MR1 blockade drives differential impact on integrative signatures based on circuits of circulating immune cells and soluble mediators in visceral leishmaniasis.

Introduction: Visceral leishmaniasis (VL) is an important tropical and neglected disease and represents a serious global health problem. The initial interaction between the phagocytes and the parasite is crucial to determine the pathogen's capacity to initiate infection and it shapes the subsequent immune response that will develop. While type-1 T-cells induce IL-6, IL-1ß, TNF-α, and IL-12 production by monocytes/macrophages to fight the infection, type-2 T-cells are associated with a regulatory phenotype (IL-10 and TGF-ß) and successful infection establishment. Recently, our group demonstrated the role of an important Th1/Th17 T-cell population, the mucosal-associated invariant T (MAIT) cells, in VL. MAIT cells can respond to L. infantum by producing TNF-α and IFN-γ upon MR1-dependent activation. Objective and methods: Here, we describe the impact of the MR1-blockage on L. infantum internalization on the functional profile of circulating neutrophils and monocytes as well as the impact of the MR1-blockage on the soluble mediator signatures of in vitro whole blood cultures. Results: Overall, our data showed that VL patients presents higher percentage of activated neutrophils than asymptomatic and non-infected controls. In addition, MR1 blockade led to lower TNF-α and TGF-ß production by non-activated neutrophils from asymptomatic individuals. Moreover, TNF-α and IL-10 production by monocytes was higher in VL patients. In the analysis of soluble mediators produced in vitro, MR1-blockade induced a decrease of IFN-γ and an increase of IL-10, IL-27 and IL-33 in the cell cultures of AS group, a cytokine pattern associated with type 2 deleterious response. Discussion and conclusion: These data corroborate the hypothesis that MR1-restricted responses are associated to a protective role during Leishmania infection.

COVID-19-associated coagulopathy and acute kidney injury in critically ill patients.

OBJECTIVE: The incidence of thrombotic events and acute kidney injury is high in critically ill patients with COVID-19. We aimed to evaluate and compare the coagulation profiles of patients with COVID-19 developing acute kidney injury versus those who did not, during their intensive care unit stay. METHODS: Conventional coagulation and platelet function tests, fibrinolysis, endogenous inhibitors of coagulation tests, and rotational thromboelastometry were conducted on days 0, 1, 3, 7, and 14 following intensive care unit admission. RESULTS: Out of 30 patients included, 13 (43.4%) met the criteria for acute kidney injury. Comparing both groups, patients with acute kidney injury were older: 73 (60-84) versus 54 (47-64) years, p=0.027, and had a lower baseline glomerular filtration rate: 70 (51-81) versus 93 (83-106) mL/min/1.73m2, p=0.004. On day 1, D-dimer and fibrinogen levels were elevated but similar between groups: 1780 (1319-5517) versus 1794 (726-2324) ng/mL, p=0.145 and 608 (550-700) versus 642 (469-722) g/dL, p=0.95, respectively. Rotational thromboelastometry data were also similar between groups. However, antithrombin activity and protein C levels were lower in patients who developed acute kidney injury: 82 (75-92) versus 98 (90-116), p=0.028 and 70 (52-82) versus 88 (78-101) µ/mL, p=0.038, respectively. Mean protein C levels were lower in the group with acute kidney injury across multiple time points during their stay in the intensive care unit. CONCLUSION: Critically ill patients experiencing acute kidney injury exhibited lower endogenous anticoagulant levels. Further studies are needed to understand the role of natural anticoagulants in the pathophysiology of acute kidney injury within this population.

Senses and repercussions of student assistance on the eating practices of students from a Brazilian public university during the COVID-19 pandemic.

