Balanço das mudanças trazidas pela Lei 13.964/2019 ao regramento das prisões preventivas: uma análise feita sob a luz dos princípios do sistema interamericano de direitos humanos

A presente monografia analisa modificações que o regramento das prisões preventivas sofreu com a lei 13.964/2019, popularmente chamada de pacote anticrime. O critério de análise consiste nos princípios que a Corte Interamericana de Direitos Humanos desenvolveu para limitar o uso excessivo dessa medida cautelar. O primeiro capítulo compila os princípios e suas interpretações pela Corte Interamericana. O segundo capítulo promove estudo sobre como as modificações relacionam-se com os princípios. Também há exame, utilizando os mesmos critérios, dos projetos de lei que iniciaram a reforma. O terceiro capítulo aborda decisões judicias proferidas com base no novo texto legal, com especial destaque para entendimentos do STF. A conclusão da pesquisa é que, enquanto alguns pontos da reforma aproximam o direito brasileiro dos mencionados princípios, outros o afastam. Ademais, o judiciário atua restringindo importantes pontos de aproximação

Prevenção da reestenose pós-angioplastia coronária: mito ou realidade?

Coronary Artery Disease is a major cause of death in men and women in industrialized nations. It is known that these deaths are mainly caused by coronary artery arteriosclerosis. The most effective therapeutic technique for obstructive arteriosclerosis is the Percutaneous Transluminal Coronary Angioplasty (PTCA) with or without stent implantation. However, this therapy has some limitations on its success, because the main complication (restenosis) after stent implantation which occurs in 30-50% of all the clinical cases. Several drugs have been tested to prevent the restenosis, but the success was not achieved compared to the obtained restenosis rate. These drugs can be divided in two groups, consisting in systemic and local action. The ones with systemic action did not present satisfactory results, once the rates shown were between 9,5 and 40% in prevention of restenosis. The local action drugs using a coated stent with local drug delivery, have significant results. The principal drugs from this group include Rapamycin and Paclitaxel, which obtained important results to prevent neointimal hyperplasia, with 4% restenosis rate. Rapamycin, through the inhibition of smooth muscle cells proliferation, has a main role in the prevention of neointimal hyperplasia, which is confirmed in randomized and blinded studies (RAVEL), showing a restenosis rate never achieved in interventional cardiology – 0%.In spite of these promising results, there is need to extend clinical trials, so that we can define the real effectiveness of this drug in prevention of restenosis after PTCA.A doença arterial coronária é a principal causa de óbito em ambos os sexos em nações industrializadas. A maioria destas mortes ocorre devido à aterosclerose das artérias coronárias. A medida terapêutica mais eficaz para a aterosclerose obstrutiva é a Angioplastia Percutânea Transluminal Coronária (APTC) com a utilização de stent. Entretanto, esta terapia vem encontrando limitações em seu sucesso, pois em 30 a 50% dos casos de implantação de stent ocorre a principal complicação deste procedimento – a reestenose. Inúmeros fármacos têm sido testados com o propósito de prevenir o processo reestenótico, porém o sucesso foi pequeno quando comparado às taxas de reestenose encontradas. Estes fármacos podem ser divididos em dois grupos, os de ação sistêmica e local. Os sistêmicos não apresentaram resultados satisfatórios, uma vez que as taxas variaram de 9,5 a 40% na prevenção da reestenose. Já as drogas de liberação local, através do revestimento de stent com substâncias liberadas lentamente, os resultados foram significativos. Os principais fármacos estudados neste grupo incluem a Rapamicina e Paclitaxel. Este obteve resultados importantes na proliferação das camadas íntima e média, alcançando taxa de reestenose de 4%. Já a Rapamicina, através da inibição da proliferação de células musculares lisas tem importante papel naprevenção da neoformação intimal, confirmado através da realização de estudos randomizados e duplo-cegos (RAVEL),nos quais constatou-se taxa de reestenose nunca antes observada na cardiologia intervencionista – 0%. Apesar deresultados promissores, há necessidade de maiores estudos clínicos para definir a real efetividade desta droga naprevenção da reestenose pós APTC

