Pregnancy After Bariatric Surgery-Experience from a Tertiary Center.

INTRODUCTION: It is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood. METHODS: Retrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders. RESULTS: Pregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147). Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069). CONCLUSION: Pregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies.

Predicting age from blood by droplet digital PCR using a set of three DNA methylation markers.

Evaluation of DNA methylation (DNAm) patterns is a promising tool for age estimation. The duplex droplet digital PCR (ddPCR) method has been recently investigated for DNAm evaluation, revealing to be a potential methodology for DNAm evaluation and molecular age estimation. In this study, we evaluated DNAm levels of CpGs located at the three age-associated genes ELOVL2, FHL2 and PDE4C using ddPCR to develop an age prediction model. Blood-derived DNA samples from 58 healthy individuals (42 women and 16 men; aged 1-93 years old) were submitted to bisulfite conversion followed by ddPCR using dual-labeled probes targeting methylated and unmethylated DNA sequences. Simple linear regression statistics revealed a strong correlation between DNAm levels and chronological age for FHL2 (R = 0.948; P = 1.472 × 10-29) and PDE4C (R = 0.819; P = 3.917 × 10-15), addressing only one CpG for each gene. For the ELOVL2 gene, evaluating five CpG sites in simultaneous, revealed a strong age correlation (R = 0.887; P = 2.099 × 10-20) in a simple linear regression statistics and very strong age correlation (R = 0.926; P = 2.202 × 10-25) when using quadratic regression statistics. The multivariable regression analysis, using methylation information captured on ELOVL2 (squared), FHL2 and PDE4C genes, revealed a very strong age correlation (R = 0.970; P = 5.356 ×10-33), explaining 93.7 % of age variance, displaying a mean absolute deviation (MAD) between chronological and predicted age of 4.657 years (RMSE = 6.044). We postulate that the ddPCR method should be further investigated for DNAm-based age prediction, because it is a relatively simple and an accurate method that can be routinely used in forensic laboratories for testing a few numbers of markers.

O trauma psíquico: retrato de caso clínico / Psychic trauma: clinical case portrait

O trauma não é um acontecimento em si, mas a forma como esse acontecimento interpela e é processado interna e externamente pelo sujeito em seu psiquismo. Para Ferenczi o traumatismo sexual infantil é da ordem do choque e da comoção psíquica, os seus impactos são diversos e afetam a vida dos sujeitos que por ele são atravessados. Nessa perspectiva, o retrato de caso clínico de Maria, uma mulher ribeirinha da região amazônica, possibilita pensar sobre as repercussões do abuso sexual infantil na vida adulta, bem como a forma como a clínica do traumático convoca o analista a um enquadre interno. O manejo clínico, segundo Winnicott, com o estabelecimento do setting e do holding possibilitam um ambiente suficientemente bom, para que o sujeito sinta-se seguro possibilitando a translaboração psíquica(AU)

Trauma is not an event itself, but the way in which this event challenges and is processed internally and externally by the subject in his psyche. For Ferenczi childhood sexual trauma comes from the order of shock and psychic commotion, the impacts of psychic trauma are diverse and affect the lives of the subjects crossed by it. In this article, the portrait of Maria's clinical case, an Amazonian riverside woman, makes it possible to think about the repercussions of child sexual abuse in adult life, as well as the traumatic clinic summons the analyst to an internal framework. Clinical management, according to Winnicott, the establishment of the setting and the holding provide a sufficiently good environment, thus the subject feels safe, enabling psychic translaboration(AU)

DNA methylation analysis of ELOVL2 gene using droplet digital PCR for age estimation purposes.

DNA methylation (DNAm) evaluation has been investigated in various tissues and body fluids allowing the identification of many CpG markers with high correlations with chronological age, potentially useful for forensic analysis. We developed a duplex droplet digital PCR (ddPCR) assay to address methylation levels of ELOVL2 gene CpG sites. DNA samples obtained from peripheral blood of 56 healthy individuals (35 women, 21 men; aged 1-94 years old) were submitted to bisulfite conversion, followed by ddPCR analysis for a selected region of ELOVL2 and the reference gene C-LESSC1. Simple linear regression revealed a strong correlation between DNAm simultaneous captured from five CpG sites of ELOVL2 gene and chronological age (R = 0.892; P = 2.84 × 10-20), explaining 79.2% of age variation. The obtained mean absolute deviation (MAD) between predicted and chronological ages was 10.07 years. Here we describe a ddPCR-based assay to assess DNAm in ELOVL2 gene as a biomarker for potential use in forensic age prediction.

A Blood-Bone-Tooth Model for Age Prediction in Forensic Contexts.

