferação celular mostrou valores de 849,7 para o grupo ATX 7 dias e 301,8 para o CT 7 dias; 814,2 para o grupo ATX 32 h e 848,1 para o CT 32 h. Conclusão: O ácido tranexâmico mostrou-se efetivo na regeneração hepática somente em período mais longo de observação após hepatectomia parcial.

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Amostras de água utilizada pelos quatro maiores restaurantes da cidade de Salgueiro - PE foram coletadas em três períodos distintos, e submetidas a análises físico-química e microbiológica e comparadas a legislação do Ministério da Saúde, Portaria MS n° 2.914, de 12 de Dezembro de 2011. Esta estabelece os padrões de potabilidade da água. As análises físico-químicas constituíram-se da mensuração de pH e teor de cloro residual livre pelo Método DPD, enquanto Colimetria e Contagem de bactérias heterotróficas representaram as análises microbiológicas da água. Os valores de pH de todas as amostras de água ficaram dentro dos valores permitidos. Já para o teor de cloro residual, apenas as amostras advindas do sistema alternativo não atenderam à legislação. Os restaurantes RI e R2 apresentaram positividade para coliformes totais e termotolerantes em pelo menos uma das amostras, enquanto o restaurante R3 apresentou ausência de coliformes totais e termotolerantes em todas as repetições. O restaurante R4 apresentou ausência de coliformes totais e termotolerantes em todas as repetições para a água proveniente do sistema público de abastecimento, porém a água oriunda de poço extrapolou os limites para colimetria em todas as repetições. Em relação à contagem de bactérias heterotróficas, apenas uma das amostras de água proveniente de poço ultrapassou o limite, que é de 500 UFC/mL. O estudo mostrou que os restaurantes que utilizam água proveniente do sistema de abastecimento público apresentaram, de maneira geral, resultados satisfatórios quanto à colimetria, pH e cloro residual, mas o restaurante que utiliza água proveniente de poço mostrou altíssima contagem de coliformes, sendo um perigo potencial àqueles que consomem alimentos ali produzidos.(AU)

Samples of water used by the four major restaurants in the Salgueiro city, Pernambuco, were collected in three periods of different years, and subjected to physico-chemical and microbiological analyzes and compared with the legislation of the Ministry of Health, MS Ordinance No. 2914 of 12 December 2011. 11 establishes standards for potability. The physico-chemical analysis consisted of measurement of pH and free residual chlorine by DPD method, while colimetric assays and Count heterotrophic bacteria accounted for the microbiological analysis of water. The pH of all water samples were within the permissible values. As for the residual chlorine, only the samples coming from the alternative system (t.2) did not meet the law (restaurant R.4). The R.1 and R.2 restaurants tested was positive for total and fecal coliforms in at least one of the samples, while the restaurant R3 showed no total and fecal coliforms in all repetitions. The restaurant had R.4 absence of total and fecal coliforms in all replicates for water from the public supply system (t.1), but the water coming from the well (t.2) pushed the boundaries for colimetric assays in all repetitions. Regarding the counting of heterotrophic bacteria, only one of the water samples from wells exceeded the limit, which was 500 CFU / mL. The study showed that restaurants that use water from the public supply system showed, in general, satisfactory results regarding colimetric assays, pH and chlorine residual, but the restaurant that uses water from wells showed very high coliform counts, with a hazard potential to those who consume food produced there.(AU)

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OBJECTIVE: To assess the effect of tibolone on mammary tissue of castrated rats over 3 different periods of time. METHODS: Sixty virgin female Wistar rats were submitted to oophorectomy. Twenty-one days after surgery, with hypoestrogenism confirmed, the experimental rats were randomly assigned to six groups: Tibolone 1 (n=10) received tibolone 1 mg/day for 23 days, tibolone 2 (n=10) for 59 days and tibolone 3 (n=10) for 118 days. The groups control 1 (n=8), control 2 (n=7) and control 2 (n=10) received distilled water for 23, 59 and 118 days, respectively. After treatment, all six pairs of mammary glands were removed and stained with hematoxylin and eosin (HE) for histological analysis after euthanasia. The histological parameters evaluated were: epithelial cell proliferation and secretory activity. The variables were analyzed statistically, with the level of significance set at 0.05. RESULTS: Histological changes were observed in 20/55 rats, mild epithelial hyperplasia in 7/55, moderate epithelial hyperplasia in 5/55, alveolar-nodular hyperplasia in 7/55, atypia without epithelial proliferation in 1/55, and no cases of severe epithelial hyperplasia were found. Secretory activity was observed in 31/55 rats. The secretory activity was significantly higher in the tibolone groups compared to control at all the time points assessed (p=0,001). The histological changes were did not show significance when the control and tibolone groups were compared. The time of exposure to tibolone did not show significance when the three different periods of evaluation were compared. CONCLUSION: No relation between histological modification and tibolone treatment was verified after short-, medium- and long-term treatment.

