Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome.

Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postoperative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the frequency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome.

Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital.

Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role. Methods: Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%. Results: A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/psychology consultation. Conclusions: Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.

Low frequency of CD4+CD25+ Treg in SLE patients: a heritable trait associated with CTLA4 and TGFbeta gene variants.

BACKGROUND: CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. RESULTS: To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy controls (z = -6.161, P < 0.00001) and intermediate in the relatives' group. Remarkably, this T cell subset was also lower in females, most strikingly in the control population (z = 4.121, P < 0.001). We further ascertained that the decreased frequency of Treg in SLE patients resulted from the specific reduction of bona fide FOXP3+CD4+CD25+ Treg. Treg frequency was negatively correlated with SLE activity index (SLEDAI) and titers of serum anti-dsDNA antibodies. Both Treg frequency and disease activity were modulated by IVIg treatment in a documented SLE case. The segregation of Treg frequency within the SLE families was indicative of a genetic trait. Candidate gene analysis revealed that specific variants of CTLA4 and TGFbeta were associated with the decreased frequency of Treg in PBMC, while FOXP3 gene variants were associated with affection status, but not with Treg frequency. CONCLUSION: SLE patients have impaired Treg production or maintenance, a trait strongly associated with SLE disease activity and autoantibody titers, and possibly resulting from the inability to convert FOXP3+CD25- into FOXP3+CD25+ T cells. Treg frequency is highly heritable within SLE families, with specific variants of the CTLA4 and TGFbeta genes contributing to this trait, while FOXP3 contributes to SLE through mechanisms not involving a modulation of Treg frequency. These findings establish that the genetic components in SLE pathogenesis include genes related to Treg generation or maintenance.

Chiari Malformation Type I in a Patient with a Novel NKX2-1 Mutation.

Chiari Malformation Type 1 is a congenital, condition characterized by abnormally shaped cerebellar tonsils that are displaced below the level of the foramen magnum. NKX2-1 gene encodes a transcription factor expressed during early development of thyroid, lung, and forebrain, and germline NKX2-1 mutations can lead to dysfunction in any of these three organs, resulting in brain-lung-thyroid syndrome. There have been few reports of structural brain anomalies in patients with an NKX2-1-related disorder. We report the first case of a girl with a genetically identified mutation in NKX2-1 that presents with a Chiari Malformation Type 1, eventually expanding the phenotypic spectrum of NKX2-1-related disorders while also highlighting a novel heterozygous pathogenic variant at exon 3 that disrupts the reading framework, originating an NKX2-1 protein with a different C-terminal.

Movimentando-se em direção ao bem-estar físico e mental após o câncer de mama / Moving towards physical and mental well-being after breast cancer / Moviéndose hacia el bienestar físico y mental tras el cáncer de mama

O objetivo deste estudo foi compreender os efeitos do exercício físico na saúde mental de mulheres em recuperação do câncer de mama. A abordagem metodológica escolhida foi qualitativa. Participaram do estudo seis mulheres em recuperação do câncer de mama que realizavam exercício físico regulamente. As participantes compartilharam vivências e percepções sobre os efeitos do exercício físico a partir de uma entrevista estruturada. Os dados foram investigados à luz da análise temática. Os resultados apontaram que é desejável conciliar a obtenção de prazer e a função terapêutica do exercício físico. Este pode ser meio para regulação emocional e pode proporcionar trocas de experiências e de afetos. Este estudo ampliou o conhecimento nas áreas da psico-oncologia e da psicologia do esporte (AU).

The aim of this study was to understand the effects of physical exercise on the mental health of women recovering from breast cancer. The chosen methodological approach was qualita-tive. Six women recovering from breast cancer who performed re-gular physical exercise participated in the study. The participants shared experiences and perceptions about the effects of physical exercise based on a semi-structured interview. Data were investi-gated in the light of thematic analysis. The results point out that it is desirable to conciliate the obtaining of pleasure and the thera-peutic function of the physical exercise. This can be a means for emotional regulation and can provide exchanges of experiences and affections. This study expanded knowledge in the areas of psycho-oncology and sport psychology (AU).