Student assistance (SA), regulated through the National Student Assistance Program (PNAES), seeks to meet the basic social needs of university students and is inserted in the field of public policies for higher education in federal institutions in Brazil. The program allocates financial resources in order to provide scholarships, housing, food, transport, physical and mental health, and accessibility for disabled students. The present study aims to identify the senses attributed by students of a federal public university to AE and the relationship between SA and their eating practices during the COVID-19 pandemic. A qualitative approach was used. Online questionnaire and focus groups were employed for data collection. The study public consisted of undergraduate students. Descriptive statistics and content analysis were used, opting for thematic analysis, with the support of the MAXQDA software. The core meanings were organized into two categories: (i) food during pandemic and (ii) role of student assistance. A total of 55 responses were obtained, and three focus groups were carried out. About 45% reported that the pecuniary aid offered by the university was the family's only source of income during the pandemic and 65% used it to buy food. More than half described worsening in food quality, related to food prices. Although no specific evaluation instrument was used, it is plausible to admit that the students experienced a situation of food insecurity, given the uncertainty in regular access to food, the compromised quality of food, and the strategies mobilized to guarantee a minimum amount of food for all members of the family. Among the reported strategies were changing the location and mode of acquisition (receiving donations, buying in groups or in wholesalers) and choosing cheaper genres. Although students consider SA essential for access and maintenance at the university, a sense assigned to SA was the role of "help." In general, students did not link SA to social rights, as part of public educational policy and as a mechanism for food and nutrition security. SA actions developed during the pandemic were essential for keeping students at the university, also functioning, albeit unintentionally, as a food and nutritional security mechanism.

COVID-19-associated coagulopathy and acute kidney injury in critically ill patients

ABSTRACT Objective The incidence of thrombotic events and acute kidney injury is high in critically ill patients with COVID-19. We aimed to evaluate and compare the coagulation profiles of patients with COVID-19 developing acute kidney injury versus those who did not, during their intensive care unit stay. Methods Conventional coagulation and platelet function tests, fibrinolysis, endogenous inhibitors of coagulation tests, and rotational thromboelastometry were conducted on days 0, 1, 3, 7, and 14 following intensive care unit admission. Results Out of 30 patients included, 13 (43.4%) met the criteria for acute kidney injury. Comparing both groups, patients with acute kidney injury were older: 73 (60-84) versus 54 (47-64) years, p=0.027, and had a lower baseline glomerular filtration rate: 70 (51-81) versus 93 (83-106) mL/min/1.73m2, p=0.004. On day 1, D-dimer and fibrinogen levels were elevated but similar between groups: 1780 (1319-5517) versus 1794 (726-2324) ng/mL, p=0.145 and 608 (550-700) versus 642 (469-722) g/dL, p=0.95, respectively. Rotational thromboelastometry data were also similar between groups. However, antithrombin activity and protein C levels were lower in patients who developed acute kidney injury: 82 (75-92) versus 98 (90-116), p=0.028 and 70 (52-82) versus 88 (78-101) µ/mL, p=0.038, respectively. Mean protein C levels were lower in the group with acute kidney injury across multiple time points during their stay in the intensive care unit. Conclusion Critically ill patients experiencing acute kidney injury exhibited lower endogenous anticoagulant levels. Further studies are needed to understand the role of natural anticoagulants in the pathophysiology of acute kidney injury within this population.

Chronic respiratory diseases and respiratory symptoms after a mining dam rupture: Brumadinho Health Project.

OBJECTIVE: To identify factors associated with asthma and chronic obstructive pulmonary disease (COPD) and respiratory symptoms, in Brumadinho, state of Minas Gerais, Brazil, after a dam rupture. METHODS: This is a cross-sectional study, including a representative sample of adults (aged 18 years and over) in the municipality. Associations were assessed between dependent variables (medical diagnosis of asthma and COPD; symptoms of wheezing, dry cough, and nose irritation) and exploratory variables (sex, age group, smoking habit, having worked at Vale S.A. company before the dam rupture, time and area of residence in relation to the dam rupture). Logistic regression models with odds ratio (OR) calculation and 95% confidence interval were used. RESULTS: We identified a prevalence of 7.2% of asthma; 3.5% of COPD; 8.8% of wheezing; 23.6% of dry cough; and 31.8% of nose irritation. We observed a greater chance of asthma among women and residents in the affected and mining regions, while a greater chance of COPD was observed in smokers and in those with longer time of residence in the municipality. Among the symptoms, we verified a higher chance of nose irritation among women, while a higher chance of wheezing and dry cough were found among smokers (current and former). Residents of regions affected by the mud reported a greater chance of presenting all the analyzed symptoms. Conversely, level of education was negatively associated with wheezing and dry cough. CONCLUSION: We found respiratory changes and identified the groups most vulnerable to developing them, which could contribute to directing actions to reduce the population's respiratory problems.

The role of mucosal-associated invariant T cells in visceral leishmaniasis.