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OBJETIVO: Avaliar o efeito da terapia hormonal com tibolona, em três períodos de tempo diferentes, sobre o tecido mamário de ratas castradas. MÉTODO: Foram utilizadas 60 ratas Wistar adultas e virgens, submetidas à ooforectomia. Após 21 dias de pós-operatório (PO), confirmado o hipoestrogenismo, os animais foram divididos aleatoriamente em 6 grupos: tibolona 1 (n=10) recebeu tibolona 1 mg/dia por 23 dias, tibolona 2 (n=10), por 59 dias, tibolona 3 (n=10), por 118 dias; os subgrupos controle 1 (n=8), controle 2 (n=7) e controle 3 (n=10) receberam a água destilada por 23, 59 e 118 dias, respectivamente. Após o tratamento, foram ressecados seis pares de mamas, destinados à análise histológica pela coloração de hematoxilina e eosina (HE); o procedimento seguiu de eutanásia. Os parâmetros histológicos avaliados foram: hiperplasia epitelial e atividade secretora (AS). As variáveis foram submetidas à análise estatística, adotando-se como significante p<0,05. RESULTADOS: Foram observadas alterações histológicas em 20/55 ratas, sendo: hiperplasia epitelial leve (HEB1) em 7/55, hiperplasia epitelial moderada (HEB2) em 5/55, hiperplasia alvéolo-nodular (HAN) em 7/55, atipia sem proliferação epitelial em 1/55, não sendo encontrada hiperplasia severa (HEB3). Encontrou-se AS em 31/55 das ratas. A AS foi significativamente maior no grupo tibolona (T), em todos os tempos avaliados (p=0,001). As alterações histológicas analisadas não foram significantes comparando (p>0,05) os grupos controle (C) e T. A variável tempo de exposição à droga não apresentou significância, quando comparados os três períodos avaliados. CONCLUSÃO: Não foi verificada relação entre as alterações histológicas e a terapêutica com tibolona em curto, médio e longo prazo. .

OBJECTIVE: To assess the effect of tibolone on mammary tissue of castrated rats over 3 different periods of time. METHODS: Sixty virgin female Wistar rats were submitted to oophorectomy. Twenty-one days after surgery, with hypoestrogenism confirmed, the experimental rats were randomly assigned to six groups: Tibolone 1 (n=10) received tibolone 1 mg/day for 23 days, tibolone 2 (n=10) for 59 days and tibolone 3 (n=10) for 118 days. The groups control 1 (n=8), control 2 (n=7) and control 2 (n=10) received distilled water for 23, 59 and 118 days, respectively. After treatment, all six pairs of mammary glands were removed and stained with hematoxylin and eosin (HE) for histological analysis after euthanasia. The histological parameters evaluated were: epithelial cell proliferation and secretory activity. The variables were analyzed statistically, with the level of significance set at 0.05. RESULTS: Histological changes were observed in 20/55 rats, mild epithelial hyperplasia in 7/55, moderate epithelial hyperplasia in 5/55, alveolar-nodular hyperplasia in 7/55, atypia without epithelial proliferation in 1/55, and no cases of severe epithelial hyperplasia were found. Secretory activity was observed in 31/55 rats. The secretory activity was significantly higher in the tibolone groups compared to control at all the time points assessed (p=0,001). The histological changes were did not show significance when the control and tibolone groups were compared. The time of exposure to tibolone did not show significance when the three different periods of evaluation were compared. CONCLUSION: No relation between histological modification and tibolone treatment was verified after short-, medium- and long-term treatment. .

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Introdução: Queimaduras em crianças são uma das causas mais frequentes de internação e de mortalidade por fatores externos no Brasil. Crianças com mais de 30% de Superfície Corporal Queimada (SCQ) evoluem com hiperglicemia pós-traumática e resistência aos efeitos da insulina, situação que prejudica a função imune, aumenta o risco de infecção, compromete a cicatrização e aumenta a mortalidade. O controle da hiperglicemia, com o uso da insulinoterapia, já na assistência intensiva, diminui a morbidade e mortalidade e aumenta a sensibilidade à insulina. Objetivo: Identificar a alteração da sensibilidade à insulina em crianças queimadas. Método: Revisão Sistemática, realizada busca na base de dados Pubmed referente aos anos de 2009 a 2013. Resultados: Os estudos mostraram que a queimadura, nas crianças com mais de 30% de SCQ, está relacionada à hiperglicemia, aumento de catecolaminas plasmáticas, fatores inflamatórios, aumento da incidência de sepse e mortalidade. A resistência à insulina está relacionada à hiperglicemia, à via inflamatória, aos ácidos graxos livres, ao stress do retículo endoplasmático e à diminuição da oxidação mitocondrial. A insulinoterapia intensiva diminuiu a morbidade e a mortalidade dos pacientes. Crianças permaneceram com resistência à insulina por até três anos pós-injúria. Conclusão: A persistência da hiperglicemia pós-traumática e dos fatores inflamatórios, bem como o estresse do retículo endoplasmático e a diminuição da oxidação mitocondrial na criança queimada, contribuem para a resistência à insulina em até três anos após a injúria. O manejo da hiperglicemia no paciente crítico com o uso da insulinoterapia intensiva diminuiu a morbidade e a mortalidade nos estudos analisados, inclusive contribuindo para o aumento da sensibilidade à insulina e consequente diminuição de sua resistência...