El objetivo de este estudio fue comprender los efectos del ejercicio físico en la salud mental de mujeres en recuperación de cáncer de mama. El enfoque metodológico elegido fue cuali-tativo. Participaron del estudio seis mujeres en recuperación de cáncer de mama que realizaban ejercicio físico regular. Las partici-pantes compartieron experiencias y percepciones sobre los efec-tos del ejercicio físico a partir de una entrevista semiestructurada. Los datos fueron investigados a la luz del análisis temático. Los resultados apuntan que es deseable conciliar la obtención de pla-cer y la función terapéutica del ejercicio físico. Esto puede ser un medio de regulación emocional y puede propiciar intercambios de experiencias y afectos. Este estudio amplió conocimientos en las áreas de psicooncología y psicología del deporte (AU).

Movimentando-se em direção ao bem-estar físico e mental após o câncer de mama / Moving towards physical and mental well-being after breast cancer / Moviéndose hacia el bienestar físico y mental tras el cáncer de mama

O objetivo deste estudo foi compreender os efeitos do exercício físico na saúde mental de mulheres em recuperação do câncer de mama. A abordagem metodológica escolhida foi qualitativa. Participaram do estudo seis mulheres em recuperação do câncer de mama que realizavam exercício físico regulamente. As participantes compartilharam vivências e percepções sobre os efeitos do exercício físico a partir de uma entrevista semiestruturada. Os dados foram investigados à luz da análise temática. Os resultados apontaram que é desejável conciliar a obtenção de prazer e a função terapêutica do exercício físico. Este pode ser meio para regulação emocional e pode proporcionar trocas de experiências e de afetos. Este estudo ampliou o conhecimento nas áreas da psico-oncologia e da psicologia do esporte.

The aim of this study was to understand the effects of physical exercise on the mental health of women recovering from breast cancer. The chosen methodological approach was qualita-tive. Six women recovering from breast cancer who performed re-gular physical exercise participated in the study. The participants shared experiences and perceptions about the effects of physical exercise based on a semi-structured interview. Data were investi-gated in the light of thematic analysis. The results point out that it is desirable to conciliate the obtaining of pleasure and the thera-peutic function of the physical exercise. This can be a means for emotional regulation and can provide exchanges of experiences and affections. This study expanded knowledge in the areas of psycho-oncology and sport psychology.

El objetivo de este estudio fue comprender los efectos del ejercicio físico en la salud mental de mujeres en recuperación de cáncer de mama. El enfoque metodológico elegido fue cualitativo. Participaron del estudio seis mujeres en recuperación de cáncer de mama que realizaban ejercicio físico regular. Las participantes compartieron experiencias y percepciones sobre los efec-tos del ejercicio físico a partir de una entrevista semiestructurada. Los datos fueron investigados a la luz del análisis temático. Los resultados apuntan que es deseable conciliar la obtención de placer y la función terapéutica del ejercicio físico. Esto puede ser un medio de regulación emocional y puede propiciar intercambios de experiencias y afectos. Este estudio amplió conocimientos en las áreas de psicooncología y psicología del deporte.

Potencialidade do Lúdico como Promoção de Bem-Estar Psicológico de Pacientes em Hemodiálise / Ludic Activities to Improve Psychological Well-Being with Patients in Hemodialysis / Potencialidad del Lúdico para la Promoción del Bienestar Psicológico con Pacientes en Hemodiálisis

Resumo A insuficiência renal crônica é um problema da saúde pública e a hemodiálise é um tratamento invasivo e desgastante, do qual os pacientes relatam sentimentos de impotência e dependência. A pesquisa teve como objetivos propor atividades lúdicas e relaxamento durante sessões de hemodiálise e investigar opinião dos pacientes sobre o trabalho, bem como conhecer vivências e percepções quanto à doença e tratamento. Método Trata-se de uma pesquisa qualitativa realizada em um hospital geral da região da Baixada Santista – litoral sul de São Paulo – com grupos de pacientes durante as sessões de hemodiálise, na qual se realizaram atividades lúdicas, relaxamento e visualização, entrevista em profundidade e aplicação de escala Likert. As entrevistas foram categorizadas pelo método de análise de conteúdo do tipo temática. Resultados Foram realizados quatro grupos envolvendo um total de 13 participantes, com idades entre 20 e 70 anos, de ambos os sexos, com tempo de hemodiálise que variou de um mês a dois anos. Conclusão Relato dos participantes sobre as atividades propostas indicam que houve melhora relativa do humor e que elas contribuíram para melhor enfrentamento da situação de imobilidade e ociosidade durante as sessões de hemodiálise, além de permitirem a expressão de necessidades subjetivas singulares....(AU)