The development of age prediction models (APMs) focusing on DNA methylation (DNAm) levels has revolutionized the forensic age estimation field. Meanwhile, the predictive ability of multi-tissue models with similar high accuracy needs to be explored. This study aimed to build multi-tissue APMs combining blood, bones and tooth samples, herein named blood-bone-tooth-APM (BBT-APM), using two different methodologies. A total of 185 and 168 bisulfite-converted DNA samples previously addressed by Sanger sequencing and SNaPshot methodologies, respectively, were considered for this study. The relationship between DNAm and age was assessed using simple and multiple linear regression models. Through the Sanger sequencing methodology, we built a BBT-APM with seven CpGs in genes ELOVL2, EDARADD, PDE4C, FHL2 and C1orf132, allowing us to obtain a Mean Absolute Deviation (MAD) between chronological and predicted ages of 6.06 years, explaining 87.8% of the variation in age. Using the SNaPshot assay, we developed a BBT-APM with three CpGs at ELOVL2, KLF14 and C1orf132 genes with a MAD of 6.49 years, explaining 84.7% of the variation in age. Our results showed the usefulness of DNAm age in forensic contexts and brought new insights into the development of multi-tissue APMs applied to blood, bone and teeth.

Reflexões sobre o lugar da supervisão na psicanálise / Reflections on the place of supervision in psychoanalysis

Neste texto, reflito sobre a função da supervisão na clínica psicanalítica, considerada um dos pilares da formação e transmissão da psicanálise, que envolve estudo teórico, análise pessoal e prática supervisionada, assim estabelecido desde a primeira geração de psicanalistas. Fundamento minhas reflexões na concepção da supervisão como um lugar do terceiro, o analista-supervisor, que intervém nos impasses oriundos da clínica do analista supervisionado. Assim, a busca pela interlocução do tratamento clínico na prática supervisionada deve proporcionar ao analista do tratamento subsídios para melhor analisar suas identificações transferenciais e contratransferenciais, a fim de refinar sua escuta do caso. Por isso, a posição do supervisor não deve ser a de um controlador superegoico, mas receptivo às demandas do analista-supervisionado(AU)

In this text, I reflect on the role of supervision in the psychoanalytic clinic, considered as one of the pillars of the formation and transmission of psychoanalysis, which involves theoretical study, personal analysis and supervised practice, thus established since the first generation of psychoanalysts. I base my reflections on the conception of supervision as a place for the third party, the analyst-supervisor, who intervenes in the impasses arising from the supervised analyst's clinic. Thus, the search for the interlocution of clinical treatment in supervised practice should provide the treatment analyst with subsidies to better analyze their transferential and counter transferential identifications, in order to refine their listening to the case. Therefore, the supervisor's position should not be that of a superegoic controller, but rather one of receptivity to the supervised-analyst's demands(AU)

Targeted delivery in scleroderma fibrosis.

Systemic sclerosis (SSc) is considered one of the most challenging and difficult to treat among rheumatic disorders, due to its severity, multiorgan manifestation and different outcomes. It manifests fibrosis in different organs, mostly in skin and lungs. The skin fibrosis expression is considered the first sign of the disease and usually it is followed by internal organ fibrosis. An aberrant immune system activation seems to relate to the expression of the disease, but even environmental influences and dysregulation of many molecules signalling pathways are involved in the development of the disease. Current therapies are limited and characterized by multiple side effects: systemic route is the elective administration route, which decreases patient adherence to the therapy, as they are often already bothered by pain and disfigurement. Treatments available are organ-based, originally indicated for other conditions and there is no therapy available to reduce the fibroblast population size within existing fibrotic lesions. Disease-modifying therapies or immunomodulatory agents that are highly effective in other rheumatic diseases have shown disappointing results in SSc. There are thus no standardized and effective treatments for this disease, and there are even unanswered questions related to the insurgence of the pathology and all the mechanisms involved. An ideal approach could be considered "targeted therapy" that will be an increasingly attainable objective insofar as our understanding of the disease improves. The advantages in identifying the molecule and the signalling pathways involved in the pathology have helped to find some novel compounds for the therapy of scleroderma fibrosis or following innovative uses for already-approved drugs, corroborated by many clinical studies.

Age prediction in living: Forensic epigenetic age estimation based on blood samples.

