Direito e cidadania: os impactos da interdição civil no cotidiano de vida dos portadores de transtornos mentais

Este artigo pretende compartilhar algumas das reflexões produzidas no processo do trabalho de pesquisa que foi realizada através do Projeto de Iniciação Cientifica, intitulado “Direito e Cidadania: os impactos da interdição no cotidiano de vida dos portadores de transtornos mentais”. O referido projeto, inscrito no Curso de Serviço Social do UniFOA, esteve vinculado ao Programa de Iniciação Científica deste Centro Universitário em 2007. O interesse pelo estudo emergiu a partir dos debates travados em sala, na disciplina eletiva “O Serviço Social e o Campo Sócio-Jurídico” e ainda frente a observações empíricas construídas no exercício profissional de uma das autoras, que é assistente social do Tribunal de Justiça. Tais debates foram instigados pela problematização acerca da relação entre a afirmação da positividade da cidadania dos portadores de transtornos mentais e as práticas que indicam a necessidade de decretar a incapacidade civil, através da interdição para protegê-los. Ou seja, identificou-se o paradoxo entre o movimento contemporâneo que impõe a necessidade de se reconhecer o status de cidadania do louco e o decreto da interdição que impossibilita o exercício dos atos da vida civil. Frente a estas observações, foi construído, então, o objeto da pesquisa, cujos resultados serão aqui discutidos. A partir do debate apresentado, o projeto de pesquisa pretendeu, então, conhecer a realidade de vida de portadores de transtornos mentais que foram interditados, na perspectiva de elucidar a existência de relações entre esta condição legal e o processo de garantia de seus direitos

Imaging predictors of incident heart failure: a systematic review and meta-analysis

BACKGROUND: Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. METHODS: This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. RESULTS: Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). CONCLUSION: LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure

Cardiac magnetic resonance: evaluation of signal intensity decay after the injection of gadolinium in cardiac amyloidosis

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Chemical and spectroscopic characterization of humic acids extracted from the bottom sediments of a Brazilian subtropical microbasin

International audienceHumic substances (HS) perform a fundamental role in aquatic environments, exhibiting different levels of reactivity in retaining metal ions and organic pollutants. Also, they control the primary production of these ecosystems and act in the carbon sequestering process. In order to improve our understanding vis-à-vis the structural and functional features of HS from aquatic systems, this study aimed to chemically and spectroscopically characterize humic acids (HA) isolated from bottom sediment samples of a stream in a Brazilian subtropical microbasin by elemental analysis, and infrared (FT-IR), ultraviolet and visible (UV-Vis) and solid-state 13C nuclear magnetic resonance (CP-MAS 13C NMR) spectroscopies, thermogravimetry (TG), and scanning electron microscopy (SEM). Although all samples originated from the same environment, the data showed that the HA have distinct chemical and spectroscopic properties, and that the location and characteristics of the sampling points from which the sediments were collected played an important role in the differences observed. Furthermore, vascular plant matter is probably the main contributor to these samples

Indications of beta-adrenoceptor blockers in Takotsubo syndrome and theoretical reasons to prefer agents with vasodilating activity

Takotsubo syndrome (TTS) is estimated to account for 1–3% of all patients presenting with suspected ST-segment elevation myocardial infarction. A sudden surge in sympathetic nervous system is considered the cause of TTS. Nonetheless, no specific recommendations have been provided regarding β-blocking therapy. Apart from specific contra-indications (severe LV dysfunction, hypotension, bradycardia and corrected QT interval >500 ms), treatment with a β-blocker seems reasonable until full recovery of LV ejection fraction, though evidence is limited to a few animal studies, case reports or observational studies. In this review, we will reappraise the rationale for β-blocker therapy in TTS and speculate on the pathophysiologic basis for preferring non-selective agents with vasodilating activity over β1-selective drugs

Acute Effects Of Triiodothyronine T. (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3 Syndrome: A Randomized, Placebo-Controlled Study

Context: Low-T3 syndrome is a predictor of poor outcome in patients with cardiac dysfunction. The study aimed to assess the short-term effects of synthetic L-T3 replacement therapy in patients with low-T3 syndrome and ischemic or nonischemic dilated cardiomyopathy (DC). Design:Atotal of 20 clinically stable patients with ischemic (n12) or nonischemic (n8) DC were enrolled. There were 10 patients (average age 72 yr, range 66–77; median, 25–75th percentile) who underwent 3-d synthetic L-T3 infusion (study group); the other 10 patients (average age 68 yr, range 64–71) underwent placebo infusion (control group). Clinical examination, electrocardiography, cardiac magnetic resonance, and bio-humoral profile (free thyroid hormones, TSH, plasma renin activity, aldosterone, noradrenaline, N-terminal-pro-B-Type natriuretic peptide, and IL-6) were assessed at baseline and after 3-d synthetic L-T3 (initial dose: 20 g/m2 body surfaced) or placebo infusion. Results: After T3 administration, free T3 concentrations increased until reaching a plateau at 24–48 h (3.43, 3.20–3.84 vs. 1.74, 1.62–1.93 pg/ml; P 0.03) without side effects. Heart rate decreased significantly after T3 infusion (63, 60–66 vs. 69, 60–76 beats per minute; P 0.008). Plasma noradrenaline (347; 270–740 vs. 717, 413–808 pg/ml; P 0.009), N-terminal pro-B-Type natriuretic peptide (3000, 438-4005 vs. 3940, 528-5628 pg/ml; P0.02), and aldosterone (175, 152–229 vs. 231, 154–324 pg/ml; P 0.047) significantly decreased after T3 administration. Neurohormonal profile did not change after placebo infusion in the control group. After synthetic L-T3 administration, left-ventricular end-diastolic volume (142, 132–161 vs. 133, 114–158 ml/m2 body surface; P 0.02) and stroke volume (40, 34–44 vs. 35, 28–39 ml/m2 body surface; P 0.01) increased, whereas external and intracardiac workload did not change. Conclusions: In DC patients, short-term synthetic L-T3 replacement therapy significantly improved neuroendocrine profile and ventricular performance. These data encourage further controlled trials with more patients and longer periods of synthetic L-T3 administration