Mucosal-associated invariant T (MAIT) cells are restricted by MR1 and are known to protect against bacterial and viral infections. Our understanding of the role of MAIT cells in parasitic infections, such as visceral leishmaniasis (VL) caused by protozoan parasites of Leishmania donovani, is limited. This study showed that in response to L. infantum, human peripheral blood MAIT cells from children with leishmaniasis produced TNF and IFN-γ in an MR1-dependent manner. The overall frequency of MAIT cells was inversely correlated with alanine aminotransferase levels, a specific marker of liver damage strongly associated with severe hepatic involvement in VL. In addition, there was a positive correlation between total protein levels and the frequency of IL-17A+ CD8+ MAIT cells, whereby reduced total protein levels are a marker of liver and kidney damage. Furthermore, the frequencies of IFN-γ+ and IL-10+ MAIT cells were inversely correlated with hemoglobin levels, a marker of severe anemia. In asymptomatic individuals and VL patients after treatment, MAIT cells also produced IL-17A, a cytokine signature associated with resistance to visceral leishmaniasis, suggesting that MAIT cells play important role in protecting against VL. In summary, these results broaden our understanding of MAIT-cell immunity to include protection against parasitic infections, with implications for MAIT-cell-based therapeutics and vaccines. At last, this study paves the way for the investigation of putative MAIT cell antigens that could exist in the context of Leishmania infection.

Monitoring Internal Training Load, Stress-Recovery Responses, and Immune-Endocrine Parameters in Brazilian Jiu-Jitsu Training.

ABSTRACT: Campos, F, Molina Correa, JC, Canevari, VCM, Branco, BHM, Andreato, LV, and de Paula Ramos, S. Monitoring internal training load, stress-recovery responses, and immune-endocrine parameters in Brazilian jiu-jitsu training. J Strength Cond Res 36(3): 723-731, 2022-This study aimed to evaluate the relationship between training loads, stress, and immune-endocrine markers during a precompetitive period in Brazilian jiu-jitsu (BJJ) athletes. For this, 12 athletes were submitted to 1 physical and 1 technical-tactical training session per day, 5 days a week, for 7 weeks. The saliva sampling and physical tests (countermovement jump [CMJ] and squat jump [SJ]) were performed before starting the training period (pre) and at the fourth week (4-week) and eighth week (post). Session rating of perceived exertion (sRPE) and the Recovery-Stress Questionnaire-Sport (RESTQ) were applied, and the training load was calculated weekly. Repeated-measures analysis of variance and the Friedman test were used, with significance levels set at p < 0.05. Increased training loads were recorded by the sRPE method in technical-tactical training sessions (p < 0.05). Higher physical loads were reported by athletes during weeks 1-4, contributing to overall higher training load, monotony, and strain during this period (p < 0.05). Increased perception of stress, by the RESTQ, and cortisol were detected, whereas decreased salivary testosterone and salivary immunoglobulin A were observed at 4 weeks (p < 0.05). No significant differences were detected in CMJ and SJ tests, suggesting that training neither elicited significant fatigue and underperformance nor improved strength performance. However, decreasing physical training loads appeared to reduce symptoms of stress and improved recovery, favoring immune recovery and anabolic balance. Thus, the sRPE seems to be a reliable and simple method to monitor training loads in BJJ athletes because variation in values was related to the RESTQ and physiological responses to training loads.

Chronic respiratory diseases and respiratory symptoms after a mining dam rupture: Brumadinho Health Project / Doenças respiratórias crônicas e sintomas respiratórios após rompimento de barragem de mineração: Projeto Saúde Brumadinho

ABSTRACT: Objective: To identify factors associated with asthma and chronic obstructive pulmonary disease (COPD) and respiratory symptoms, in Brumadinho, state of Minas Gerais, Brazil, after a dam rupture. Methods: This is a cross-sectional study, including a representative sample of adults (aged 18 years and over) in the municipality. Associations were assessed between dependent variables (medical diagnosis of asthma and COPD; symptoms of wheezing, dry cough, and nose irritation) and exploratory variables (sex, age group, smoking habit, having worked at Vale S.A. company before the dam rupture, time and area of residence in relation to the dam rupture). Logistic regression models with odds ratio (OR) calculation and 95% confidence interval were used. Results: We identified a prevalence of 7.2% of asthma; 3.5% of COPD; 8.8% of wheezing; 23.6% of dry cough; and 31.8% of nose irritation. We observed a greater chance of asthma among women and residents in the affected and mining regions, while a greater chance of COPD was observed in smokers and in those with longer time of residence in the municipality. Among the symptoms, we verified a higher chance of nose irritation among women, while a higher chance of wheezing and dry cough were found among smokers (current and former). Residents of regions affected by the mud reported a greater chance of presenting all the analyzed symptoms. Conversely, level of education was negatively associated with wheezing and dry cough. Conclusion: We found respiratory changes and identified the groups most vulnerable to developing them, which could contribute to directing actions to reduce the population's respiratory problems.