Introduction: Burns in children are one of the most frequent causes of hospitalization and mortality by external causes in Brazil. Children over 30% TBSA (Total body surface area) evolve with posttraumatic hyperglycemia and resistance to insulin’s effects, a situation that impairs immune function, increases the risk of infection, impairs wound healing and increases mortality. The control of hyperglycemia by insulin, as in intensive care reduce morbidity and mortality and improves insulin sensitivity. Objective: To identify the change in insulin sensitivity in burned children. Methods: Systematic Review, carried out search in the Pubmed database for the years 2009 to 2013. Results: Studies have shown that burns in children over 30% TBSA, is related to hyperglycemia, increased plasma catecholamines, inflammatory factors, increased incidence of sepsis and mortality. Insulin resistance is related to hyperglycemia, the inflammatory pathway, the free fatty acids, endoplasmic reticulum stress and decreased mitochondrial oxidation. Intensive insulin therapy decreased the morbidity and mortality of patients. Children remained insulin resistance post-injury up to three years. Conclusions: The persistence of posttraumatic hyperglycemia and inflammatory factors as well as the endoplasmic reticulum stress and decreased mitochondrial oxidation in burned children contribute to insulin resistance by up to three years after the injury. Management of hyperglycemia in critically ill patients through intensive insulin therapy decreased morbidity and mortality in the assessed studies, including contributing to increased insulin sensitivity and consequentreduction of its resistance. It was observed that the target of 130 mg/dl in severely child is recommended, with indications of strict glycemic control to avoid hypoglycemic episodes. Increased vitamin A in these children, as well as increased risk of developing diabetes mellitus 2 are issues that need further studies for ...

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OBJETIVO: Contribuir para a promoção da aquisição de produtos da agricultura familiar para a alimentação escolar em Territórios da Cidadania do País. MÉTODOS: Foi realizado um estudo de intervenção com abordagem de articulação de redes intersetoriais presenciais, desenvolvidas a partir da atuação de equipes compostas por nutricionista, educador popular e engenheiro agrônomo ou técnico agrícola, que visitaram, por pelo menos dois momentos, todos os municípios pertencentes aos Territórios da Cidadania, visando articular redes intersetoriais presenciais capazes de desencadear processos locais de mobilização, organização e apoderamento de diferentes atores para a aquisição de produtos da agricultura familiar para a alimentação escolar nos municípios que compõem os referidos territórios. RESULTADOS: Os resultados mais expressivos foram: 14% dos municípios visitados apresentaram melhora na organização da agricultura familiar; 14% dos gestores passaram a apoiar o processo de aquisição de alimentos segundo a Lei nº 11.947/2009, e 27% dos municípios que não possuíam nutricionista contrataram o profissional. Não foram considerados satisfatórios os resultados obtidos para situação do Conselho de Alimentação Escolar. CONCLUSÃO: As ações desenvolvidas foram capazes de contribuir positivamente para o avanço da implementação da Lei Federal nº 11.947/2009 nos Territórios de Cidadania abordados.

OBJECTIVE: This study hopes to promote the acquisition of family farm products for school meals in Brazil's Territories of Citizenship. METHODS: This intervention study coordinated intersectoral networks face-to-face. The networks consisted of teams composed of a dietician, popular educator, and agronomist or agronomy technician. These teams visited all municipalities within the Citizenship Territories at least twice to coordinate the said networks, capable of promoting local mobilization processes, organization, and empowerment of different actors to acquire family farm products for school meals in the said municipalities. RESULTS: The most expressive results were: 14% of the municipalities improved the family farm organization; 14% of the managers began to support the food acquisition process according to Law nº 11.947/2009; and 27% of the municipalities without a dietician hired one. The results were not considered satisfactory by the School Food Council. CONCLUSION: The actions were capable of promoting the implementation of the Federal Law Lei Federal nº 11.947/2009 in the study Territories of Citizenship.

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The scope of this article is to analyze the Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais. It is a qualitative and quantitative cross-sectional study with a sample of 1500 students, representing the population of the state schools of Minas Gerais, involving the administration of a semi-structured questionnaire. The data were analyzed using simple frequency, mean, standard deviation, Fisher's exact test, the chi-square test and logistic regression (p < 0.05, CI 95%). The effective acceptance of the program was 28.8% and the effective adhesion to the program was 45.1%. Program acceptance was significantly higher among males and students who consumed less extra-institutional food. Acceptance and adhesion to the program was significantly higher among the older students and those who reported participating in activities related to nutritional education. In total, 73.5% of the students suggested improvements in school food. Many of the program's norms and guidelines are not being implemented. The acceptance of school food was negatively influenced by the consumption of extra-institutional foods and positively influenced by food and nutritional education activities.

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