Abstract Chronic renal failure is a public health problem and hemodialysis is considered an invasive and exhausting long-term process. Patients usually report feelings of helplessness and dependence, and ludic activities might provide involvement, joy and pleasure. Objectives To propose ludic activities, to investigate patients’ opinions about these activities, and to understand patients’ experience regarding disease and treatment. Method This was a qualitative study conducted in a general hospital in the metropolitan area of Santos, Brazil, with groups of patients during hemodialysis sessions, where ludic activities, relaxation and visualization, in-depth interviews and application of a Likert scale were performed. The speeches were categorized by the method of content thematic analysis. Results We had four groups involving 13 participants, aged between 20 and 70 years, of both sexes. Conclusion The proposed activity is a positive factor for mood improvement and contributed to better cope with the situation of immobility and idleness, mobilizing objectively and subjectively, and in addition, allowing the expression of emotions in a constructive way, revealing patients’ unique needs and idiosyncrasies....(AU)

Resumen La enfermedad renal crónica es un problema de salud pública y la hemodiálisis es un tratamiento invasivo y agotador del que los pacientes reportan sentimientos de impotencia y dependencia. La investigación tuvo como objetivo ofrecer actividades lúdicas y de relajación durante las sesiones de hemodiálisis, investigar la opinión de los pacientes acerca de la propuesta de trabajo y conocer las experiencias y percepciones acerca de la enfermedad y el tratamiento. Método se realizó un estudio cualitativo en un hospital general en la región de Santos - costa sur de São Paulo - con grupos de pacientes durante las sesiones de hemodiálisis, en las que se realizaron actividades lúdicas, de relajación y de visualización, entrevistas en profundidad y la aplicación de la escala de Likert. Las entrevistas fueron categorizadas por el análisis de contenido temático. Resultados cuatro grupos con un total de 13 participantes, con edades comprendidas entre 20 y 70 años, de ambos sexos, con una duración de hemodiálisis que osciló entre un mes y dos años. Conclusión la opinión de los participantes sobre las actividades propuestas fue que produjeron una relativa mejora del estado de ánimo y ayudaron a enfrentar la situación de inmovilidad e inactividad durante las sesiones de hemodiálisis, permitiendo la expresión de necesidades individuales subjetivas....(AU)

Assessment of the diet quality of team sports athletes / Avaliação da qualidade da dieta de atletas de esportes coletivos

Abstract Few studies about food consumption of athletes have assessed the quality of their food choices, and the factors that influence these choices. The aim of this study was to assess the diet of team sports athletes through a revised version of the Healthy Eating Index (HEI-R) in order to identify their nutritional knowledge and the stage of intention to change eating behavior (SICEB) and to identify possible association with demographic and anthropometric variables. Seventy-two athletes (35 men) were evaluated for the following variables: body mass, height, Body Mass Index (BMI), body fat percentage (BF%), nutritional knowledge (questionnaire), food intake (24-hour recall), diet quality (HEI-R) and SICEB (transtheoretical model). For statistical analysis, the Student t test and the Pearson correlation coefficient were used. None of the athletes presented diet classified as "healthy" and 45.7% (men) and 51.4% (women) had "inadequate" diets. Low consumption of fruits, vegetables, whole grains, milk and dairy products was observed. The HEI-R "meats, legumes and eggs" component received the best scores. Pre-contemplation (25.0%) and action (23.6%) stages were the most frequent in the group. The mean percentage of correct answers in the nutritional knowledge questionnaire was 55.7% (men) and 57.3% (women). No association was found between HEI-R and variables age, BMI, BF%, SICEB, nutritional knowledge score and energy intake. This group presents inadequate dietary intake. The lack of association between study variables indicates the need to investigate other factors that influence athlete's feeding behavior.