RESUMO: Objetivo: Identificar fatores associados a asma, doença pulmonar obstrutiva crônica (DPOC) e sintomas respiratórios em Brumadinho (MG), após rompimento de barragem. Métodos: Estudo transversal com amostra representativa de adultos. Verificaram-se associações entre variáveis dependentes (diagnóstico médico de asma e DPOC e os sintomas chiado no peito, tosse seca e irritação nasal) e variáveis exploratórias (sexo, faixa etária, tabagismo, ter trabalhado na Vale S.A. antes do rompimento da barragem, tempo e área de residência em relação ao rompimento da barragem). Modelos de regressão logística com cálculo da odds ratio e intervalo de confiança de 95% foram empregados. Resultados: Identificou-se prevalência de asma de 7,2%, de DPOC de 3,5%, de chiado no peito de 8,8%, de tosse seca de 23,6% e de irritação nasal de 31,8%. Maior chance de asma foi observada no sexo feminino e nos residentes em área diretamente atingida pela lama e área de mineração, enquanto maior chance de DPOC foi vista nos fumantes e naqueles com maior tempo de residência no município. Entre os sintomas, maior chance de irritação nasal foi observada no sexo feminino, e de chiado no peito e tosse seca em fumantes (atuais e no passado). Residentes em área atingida pela lama relataram maior chance de apresentarem todos os sintomas analisados. Já a escolaridade apresentou associação negativa com chiado no peito e tosse seca. Conclusão: O estudo mostrou alterações respiratórias e identificou os grupos com maior vulnerabilidade para desenvolvê-las, podendo contribuir com o direcionamento de ações para a redução de problemas respiratórios da população.

The Salivary Concentration of Chemical Elements in Response to Training Loads in Brazilian Jiu-Jitsu Athletes / Concentração Salivar de Elementos Químicos em Resposta a Cargas de Treinamento em Atletas de Brazilian Jiu-Jitsu

The saliva analysis by Total Reflection X-Ray Fluorescence (TXRF) for monitoring training loads could be useful due to the ease of sample analysis and a large range of chemical elements can be detected. Twelve BJJ athletes were submitted to 7 weeks of training scheduled with high training loads (weeks 1 to 4) and tapering (weeks 5 to 7). Saliva samples were collected before (Pre), at week 4, and at week 8 (Post), to quantify chemical element concentrations by TXRF. The internal training load was monitored using the session rating of perceived exertion of session (RPE) method for physical and technical tactical training sessions. All the saliva samples presented Phosphorus (P), Sulfur (S), Chlorine (Cl), Potassium (K), Calcium (Ca), Zinc (Zn), Bromine (Br), and Rubidium (Rb) at Pre, 4 weeks and Post time points. Salivary concentrations of Cl, K, Manganese (Mn), Copper (Cu), Br, and Rb significantly decreased in 4 weeks (p<0.05); and K, Cu, and Rb concentration remained at low levels at Post (p<0.05). Medium to large Cohen´s effect sizes for decrements in element concentrations from Pre to 4 weeks was observed for all the elements except Zn. Reduced S concentration at 4 weeks was negatively correlated to high training load period (r=-0.56, p=0.05). The results suggest that BJJ training modulates salivary electrolyte composition and salivary P, S and Rb are correlated with training loads in BJJ athletes. (AU)

