Extensive Skin Necrosis Induced by Low-Molecular-Weight Heparin in a Patient With Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Low-molecular-weight heparin-induced skin necrosis can occur as a clinical feature of heparin-induced thrombocytopenia syndrome. Heparin-induced thrombocytopenia and antiphospholipid syndromes have some clinical features in common, including thrombocytopenia and thrombotic events. We describe a 46-year-old woman who developed extensive necrosis in the breast and other sites secondary to the use of enoxaparin after an elective hysterectomy. During the postoperative period, diagnoses of systemic lupus erythematosus and antiphospholipid syndrome were made because of some clinical and laboratory features (seizure, nephritis, bicytopenia, positive nuclear antibody, and positive antiphospholipid antibodies with a previous thrombotic event). The patient's clinical course improved only after corticosteroid therapy and the suspension of enoxaparin. Heparin-induced thrombocytopenia and antiphospholipid syndromes can have platelet factor 4 as a common denominator in their pathogenesis because platelet factor 4 tetramers can bind beta(2)-glycoprotein molecules. This case suggests that use of low-molecular-weight heparins could be more risky in patients with an underlying immune disease and/or could trigger immune reactions that must be analyzed in larger studies.18419619

Família em situação de vulnerabilidade social: uma questão de políticas públicas Socially vulnerable families: a public issue

A gravidade do quadro de pobreza e miséria, no Brasil, constitui permanente preocupação e obriga a refletir sobre suas influências no social e, principalmente, na área de atuação junto da família, na qual as políticas públicas ainda se ressentem de uma ação mais expressiva. Para a família pobre, marcada pela fome e pela miséria, a casa representa um espaço de privação, de instabilidade e de esgarçamento dos laços afetivos e de solidariedade. Este estudo tem como objetivo apontar a vulnerabilidade da família pobre que, desassistida pelas políticas públicas, se vê impossibilitada de responder às necessidades básicas de seus membros, e de favorecer o aprofundamento do debate acerca da construção de alternativas para o fortalecimento da família. Trata-se de um estudo de campo, exploratório, fundamentado na Teoria das Representações Sociais. Os instrumentos utilizados na coleta de dados foram: teste de Associação Livre de Palavras, e entrevista semi-estruturada. Os resultados mostraram que "família" representa sentimentos ambivalentes, agregador/desagregador, associada à imagem de família real e sonhada construída a partir da interação dos sujeitos no seu cotidiano, influenciando e sendo influenciada por relações familiares conflituosas, geradas a partir da pobreza a que estão sujeitas as famílias.<br>The gravity situation of poverty and misery in Brazil is part of the constant worry and make to think about its social influence and, specially, on the family area, where the public politics still resent a more expressive action. To the poor family, designated by hunger and misery, home represents a place of privation, instability and family's links break and solidarity. This study aims to point out the vulnerability of the poor family that is not assisted by public politics being impeached to attend the basic necessities of their members, and support the profundity of the discussing about the construction of alternatives to the family empowerment. It is a field study, exploratory, based on the Social Representations Theory. The instruments used for the collection of data were: Free Association of Words test and semi-structured interview. The results showed that family represents ambiguous feelings, of unity and disunity, associated with the image of lived up family and desired family constructed from the individuals' daily interaction; influencing and being influenced by the conflicting family relationships, conceived due to poverty that the families are submitted