Resumo Poucos estudos sobre o consumo alimentar de atletas avaliam a qualidade dos alimentos selecionados e os fatores que interferem nessas escolhas. Objetivou-se avaliar a dieta de atletas de esportes coletivos por meio do Índice de Qualidade da Dieta - Revisado (IQD-R), identificar seu conhecimento nutricional, estágio de intenção de mudança de comportamento alimentar (EIMCA) e identificar possíveis associações com variáveis demográficas e de antropometria. Foram avaliadas as seguintes variáveis em 72 atletas (35 homens): massa corporal (MC), estatura, IMC, percentual de gordura (%G), conhecimento nutricional (questionário), consumo alimentar (recordatório de 24-horas), qualidade da dieta (IQD-R) e EIMCA (modelo transteórico). Para a análise estatística empregou-se o teste t de Student e coeficiente de correlação de Pearson. Nenhum atleta apresentou dieta classificada como "saudável" e 45,7% (homens) e 51,4% (mulheres) apresentaram dieta "inadequada". Há baixo consumo de frutas, hortaliças, cereais integrais e leite e derivados. O componente do IQD-R "carnes, leguminosas e ovos" recebeu a melhor pontuação. Os estágios pré-contemplação (25,0%) e ação (23,6%) foram os mais frequentes. O percentual médio de acertos dos atletas no questionário de conhecimentos nutricionais foi 56,5%. Não foi observada associação entre IQD-R e as variáveis: idade, IMC, %G, EIMCA, escore de conhecimento nutricional e consumo energético. O grupo apresenta inadequação do consumo alimentar. A falta de associação entre as variáveis estudadas indica a necessidade de investigação de outros fatores que influenciam o comportamento alimentar de atletas.

Fantasias freudianas: aspectos centrais e possível aproximação com o conceito de esquemas de Aaron Beck / The Freudian fantasies: central aspects and possible approaches with concepts of Aaron Beck’s schemes / Fantasías freudianas: aspectos centrales y posible aproximación con el concepto de esquemas de Aaron Beck

Este artigo aborda pontos sobre o conceito de fantasia, de Sigmund Freud, e propõe um diálogo entre eles e o conceito de esquemas, proposto pela teoria da terapia cognitiva de Aaron Beck. Essa sugestão não indica ecletismo teórico ou prático, abordando esses conceitos considerando as diferenças dos seus pressupostos. De acordo com a teoria freudiana, as fantasias representam uma forma de leitura subjetiva, organizada a partir dos desejos e dos mecanismos de defesa, da realidade dos fatos. Trata-se do que Freud denomina realidade psíquica, a qual tem suas bases na infância e nas fantasias filogenéticas. A teoria de Beck não faz referências à noção de fantasia, contudo considera o papel das impressões e das interpretações subjetivas dos eventos, especialmente aqueles vividos na infância. Assim desenvolve a tese de que os esquemas organizam processos cognitivos, afetivos e comportamentais. O diálogo entre tais teorias tem sido corroborado por estudos das ciências cognitivas.

This article discusses points about the concept of fantasy of Sigmund Freud, and suggests a dialogue between them and the concept of schemes proposed by Aaron Beck’s cognitive therapy theory. This suggestion does not indicate any form of eclecticism, theoretical or practical, and discusses these concepts considering the differences in their assumptions. According to Freudian theory, the fantasy represents a form of subjective reading, organized from the wishes and defense mechanisms, of facts’ reality. This is what Freud called psychic reality, which has its basis in childhood and the phylogenetic fantasies. Beck’s theory does not make references to the notion of fantasy, however, and considers the role of subjective impressions and interpretations of events, especially those experienced in childhood. Thus, he develops the thesis that the schemes organize cognitive, affective and behavioral processes. The dialogue between these theories has been supported by studies in cognitive science.

Este artículo discute los puntos sobre el concepto de fantasía, de Sigmund Freud, y se propone a un diálogo entre ellos y el concepto de esquemas propuesto por la teoría de la terapia cognitiva de Aaron Beck. Esa sugerencia no significa eclecticismo teórico o práctico y aborda estos conceptos teniendo en cuenta las diferencias en sus suposiciones. Según la teoría freudiana, las fantasías representan una forma de lectura subjetiva, organizada a partir de los deseos y de los mecanismos de defensa, de la realidad de los hechos. Se trata de lo que Freud llamó de la realidad psíquica, la cual tiene sus bases en la infancia y en las fantasías filogenéticas. La teoría de Beck no hace referencia a la noción de fantasía, sin embargo, considera el papel de las impresiones y de las interpretaciones subjetivas de los acontecimientos, especialmente aquellos vividos en la infancia. Así se desarrolla la tesis de que los esquemas organizan procesos cognitivos, afectivos y comportamentales. El diálogo entre esas teorías ha sido apoyado por estudios de las ciencias cognitivas.