The role of endoscopic surgery in the treatment of nasal inverted papilloma

SummaryThe inverted papilloma is a benign neoplasm, prone to malignancy, and bearing a high rate of post-op recurrence. There is much debate in the literature concerning the issue that an endoscopic approach may offer a benefit over an external approach.AimDemonstrate the efficacy of an endonasal endoscopic approach in the treatment of inverted papilloma.Study designRetrospective.Materials and MethodsRetrospective analysis of patients with inverted papilloma operated at the University Hospital - FMUSP from 1994 to 2004.ResultsTwenty-eight patients' records were studied. Nine patients (32.1%) had tumor recurrence, one being operated via the endoscopic method and eight by external approach.DiscussionKrouse's staging system for inverted papillomas can facilitate both treatment planning and comparison of surgical outcomes. The use of the endoscopic approach resulted in fewer relapses than when the external one was used in cases with the same tumor staging.ConclusionThe use of the endoscope in this type of surgical treatment is an important success factor in the treatment of inverted papilloma

Arbitragem e direito processual

- Divulgação dos SUMÁRIOS das obras recentemente incorporadas ao acervo da Biblioteca Ministro Oscar Saraiva do STJ. Em respeito à Lei de Direitos Autorais, não disponibilizamos a obra na íntegra.- Localização na estante: 347.918 A664d- Coordenado por: Luiz Guilherme Marinoni, Cristina Bichels Leitão e Carlos Francesco Marinoni Abdo

Achados oftalmológicos nos recém-nascidos com infecção congênita pelo Zika Vírus: uma revisão bibliográfica / Ophthalmological findings in newborns with congenital Zika Virus infection: a literature review

Objetivo: Identificar as afecções oftalmológicas provocadas pela infecção congênita do ZIKV em RN. Métodos: Foi realizada uma revisão narrativa sobre achados oftalmológicos nos recém nascidos com infecção congênita pelo zika vírus, utilizando os descritores “ophthalmology”, “pediatric” e “Zika virus”. Resultados e discussão: Os artigos científicos encontrados demonstraram que a SCZ em RN está associada à microcefalia e a diversos achados oftalmológicos. Dentre as alterações, estão: astigmatismo, hipermetropia e miopia, além de anormalidades da retina, da mácula e do nervo óptico, assim como acometimentos do segmento ocular anterior. Devido ao tropismo neurológico desse vírus, culminou-se na descoberta das manifestações oculares. Apesar do amplo espectro de achados oculares descritos na literatura, os achados oculares mais típicos na SCZ são os acometimentos do segmento posterior do olho, como a retina e o nervo óptico. Considerações finais: A SCZ está associada a diversas afecções oftalmológicas, que acometem principalmente o segmento posterior do olho e que podem estar presentes mesmo em lactentes sem outras anormalidades do SNC. Portanto, recomendamos que testes de triagem oftalmológica sejam feitos em RN sob risco de exposição pré-natal ao ZIKV, sobretudo em áreas endêmicas, independentemente da presença de microcefalia

A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression

Background: A history of child sexual abuse (CSA) is related to higher suicide rates and poor treatment outcomes in depressed adult patients. Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the CSA effects on this emerging treatment. Here, we assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD). Methods: A directed acyclic graphic (DAG) was designed to identify clinical confounders between CSA and esketamine predictors of response. The confounders were applied in a statistical model to predict depression symptom trajectory in a sample of 67 TRD outpatients. Results: The patient sample had a relatively high prevalence rate of CSA (35.82%). Positive family history of first-degree relatives with alcohol use disorder and sex were clinical mediators of the effects of esketamine in a CSA adult population. Overall, the presence of at least one CSA event was unrelated to esketamine symptom reduction. Conclusions: Unlike responses to conventional antidepressants and psychotherapy, CSA does not appear to predict poor response to esketamine.publishedVersio

Novel Primate-Specific Genes, RMEL 1, 2 and 3, with Highly Restricted Expression in Melanoma, Assessed by New Data Mining Tool