A análise de saliva por meio de Fluorescência de Raios-X de Reflexão Total (TXRF) para monitorar cargas de treinamento pode ser útil devido à facilidade de análise da amostra e a ampla variedade de elementos químicos detectados. Doze atletas de BJJ foram submetidos a 7 semanas de treinamento programado com altas cargas de treinamento (semanas 1 a 4) e polimento (semanas 5 a 7). Amostras de saliva foram coletadas antes (Pré), na semana 4 (Meio) e na semana 8 (Pós), para quantificar as concentrações dos elementos químicos por TXRF. A carga interna de treinamento foi monitorada por meio do método de percepção subjetiva de esforço da sessão (PSE) nas sessões de treinamento físico e técnico-tático. Todas as amostras de saliva apresentaram Fósforo (P), Enxofre (S), Cloro (Cl), Potássio (K), Cálcio (Ca), Zinco (Zn), Bromo (Br) e Rubídio (Rb) no momento Pré, 4 semanas e Pós. As concentrações salivares de Cl, K, Manganês (Mn), Cobre (Cu), Br e Rb diminuíram significativamente em 4 semanas (p <0,05); e a concentração de K, Cu e Rb permaneceram em níveis baixos no Pós (p <0,05). Os tamanhos de efeito de Cohen médio a grande para decréscimos nas concentrações de elementos, de Pré a 4 semanas, foram observados para todos os elementos, exceto para Zn. A redução da concentração de S em 4 semanas foi negativamente correlacionada com o período de alta carga de treinamento (r = -0,56, p = 0,05). Os resultados sugerem que o treinamento de BJJ modula a composição eletrolítica salivar e o P, S e Rb salivares estão correlacionados com as cargas de treinamento no BJJ. (AU)

Coagulation profile of COVID-19 patients admitted to the ICU: An exploratory study.

BACKGROUND: Coagulation abnormalities in COVID-19 patients have not been addressed in depth. OBJECTIVE: To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. METHODS: Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. RESULTS: Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM-FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Also, D-dimer plasma levels were higher than normal reference range in both groups and free protein S plasma levels were low in both groups at baseline and increased over time, Finally, patients in group SOFA > 10 had lower plasminogen levels and Protein C ​​than patients with SOFA <10, which may represent less fibrinolysis activity during a state of hypercoagulability. CONCLUSION: COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was not only detected by ROTEM but it much more complex, where changes were observed on the fibrinolytic and endogenous anticoagulation system.

Empathy in Alzheimer's Disease: Review of Findings and Proposed Model.

Empathy is essential for social interaction and a crucial trait to understand the intentions and behaviors of others and to react accordingly. Alzheimer's disease (AD) affects both cognitive and emotional processes and can lead to social dysfunction. Empathy results from the interaction of four components: shared neural representation, self-awareness, mental flexibility, and emotion regulation. This review discusses the abilities and deficits of patients with AD from the perspective of subcomponents of empathy and integrates these facets into a model of human empathy. The aim was to investigate the components that are affected by AD and the ways in which patients are still able to empathize with others in their social environment. It concludes that AD patients show a pattern of relatively preserved affective aspects and impairments in cognitive components of empathy and points out specific areas with the need for further research.

Thromboelastometry-guided blood transfusion in septic shock complicated with disseminated intravascular coagulation: a case report.

Approximately 25-50% of septic patients develop disseminated intravascular coagulation. The thromboelastometry evaluates whole blood clot formation and dissolution in real time and has been considered for management of bleeding in diverse clinical conditions. We present a case of thromboelastometry-guided bleeding management of a septic shock patient with overt disseminated intravascular coagulation (DIC).

Scenario of research on Food Service in Brazil / Cenário da pesquisa em Alimentação Coletiva no Brasil

ABSTRACT Objective: The present study aims to investigate the scenario of research on Food Service in Brazil based on the Stricto Sensu Graduate Programs in Nutrition, research groups, and scientific production. Methods: A search of the research lines including studies related to this topic and the researchers engaged in those studies was conducted. The research groups were identified on the Directory of Research Groups in Brazil website and the profile of the scientific production was based on articles included in the Scientific Electronic Library Online database. Articles published in international journals that were related to research lines focused on food production were also searched and analyzed. Results: The search identified only two graduate programs with research lines that describe the food production as the object of study although 13 graduate programs carry out research related to Food Service, especially focused on nutritional and sanitary aspects of food. The same trend was observed in the national articles. The internationalization of these two research line results from the academic publication in 22 different journals over the past 5 years. Thirty five professors were identified and most of them hold a PhD in Food Science and Technology. The number of research groups increased from two in 2000 to twenty nine in 2010. Conclusion: The inclusion of Food Service in graduate programs is still limited. The main trend observed is towards a closer relationship with Food Science and Technology in terms of the lines of research, professional qualification, and published studies.