A pulsão de morte e a gênese da angústia / Death impulse and the genesis of anguish

Com base na tese sobre a angústia somática, a qual assume que o substrato da angústia é a tensão sexual excessiva e desligada, apresenta-se a hipótese de que a ação da pulsão de morte sobre a pulsão de vida produz uma forma primordial de angústia. Essa angústia ainda não se caracterizaria como sensação, mas como pura quantidade que, com o desenvolvimento do aparelho psíquico, seria utilizada pelo ego para defesa. Portanto, a prontidão angustiada (Angstbereitschaft), descrita em Além do princípio do prazer, teria como fundamento tal forma de angústia.

Based in the thesis about somatic anguish, which declares that the substratum of anguish are extreme sexual tension and extreme sexual off, this article presents the hypothesis that the action of death impulse around of life impulse produces a primordial form of anguish. This anguish is not yet characterized as sensation, but as pure amount that, with the development of the psychic apparatus, would be used by the ego for the defense. Therefore, the readiness for anguish (Angstbereitschaft), described in Beyond the principle of the pleasure, would have as bedding such form of anguish.

Transferência e complexo de édipo, na obra de Freud: notas sobre os destinos da transferência / Transference and oedipus complex, within Freud's theory: notes about the transference destiny

Este artigo comunica algumas considerações sobre o conceito de transferência, na teoria freudiana. Especial atenção é voltada para as relações entre transferência, complexo de Édipo e complexo de castração. Partindo dessas relações e da hipótese segundo a qual Freud não apresenta um final possível para o complexo de Édipo, o presente trabalho entende que esse autor não fornece uma teoria sobre o final da transferência. Esse pensamento evoca o impasse freudiano em relação aos términos das análises. Nesse ponto, é feita uma breve referência à teoria lacaniana sobre a castração e a transferência ao final de análise.

Reflexões sobre a violência e o homem contemporâneo / About violence and the contemporary human being

Esta resenha propõe uma reflexão sobre a violência subjacente a determinadas situações humanas. Para tanto, foi feita uma análise do homem ocidental contemporâneo e de suas formas de vida, baseada em idéias das teorias psicanalíticas de Freud e Lacan e nas perspectivas de Heidegger e Merleau-Ponty. Nosso raciocínio parte do pressuposto de que a civilização só é capaz de inibir a agressividade do homem mediante promessas que o favoreçam. Assim, perguntamo-nos: que promessas são feitas hoje? Essa questão orienta nossas hipóteses sobre o homem atual, entre elas, a de que hoje há uma reificação da condição humana

This report proposes a reflection about the underlying violence of certain situations faced by human beings. An analysis of the contemporary occidental human beings and their ways of life was made based on the freudian and lacanian psychoanalytic theory and on Heidegger´s and Merleau-Ponty´s perspectives. Our interpretation presupposes that the only way civilization may inhibit man’s aggressiveness is through promises that give support to the human beings. Thus, we ask ourselves: what promises are made today? This question guides our hypotheses about the human being, among them, the current objectivation of the human condition.

A função da angústia segundo Freud / The function of anguish according to Freud

Segundo Freud, a angustia possui importante função psicológica. Os primeiros escritos do autor, através do conceito de angústia somática considerem a angústia uma forma de descarga das excitações sexuais acumuladas. Essa tese atende ao princípio de constância e participa da primeira teoria freudiana sobre a angústia para a qual a angústia e resultado da transformação da libido. Tal postulado é revisado ate a formulação da segunda teoria de Freud sobre a angústia. Nela a angústia é definida como sinal dado pelo Eu de perigo. Nesse caso, a angústia passa a ser considerada a reação adaptativa fundamental para a sobrevivência do aparelho psiquico.

According to Freud anguish has an important psychophysiological function. The first author writings, through the concept of somatic anguish, consider anguish a kind of discharge of the accumulated sexual excitements. This thesis obeys the principle of constancy and takes part in Freud's first theory about anguish, in which anguish is the result of libido transformation. Such thought is reviewed until the formulation of Freud's second theory about anguish. In this theory, anguish is defined as a sign of danger given by the ego. In this case, anguish begin to be considered the fundamental adaptative reaction to the survival of psychic system.