Melanoma is a highly aggressive and therapy resistant tumor for which the identification of specific markers and therapeutic targets is highly desirable. We describe here the development and use of a bioinformatic pipeline tool, made publicly available under the name of EST2TSE, for the in silico detection of candidate genes with tissue-specific expression. Using this tool we mined the human EST (Expressed Sequence Tag) database for sequences derived exclusively from melanoma. We found 29 UniGene clusters of multiple ESTs with the potential to predict novel genes with melanoma-specific expression. Using a diverse panel of human tissues and cell lines, we validated the expression of a subset of three previously uncharacterized genes (clusters Hs.295012, Hs.518391, and Hs.559350) to be highly restricted to melanoma/melanocytes and named them RMEL1, 2 and 3, respectively. Expression analysis in nevi, primary melanomas, and metastatic melanomas revealed RMEL1 as a novel melanocytic lineage-specific gene up-regulated during melanoma development. RMEL2 expression was restricted to melanoma tissues and glioblastoma. RMEL3 showed strong up-regulation in nevi and was lost in metastatic tumors. Interestingly, we found correlations of RMEL2 and RMEL3 expression with improved patient outcome, suggesting tumor and/or metastasis suppressor functions for these genes. The three genes are composed of multiple exons and map to 2q12.2, 1q25.3, and 5q11.2, respectively. They are well conserved throughout primates, but not other genomes, and were predicted as having no coding potential, although primate-conserved and human-specific short ORFs could be found. Hairpin RNA secondary structures were also predicted. Concluding, this work offers new melanoma-specific genes for future validation as prognostic markers or as targets for the development of therapeutic strategies to treat melanoma

Simultaneous Low (1 Hz)- and High (10 Hz)-Frequency Bilateral Transcranial Magnetic Stimulation in a Patient With Severe Depression and Crohn Disease

We present a case report in which electroconvulsive therapy had a good effect for the treatment of depression in association with Crohn disease, but adverse effects limited its use. Repetitive transcranial magnetic stimulation was tried both in a conventional way (high frequency over the left dorsolateral prefrontal cortex) and in a bilateral sequential way (high frequency in the same region followed in the same session by low frequency on the right side). Finally, bilateral simultaneous stimulation (high frequency over the left and low frequency over the right side) was tried and resulted in a response similar to that of electroconvulsive therapy.Universidade Federal de São Paulo, São Paulo, BrazilIPAN, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Ultrabrief (0.3 ms) or Brief (0.5 ms) Pulses for Right Unilateral Electroconvulsive Therapy Is There a Difference in Seizure Thresholds?

Objectives: To compare the minimum charge to elicit a seizure using 2 different pulse widths, the brief pulse (0.5 milliseconds [ms]) and the ultrabrief pulse (0.3 ms).Methods: We compared retrospectively the last 30 patients in our ECT unit whose seizure thresholds were titrated using a pulse width of 0.5 ms to the last 30 patients whose seizure thresholds were titrated using a pulse width of 0.3 ms. the former were regular clinical patients, and the latter were participating in a clinical trial on the use of ultrabrief pulse treatment. All titrations were performed with right unilateral electrode positioning. Most patients continued to use psychotropic medications.Results: Initial seizure threshold (as measured in millicoulombs [mC]) for the brief pulse group (0.5ms) was 16 (n = 1); 32 (n = 21), and 64 (n = 8); whereas for the ultrabrief pulse group (0.3 ms), it was 9.2 (n = 3), 38.4 (n = 21), 19.2 (n = 3), 76.8 (n = 2), and 307.2 (n = 1). Excluding the outlier, there was no statistical difference between mean seizure thresholds.Conclusions: If we exclude the outlier from the ultrabrief group (seizure threshold [ST], 307 mC), we can observe that most of the patients in both groups had an ST between 30 and 40 mC. No patient in the brief pulse group showed a lower ST than 16 mC, probably because this was the first step of titration for this group. the data suggest that the difference between 0.3 and 0.5 ms may not be big, although randomized prospective studies with a more precise and similar steps used for titration are needed. Clinical efficacy was not compared in the present study.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, São Paulo, BrazilIPAN, São Paulo, BrazilUniv São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilFAPESP: 2006/03419-9Web of Scienc