A representação e o gozo na clínica do autismo

Considering that autism brings up questions about the most primitive moment of the subjectivity constitution, this paper first approaches the particularities of the enjoyment that, according to psychoanalytic theory, establishes representation as an inscription on inconscient tying up the subject to the Other. Then, since in autism the enjoyment is situated beyond representation, it is envisaged from the viewpoint proposed by Lacan with the concept of lalangue, the precursor of representation as enjoyment.Considerando que el autismo plantea cuestiones relativas a las fechas más primitivas de la subjetividad, el texto aborda inicialmente las particularidades que participan del goce que, de acuerdo con la teoría psicoanalítica, postula la representación como una inscripción en el inconsciente que vincula el sujeto al Otro. Entonces, el goce en el autismo, en la medida en que se plantea por debajo de la representación, se discute desde el concepto de lalengua, propuesto por Lacan como el precursor de la representación como goce.Considerando que o autismo suscita questões referentes ao momento mais primitivo da constituição da subjetividade, o trabalho aborda inicialmente as particularidades implicadas no gozo que, segundo a teoria psicanalítica, estabelece a representação como uma inscrição no inconsciente ao atrelar o sujeito ao Outro. Em seguida, o gozo no autismo, na medida em que se situa num aquém da representação, é abordado a partir do conceito de alíngua proposto por Lacan como o precursor da representação como gozo

Purification and characterization of trypsin from Luphiosilurus alexandri pyloric cecum

AbstractTrypsin from L. alexandri was purified using only two purification processes: ammonium sulfate precipitation and anion exchange liquid chromatography in DEAE-Sepharose. Trypsin mass was estimated as 24kDa through SDS-PAGE, which showed only one band in silver staining. The purified enzyme showed an optimum temperature and pH of 50°C and 9.0, respectively. Stability was well maintained, with high levels of activity at a pH of up to 11.0, including high stability at a temperature of up to 50°C after 60min of incubation. The inhibition test demonstrated strong inhibition by PMSF, a serine protease inhibitor, and Kinetic constants km and kcat for BAPNA were 0.517mM and 5.0S−1, respectively. The purified enzyme was also as active as casein, as analyzed by zymography. Therefore, we consider trypsin a promising enzyme for industrial processes, owing to its stability in a wide range of pH and temperature and activity even under immobilization

Via aérea difícil não prevista em paciente com tumor de amígdala: relato de caso

A via aérea difícil é a situação clínica, na qual um anestesiologista treinado tem dificuldade na ventilação da via aérea superior com máscara facial, dificuldade na intubação traqueal, ou ambas. A via aérea pode ser identificada como difícil antes do seu manejo, através da consulta pré-anestésica. Essa avaliação corrobora com o planejamento adequado para o momento da intubação orotraqueal. Contudo, existem situações nas quais a via aérea não é classificada como difícil, porém, no momento do manejo da via aérea, o anestesiologista tem dificuldades para realizar a intubação orotraqueal, implicando em uma via aérea difícil não prevista. Casos imprevistos não são encontrados com frequência na literatura. Por isso, mais estudos, como este, a respeito da via aérea difícil imprevista tornam-se essenciais para que o planejamento do acesso à via aérea seja realizado de forma mais rigorosa, com o intuito de um desfecho positivo da intubação orotraqueal

Comparative effectiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis

Funding Information: positions on two Pfizer sponsored trials and has directed an educational course supported by Bristol Myers Squibb. He serves as an epidemiology consultant to CORRONA. J.A.P.S. has received honoraria as a speaker or consultant and benefited from research support from several pharmaceutical companies involved in the production of biologic agents (Abbott, Amgen, MSD, Pfizer and Roche), always at sums less than E10 000. All other authors have declared no conflicts of interest. Funding Information: Funding: This work was supported by a grant from Harvard-Portugal Program HMSP-ICS/SAU-ICT/0002/ 2010.Objectives: Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.Methods: Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified.Results: The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response.Conclusion: Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.publishersversionpublishe

Análise epidemiológica da sífilis congênita no nordeste brasileiro / Epidemiological analysis of congenital syphilis in northeast Brazil