RESUMO Objetivo: Busca-se uma aproximação com o cenário da pesquisa em Alimentação Coletiva no Brasil a partir dos programas de pós-graduação Stricto Sensu pertencentes à área da Nutrição, dos grupos de pesquisa e da produção científica. Métodos: Foi realizado levantamento das linhas de pesquisa em que são desenvolvidos trabalhos de interesse, bem como de docentes vinculados a estas linhas. Para identificação dos grupos de pesquisa, empregou-se o site do Diretório de Grupos de Pesquisa no Brasil e o recorte da produção científica foi baseado nos artigos publicados no Scientific Eletronic Library Online. Também foi investigada a publicação internacional vinculada às linhas de pesquisa que se voltam à produção de refeições. Resultados: Apenas dois programas possuem linhas de pesquisa que descrevem a produção de refeições como objeto de estudo, embora 13 programas de pós-graduação desenvolvam estudos em interface com a Alimentação Coletiva voltados, principalmente, para aspectos nutricionais e sanitários dos alimentos. Essa tendência também foi observada nos artigos nacionais. A internacionalização nas duas linhas de pesquisa destacadas ocorreu por meio da publicação em 22 revistas diferentes nos últimos cinco anos. Entre os 35 docentes identificados, a maioria possui doutoramento na área de Ciência e Tecnologia de Alimentos. O número de grupos de pesquisa cresceu de dois, no ano 2000, para 29, em 2010. Conclusão: A inserção da Alimentação Coletiva na pós-graduação é limitada. A principal tendência é de aproximação com a Ciência e Tecnologia de Alimentos no que se refere às linhas de pesquisa, qualificação docente e trabalhos publicados.

Do traumático ao trauma: a lógica do presente permanente / From traumatic to trauma: the permanent present logic / De lo traumático al trauma: la lógica del presente permanente

A partir do atendimento psicanalítico de pacientes portadores de lesões cerebrais, foi possível formular a hipótese de que, em muitos casos, o quadro psicopatológico que se instala após a percepção e a experiência das sequelas de adoecimentos neurológicos pode ser localizado em algum ponto entre a neurose traumática e as patologias narcísico-identitárias. Para fundamentar e ilustrar o desenvolvimento teórico dessa hipótese, apresentaremos um caso clínico no qual a compulsão à repetição é convocada como mecanismo de defesa: a experiência subjetiva de adoecimento neurológico é vivida como um golpe traumático que divide a vida entre um antes e um depois. A consequência disso é que os recursos para a elaboração psíquica são roubados, criando ou intensificando zonas psíquicas não integradas. Desse modo, é instalada uma temporalidade baseada em um presente permanente, isto é, num tempo que não fica para trás e tampouco fornece uma abertura para o que está por vir

Based on the psychoanalytic treatment of patients with brain injury, it was possible to formulate the hypothesis that, in many cases, the psychopathological condition that sets in after the perception and experience of Sequelae from neurological illnesses can be centralized in a place between traumatic neurosis and the narcissistic-identity disorders. To support and illustrate the theoretical development of this hypothesis, we present a case in which the repetition compulsion is conveyed as a defense mechanism: the subjective experience of neurological illness is experienced as a traumatic blow that divides life between before and and after. The consequence of this is that resources for mental development are diverted, creating or intensifying non-integrated psychic areas. Therefore it is installed a temporality based on a permanent present, that is, in a time that does not fall behind nor provides a foot hold for what is to come

El tratamiento psicoanalítico de pacientes con lesiones cerebrales ha permitido formular la hipótesis de que, en muchos casos, la condición psicopatológica que se instala después de la percepción y la experiencia de las secuelas de daños neurológicos puede ser localizado en algún punto entre la neurosis traumática y las patologías de identidad narcisista. Para fundamentar e ilustrar el desarrollo teórico de esta hipótesis, se presenta un caso clínico en el cual la compulsión a la repetición fue convocada como un mecanismo de defensa: la experiencia subjetiva de la enfermedad neurológica se experimenta como un golpe traumático que divide la vida entre un antes y un después. La consecuencia de esto es que los recursos para la elaboración psíquica son robados, creando o intensificando zonas psíquicas no integradas. Por lo tanto, se instala una temporalidad en base a un presente permanente, es decir, un tiempo que no vuelve atrás ni ofrece una apertura para lo que está por venir