DNA methylation analysis in a variety of genes has brought promising results in age estimation. The main aim of this study was to evaluate DNA methylation levels from four age-correlated genes, ELOVL2, FHL2, EDARADD and PDE4C, in blood samples of healthy Portuguese individuals. Fifty-three samples were analyzed through the bisulfite polymerase chain reaction (PCR) sequencing method for CpG dinucleotide methylation status. Linear regression models were used to analyze relationships between methylation levels and chronological age. The highest age-associated CpG in each locus was chosen to build a multi-locus age prediction model (APM), allowing to obtain a Mean Absolute Deviation (MAD) between chronological and predicted ages of 5.35 years, explaining 94.1% of age variation. Validation approaches demonstrated the accuracy and reproducibility of the proposed multi-locus APM. Testing the APM in 51 blood samples from deceased individuals a MAD of 9.72 years was obtained. Potential differences in methylation status between samples from living and deceased individuals could exist since the highest age-correlated CpGs were different in some genes between both groups. In conclusion, our study using the bisulfite PCR sequencing method is in accordance with the high age prediction accuracy of DNA methylation levels in four previously reported age-associated genes. DNA methylation pattern differences between blood samples from living and deceased individuals should be taken into account in forensic contexts.

DNA methylation age estimation in blood samples of living and deceased individuals using a multiplex SNaPshot assay.

Many studies in the forensic field have reported that analysis of DNA methylation is the most reliable method of predicting age. In a previous study, 5 CpG sites located in ELOVL2, FHL2, KLF14, C1orf132 and TRIM59 genes were tested for age prediction purposes in blood, saliva and buccal swab samples from Korean individuals using a multiplex methylation SNaPshot assay. The main goals of the present study were i) to replicate the same multiplex SNaPshot assay in blood samples from Portuguese individuals, ii) to compare DNA methylation status between two different populations and iii) to address putative differences in the methylation status between blood from living and deceased individuals. Blood samples from 59 living individuals (37 females, 22 males; aged 1-94 years-old) and from 62 deceased individuals (13 females, 49 males; aged 28-86 years-old) were evaluated. The specific primers were those previously described. Linear regression models were used to analyse relationships between methylation levels and chronological age using IBM SPSS software v.24. Our results allowed to build a final age prediction model (APM) for blood samples of living individuals with 3 CpG sites, at ELOVL2, FHL2 and C1orf132 genes, explaining 96.3% of age variation, with a mean absolute deviation (MAD) from chronological age of 4.25 years. Some differences were found in the extent of the age association in the targeted loci comparing Portuguese with Korean individuals. The final APM built for deceased individuals included 4 CpG sites, at ELOVL2, FHL2, C1orf132 and TRIM59 genes, explaining 79.3% of age variation, with a MAD of 5.36 years. Combining both sets of samples from living and deceased individuals, the most accurate APM with 4 CpGs, at ELOVL2, FHL2, C1orf132 and TRIM59 genes, explained 92.5% of variation in age, with a MAD of 4.97 years. In conclusion, our study replicated in blood samples of Portuguese living individuals a previous SNaPshot assay for age estimation. The possibility that age markers might be population specific and that postmortem changes can alter the methylation status among specific loci was suggested by our data. Our study showed the usefulness of the multiplex methylation SNaPshot assay for forensic analysis in blood samples of living and deceased individuals.

Age Estimation Based on DNA Methylation Using Blood Samples From Deceased Individuals.

Age estimation using DNA methylation levels has been widely investigated in recent years because of its potential application in forensic genetics. The main aim of this study was to develop an age predictor model (APM) for blood samples of deceased individuals based in five age-correlated genes. Fifty-one samples were analyzed through the bisulfite polymerase chain reaction (PCR) sequencing method for DNA methylation evaluation in genes ELOVL2, FHL2, EDARADD, PDE4C, and C1orf132. Linear regression was used to analyze relationships between methylation levels and age. The model using the highest age-correlated CpG from each locus revealed a correlation coefficient of 0.888, explaining 76.3% of age variation, with a mean absolute deviation from the chronological age (MAD) of 6.08 years. The model was validated in an independent test set of 19 samples producing a MAD of 8.84 years. The developed APM seems to be informative and could have potential application in forensic analysis.

Concepção de contratransferência em Pierre Fédida / The countertransference conception in Pierre Fédida

A problematização do fenômeno da contratransferência emerge no campo psicanalítico a partir da década de 1910 e promove um aprofundamento na especificação da técnica analítica a fim de evitar os 'desvios' à regra fundamental. Mas é a partir da década de 1940 que emerge uma vasta literatura que enfatiza os efeitos do processo contratransferencial no trabalho analítico, principalmente dos casos considerados difíceis à regra técnica freudiana. O objetivo deste trabalho é destacar a elaboração da contratransferência em Pierre Fédida(AU)

The countertransference phenomenon problematization emerges in the psychoanalytical field in the 1910s and promotes a deepen on the specification of the analytical technique in order to avoid 'deviations' to the fundamental rule. But it is from the 1940s that emerges a vast literature which emphasizes the countertransferential process effects in the analytical work, mainly for cases considered as difficult for Freudian technical rule. This paper's objective is to highlight Pierre 's Fédida elaboration about countertransference(AU)

Management of post-traumatic stress disorder: A protocol for a multiple treatment comparison meta-analysis of randomized controlled trials.