A sífilis representa uma infecção sexualmente transmissível (IST) que pode ser transmitida verticalmente por via transplacentária ou durante o parto, ocasionando o quadro de sífilis congênita. Sabe-se que tal agravo é a segunda principal causa de natimortos evitáveis em todo o mundo, superando o número de consequências reportadas devido a infecção congênita pelo HIV, o que ilustra o importante acometimento da saúde materno-infantil. Neste cenário, o presente trabalho visa traçar o perfil epidemiológico dos casos de sífilis congênita referentes à região nordeste do Brasil. Consiste em um estudo epidemiológico, retrospectivo e descritivo, cujos dados foram obtidos do Sistema de Informação de Agravos de Notificação (SINAN) no período de 2007 a 2017. As variáveis utilizadas foram: casos confirmados, região, faixa etária, escolaridade materna, tratamento dos parceiros, pré-natal e óbitos infantis. A região Nordeste apresentou 44.944 casos de sífilis congênita, atrás apenas da região Sudeste (62.269). Embora tenha cobertura pré-natal (76,3%) próxima da média nacional (78%), a região ficou em último lugar quando comparada com outras localidades do país. Os estados mais afetados foram Pernambuco (10.779), Ceará (9.865) e Bahia (7.809), sendo concomitantemente os que apresentam menor quantitativo de tratamento dos parceiros. Quanto à escolaridade materna, a maioria (61,2%) possuía ensino fundamental incompleto. Por fim, foram catalogados 978 óbitos, dos quais 933 ocorreram na primeira semana de vida. O Nordeste projetou-se em 2° lugar nos casos de sífilis congênita, quadruplicando esse valor entre o primeiro e o último ano analisados, o que pode ser atribuído a avanços da vigilância epidemiológica ou a piora do panorama relacionado a esse agravo. Pernambuco, Ceará e Bahia demonstraram maior prevalência, possivelmente por uma menor qualidade no atendimento do pré-natal ou o não tratamento do parceiro. Nesse contexto, o menor índice de cobertura pré-natal e a baixa escolaridade materna são fatores que demonstraram favorecer a perpetuação da sífilis congênita no Nordeste. Nota-se que a melhoria do panorama desse importante agravo perpassa por um adequado acompanhamento pré-natal, tratamento dos parceiros e, especialmente, incentivo à educação em saúde

Alimentação popular em São Paulo (1920 a 1950): políticas públicas, discursos técnicos e práticas profissionais

This article discusses how the concept of lower-class eating habits came about and developed in the intellectual circles of São Paulo during the first half of the 20th century. It starts by reconstructing the elements of the debate around the income and ignorance of the underprivileged as the main reasons behind their bad eating habits. Then, it looks at the focal points for interventions and public policies proposed by the government to deal with the problem thus identified, namely: training methods to produce sanitation counselors capable of offering dietary guidance as well; popular educational campaigns and new learning sites in addition to schools (e.g. healthcare centers and households); lunch and other means of offering food at schools; and diagnostic studies about food intake and eating habits among laborers. Because they were translated into technical and scientific language, the proposals and policies implemented in São Paulo left traces in a variety of supporting documents and media (photographs, primers, posters, inquiry notebooks, and academic literature).O artigo discute a construção da idéia de alimentação popular nos meios intelectuais em São Paulo, na primeira metade do século XX. Para isso, reconstitui, como motivos da má alimentação, elementos do debate em torno da renda e da ignorância dos mais pobres. Identificado o problema, as propostas de intervenção e as políticas públicas concentraram-se em alguns setores, abordados neste trabalho: métodos para a formação de educadores sanitários aptos a atuar também na educação alimentar; campanhas de instrução popular e criação de novos lugares de aprendizado (além das escolas, os centros de saúde e os lares); merenda escolar e outras alternativas de alimentação nas escolas; e diagnósticos referentes ao conteúdo e à forma da alimentação dos operários. Traduzidas em discurso técnico-científicos, as propostas e políticas implementadas na cidade deixaram indícios em documentação de suporte e tipologia variados (fotografias, cartilhas, cartazes, cadernetas de inquéritos e textos acadêmicos).Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort.

BACKGROUND: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. METHODS: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. RESULTS: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were 'at risk of development delay' according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were 'at risk of development delay'. For children without microcephaly, the percentages found to be 'at risk of developmental delay' were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. CONCLUSIONS: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management

Estudos Artísticos

Arte em transe. De um modo especializado, dentro do projeto criadores sobre outras obras, a revista Croma interessa-se pela implicação, a intervenção, e a valorização. Nesta sétima edição reuniram-se 17 artigos que tomam como ponto comum a abordagem de obras que exigem diferentes formas de participação. As propostas artísticas não funcionam sem a interação das pessoas. O seu suporte vital, funcional, o seu sentido, estas dimensões, materiais e imateriais, convergem para as pessoas vivas que com elas atuam. Sobre estes artigos podemos promover diferentes abordagens. Mas interessará estudar o que motivou os temas apresentados. Podem detetar-se regularidades dentro dos espaços de implicação que privilegiamos na revista Croma. Quais são estas regularidades? Encontramos alguns núcleos problematizadores comuns: o género, a inclusão, a migração, o corpo, a identidade.info:eu-repo/semantics/publishedVersio

Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State of Pernambuco, Brazil.

Congenital viral infections and the occurrence of septo-optic dysplasia, which is a combination of optic nerve hypoplasia, abnormal formation of structures along the midline of the brain, and pituitary hypofunction, support the biological plausibility of endocrine dysfunction in Zika-related microcephaly. In this case series we ascertained the presence and describe endocrine dysfunction in 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort, referred for endocrinological evaluation between February and August 2019. Of the 30 children, 97% had severe microcephaly. The average age at the endocrinological consultation was 41 months and 53% were female. The most frequently observed endocrine dysfunctions comprised short stature, hypothyroidism, obesity and variants early puberty. These dysfunctions occurred alone 57% or in combination 43%. We found optic nerve hypoplasia (6/21) and corpus callosum hypoplasia (20/21). Seizure crises were reported in 86% of the children. The most common-and clinically important-endocrine dysfunctions were pubertal dysfunctions, thyroid disease, growth impairment, and obesity. These dysfunctions require careful monitoring and signal the need for endocrinological evaluation in children with Zika-related microcephaly, in order to make early diagnoses and implement appropriate treatment when necessary