Food service in the scientific field of Food and Nutrition: Reflections about scientific conceptions and research / Alimentação coletiva no campo científico da Alimentação e Nutrição: reflexões sobre concepções científicas e pesquisa

ABSTRACT Supported by the categories of capital and scientific field of Bourdieu, this paper aims to situate, in the Food and Nutrition field, the core of knowledge and practices here called food service, and to provide evidence that the agents that operate in this core acknowledge that their quantum of scientific capital is insufficient to maintain distinct positions in the field. Realizing their lack of prestige in the scientific field, some of these agents seek to redirect their activities, traditionally focused on the labor market, aiming to participate in graduate programs, since that is where institutionally recognized scientific research occurs. The outline of an approaching movement with the world of research is recognized in this core. This discussion proposes a reflection on the image of science that anchors food service research and the challenges related to the current conditions for scientific practice in Brazil. This essay discusses the framing in the hegemonic research model, based on the natural sciences. We questioned the adoption of a single way of research, since food service has multifaceted aspects, which demands epistemological plurality.

RESUMO Apoiado nas categorias de campo e capital científico de Bourdieu, o presente trabalho busca situar o núcleo de saberes e práticas, aqui denominado alimentação coletiva, dentro do campo da Alimentação e Nutrição, bem como apresentar elementos que mostram que os agentes atuantes nesse núcleo reconhecem como insuficiente seu quantum de capital científico para manter posições mais distintas no campo. Percebendo-se desprivilegiados no campo científico, parte desses agentes busca redirecionar suas atividades, tradicionalmente voltadas para o mercado de trabalho, com o fito de participar de programas de pós-graduação, já que estes se configuram como local institucionalmente reconhecido da pesquisa científica. Esboça-se um movimento no sentido de aproximar mais esse núcleo do mundo da pesquisa. A partir dessa discussão, busca-se refletir sobre a imagem de ciência que ancora a pesquisa na alimentação coletiva e os desafios que se colocam ante as condições atualmente estabelecidas para a prática científica no Brasil. Problematiza-se, neste ensaio, o enquadramento no modelo hegemônico de pesquisa, calcado nas ciências da natureza. Questiona-se a adoção de uma única forma de pesquisar no âmbito da alimentação coletiva que, frente ao seu caráter multifacetado, demanda abordagens pluriepistêmicas.

Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say?

BACKGROUND: Primary appendectomy is the current standard of care for treating uncomplicated acute appendicitis, but interest in conservative treatment with antibiotics alone has been increasing in recent years. Clinical trials so far have shown controversial results. METHODS: A series of meta-analyses were reviewed. Studies comparing surgery versus antibiotics alone for treating uncomplicated acute appendicitis in adults were included. Descriptive statistics and data on treatment effects were retrieved and summarized. RESULTS: The conservative approach has a success rate of around 60 % and is associated with shorter pain duration, reduced analgesic medication, faster resolution of the inflammation process, lower expenses and quicker return to work. On the other hand, medical treatment leads to high (up to 20 %) readmission rates and more often requires surgery. An operative approach is associated with higher treatment success rates (>90 %) and very a low mortality rate. CONCLUSION: Based on the current body of evidence, the use of antibiotics for primary treatment of uncomplicated acute appendicitis cannot be routinely recommended. Appendectomy remains the gold-standard treatment.

A virtualidade para a cognição situada / Virtuality and embodied cognition

A separação entre Mente e Corpo, introduzida pelo dualismo cartesiano vem, gradativamente, sendo substituída por novos modelos de representação do organismo humano. A Teoria da Cognição Situada introduz paradigmas que rompem com a hegemonia do cérebro frente a outras partes do corpo e com a ideia de que os processos cognitivos ocorrem exclusivamente a partir de etapas mentais e internas. Ao apresentar a cognição como fruto do acoplamento entre organismo e ambiente, esta teoria muda o eixo de muitas questões atuais. A partir disso, são abordados temas contemporâneos, como a virtualidade e algumas produções científicas e cinematográficas recentes­ como os filmes Matrix e Avatar ­ com o intuito de aprofundar esta discussão e apresentar alguns questionamentos a essa concepção de cognição