Cardiac magnetic resonance findings in patients with type 1 myotonic dystrophy

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart disease is a major determinant of prognosis in type 1 myotonic dystrophy (DM1), second only to respiratory complications. Cardiac imaging, possibly including cardiac magnetic resonance (CMR), is recommended in patients with DM1. However, limited information is available on CMR findings and their prognostic significance in DM1. Methods We identified all patients with DM1 evaluated from 2009 to 2020 in a CMR laboratory with an established collaboration with a Neuromuscular Disorder Unit. Results Thirty-four patients were retrieved (21 males, aged 45 ± 12). At the time of CMR examination, 97% had neuromuscular symptoms (mean duration 16 ± 13 years), 12 (35%) presented with atrioventricular block (n = 11 1st degree, n = 1 2nd degree type 1), 15 (44%) with intraventricular conduction disturbances (n = 5 left bundle branch block, n = 5 right bundle branch block, n = 3 left anterior fascicular block, n = 2 other non-specific intraventricular conduction delay), 4 (12%) with atrial fibrillation or flutter. No patient had a device. At CMR, 5 (15%) patients had left ventricular (LV) systolic dysfunction (LV ejection fraction [LVEF] <50%) and 5 (15%) a depressed right ventricular (RV) function (RVEF <50%). Compared to age- and sex-specific reference values for our laboratory, 12 (35%) patients showed a decreased LV end-diastolic volume index (LVEDVi), 7 (21%) a decreased LV mass index (LVMi), and 29 (83%) a decreased LVMi/LVEDVi ratio. Nine (26%) patients had mid-wall late gadolinium enhancement (LGE, mean extent 4.5 ± 2.0% of LVM; n = 8 septal, n = 4 inferolateral, n = 2 inferior, n = 1 anterolateral), and 14 (40%) some areas of fatty infiltration (n = 9 involving the LV, n = 13 the RV). Native T1 in the interventricular septum (1,041 ± 53 ms) approached the upper reference limit (1,089 ms), and the extracellular volume was slightly increased (33 ± 2%, reference values <30%). Over a median follow-up of 3.3 years (interquartile interval 1.6-4.7), 2 (6%) patients died, one for infectious and respiratory complications and the other for unknown causes, 5 (15%) patients underwent pacemaker implantation for conduction disturbances, and 4 (12%) had a documentation of high-risk (Lown class ≥4) ventricular ectopic beats (VEBs). Among all CMR variables collected, higher values of LVMi/LVEDVi ratio emerged as univariate predictor of all-cause death (p = 0.044). At logistic regression analysis, anteroseptal wall thickness was associated with the need for pacemaker implantation (p = 0.028), while LGE mass was associated with high-risk VEBs (p = 0.026). Conclusions Patients with DM1 display several structural and functional cardiac abnormalities, with variable degrees of cardiac muscle hypotrophy, fibrosis and fatty infiltration. The possibility to predict the need for pacemaker implantation, ventricular arrhythmias and all-cause or cardiovascular mortality should be verified in larger cohorts

Direito e cidadania:os impactos da interdição no cotidiano de vida dos portadores de transtornos mentais

A interdição é promovida frente prova da incapacidade para atos civis. identificada como medida de proteção.Mas se as leis forem compreendidas com mecanismos de legitimação de discursos de verdades, o debate sobre interdição deve se remetido ao próprio significado da loucura.As representações de que o louco é aquel desprovido da razão contaminou a cultura moderna.O movimento da reforma psiquiátric vem problematizando questões relativas ao “lugar” destinado ao louco. Assim, surg debate sobre sua cidadania,na perspectiva de se reconhecer sua condição de cidadã Mas,levando-se em consideração que, para proteger o louco é preciso interditá-lo e qu tal condição pressupõe a perda dos direitos civis, recorta-se aqui uma questão paradoxa Objetivos:Conhecer a realidade de vida de portadores de transtornos mentais que fora interditados, na perspectiva de elucidar a existência de relações entre esta condição leg  e o processo de garantia de seus direitos Metodologia: a pesquisa é qualitativa. O instrumentos serão: entrevista semi-estruturada, questionário e observação participant Será realizado levantamento dos processos que tramitaram em 2006 na 2ª Vara d Família.Resultados:o projeto está em desenvolvimento.Conclusão:A pesquisa poder contribuir no processo de afirmação da condição de cidadania dos chamados loucos