The historical divorce beetween body and mind, introduced by Descartes's dualismo, is gradually being substituted by other models of the human organism. The theory of embodied cognition brings in paradigms that rearrange the hegemony of the brain over the body and discloses the ideia that cognition processes occur exclusively from inner and mental activities. By introducing cognition as the result of the connection between organism and enviroment, this theory changes the axle of many present issues. From that on, some contemporaneous subjects ­ like virtuality e some movies, as "Matrix" and "Avatar" - can be approached with the goal of deepen this discussion and can present some other issues linked to this conception of cognition

Leishamniose tegumentar americana: um desafio diagnóstico na prática pediátrica / Leishamniose american cutaneous: challenging diagnosis in pediatric practice

O objetivo deste artigo foi descrever as particularidades clínicas da leishmaniose tegumentar americana (LTA) e as dificuldades em realizar o diagnóstico dessa doença em Pediatria. Serão relatados três casos clínicos provenientes de serviço de referência no atendimento de doenças infecciosas para o estado de Minas Gerais, de janeiro a março de 2011, com as seguintes formas de manifestação da doença: lesão cutânea localizada e lesão cutânea disseminada. Um dos casos evidencia lesão cicatricial mutiladora. Os três casos relatados revelam a dificuldade do diagnóstico precoce de LTA. Em todos eles os pacientes foram examinados por vários pediatras e receberam tratamento empírico com antibioticoterapia, sem sucesso. Devido ao aumento da incidência da doença próximo dos grandes centros urbanos, é de suma importância que o pediatra se familiarize com os aspectos clínicos e epidemiológicos da leishmaniose para realizar um diagnóstico mais precoce, minimizando as sequelas para o paciente.

The purpose of this article is to describe the clinical characteristics of American Cutaneous Leishmaniasis ( ACL) and the difficulties in making a diagnosis of this disease in pediatrics. Three clinical cases from reference service in the care of infectious diseases in the state of Minas Gerais, January-March 2011, with the following manifestations of the disease are reported: localized cutaneous lesion and skin disseminada. An injury casesshows mutilating scar tissue. The three reported cases show the difficulty of early diagnosis of ATL. In all cases, the patients were examined for various pediatric and received empirical treatment with antibiotics without success. Due to the increased incidence of disease close to large urban centers is of paramount importance that pediatricians become familiar with the clinical and epidemiological aspects of leishmaniasis to make an earlier diagnosis minimizing the consequences for the patient.

Incidence of congenital toxoplasmosis among infants born to HIV-coinfected mothers: case series and literature review

Introduction: There is a paucity of data on the occurrence of congenital toxoplasmosis in children born to mothers dually infected with HIV and Toxoplasma gondii. Objective: To evaluate aspects of the mother–infant pairs associated with vertical transmission of toxoplasmosis in women co-infected with HIV in a referral center for perinatally acquired infections in Belo Horizonte, Brazil. Methods: Descriptive study of HIV vertically exposed children, with congenital toxoplasmosis, followed at a referral center (cohort/Belo Horizonte). Prenatal and post-natal variables for the mother–infant pairs were evaluated. A literature review with no filtering for time and language was performed to identify reports of congenital toxoplasmosis in HIV vertically exposed children. Results: Among 2007 HIV vertically exposed children evaluated in the period from 1998 to 2011, 10 cases of congenital toxoplasmosis were identified (incidence: 0.5%, 95% confidence interval: 0.24–0.91). In searching the literature 22 additional cases in 17 reports were found. Combining the findings of our cohort with other reported cases, 50% (16/32) of congenital toxoplasmosis in HIV vertically exposed children were from Brazil. The cases of congenital toxoplasmosis in HIV vertically exposed children identified in Brazil occurred mainly in the post-Highly Active Antiretroviral Therapy era (p = 0.002) and presented a lower death rate (p = 0.003) than those from other countries. In the cohort/Belo Horizonte, HIV infection was identified mainly during gestation; T. gondii vertical transmission was observed in pregnant women with CD4+>500 cells/mm3 and latent toxoplasmosis. High rates of ocular lesions (87.5%) and central nervous system involvement (70%) were detected. Conclusions: The risk of vertical transmission of T. gondii in HIV-infected women is low and has been usually associated with maternal immunosuppression and elevated viral load. However, ...