BACKGROUND: Most systematic reviews have explored the efficacy of treatments on symptoms associated with post-traumatic stress disorder (PTSD), which is a chronic and often disabling condition. Previous network meta-analysis (NMA) had limitations such as focusing on pharmacological or psychotherapies. Our review is aims to explore the relative effectiveness of both pharmacological and psychotherapies and we will establish the differential efficacy of interventions for PTSD in consideration of both symptom reduction and functional recovery. METHODS: We will conduct a network meta-analysis of randomized controlled trials evaluating treatment interventions for PTSD. We will systematically search Medline, PILOT, Embase, CINHAL, AMED, Psychinfo, Health Star, DARE and CENTRAL to identify trials that: (1) enroll adult patients with PTSD, and (2) randomize them to alternative interventions or an intervention and a placebo/sham arm. Independent reviewers will screen trials for eligibility, assess risk of bias using a modified Cochrane instrument, and extract data. Our outcomes of interest include PTSD symptom reduction, quality of life, functional recovery, social and occupational impairment, return to work and all-cause drop outs. RESULTS: We will conduct frequentist random-effects network meta-analysis to assess relative effects of competing interventions. We will use a priori hypotheses to explore heterogeneity between studies, and assess the certainty of evidence using the GRADE approach. CONCLUSION: This network meta-analysis will determine the comparative effectiveness of therapeutic options for PTSD on both symptom reduction and functional recovery. Our results will be helpful to clinicians and patients with PTSD, by providing a high-quality evidence synthesis to guide shared-care decision making.

Violência e terror nas redes sociais: considerações sobre cultura, desamparo e narcisismo / Violence and terror in social networks: considerations on culture, helplessness and narcisism

Este artigo traz reflexões sobre a violência, o terror e o terrorismo nas redes sociais. Vivemos numa dimensão em que realidade e virtualidade se confundem, dormimos e acordamos plugados numa atmosfera de contato imediato. O fascínio pelo encontro a qualquer minuto nos coloca frente à onipotência de pensamento, como Freud (1905) já anunciava. É certo que a sociedade virtual reflete o que a sociedade real representa. Quando o terror e o terrorismo assolam o mundo, vemos o mesmo acontecer nas redes sociais: o real e o virtual se espelham. A história do Eu repete a história da espécie, e todo organismo vivo traz em seu bojo a sua própria destruição. O terrorismo se caracteriza pelo modo de coagir, ameaçar ou influenciar outras pessoas, mais precisamente pela imposição do uso sistemático do terror. O efeito disso é o surgimento de um estado de medo nas pessoas e na população afetada. Muitas vezes, observa-se uma perda parcial do teste de realidade. O encontro com o outro nos remete à diferença, à castração, logo à agressividade, pois não há satisfação substitutiva que repare nosso narcisismo abandonado. Todo contexto social – independentemente do modo de produção – pode criar situações que levam a uma ruptura do laço social produzindo violência. Seja no mundo real, seja no mundo virtual, não escapamos do sofrimento psíquico, que nos confronta com a castração e com o desamparo.(AU)

This article reflects on violence, terror and terrorism in social networks. We live in a dimension in which reality and virtuality are confused, we sleep and wake up plugged in an atmosphere of immediate contact. The fascination with encounter at any minute puts us before the omnipotence of thought, as Freud (1905) already announced. It is certain that the virtual society reflects what the real society represents. When terror and terrorism plague the world, we see the same thing happen in social networks, the real and the virtual mirror. The story of the Self repeats the history of the species, and every living organism brings its own destruction to its bosom. Terrorism is characterized by the way it coerces, threatens or influences other people, more precisely by imposing the systematic use of terror. The effect of this is the emergence of a state of fear in the affected people and population. Often, a partial loss of reality test is observed. The encounter with the other reminds us of the difference between castration and aggressiveness, since there is no substitutive satisfaction that repairs our abandoned narcissism. Any social context – independent of the mode of production – can create situations that lead to a rupture of the social bond producing violence. Whether in the real or virtual world, we do not escape the psychic suffering that confronts us with castration and helplessness.(AU)

Situação de crise psíquica e desejo de saber / The psychic crisis situation and the wish do know / Situation de crise psychique et désir de savoir / Situación de crisis psíquica y deseo de saber / Psychische Krisensituation und der Wunsch, sich selbst zu verstehen / 心理危机状态和认识自我的欲望。

Este artigo, resultado de uma pesquisa de pós-doutorado, aborda a noção de crise psíquica em Pierre Fédida. Articula-se ao caso de uma paciente com HIV-AIDS, hospitalizada, cujos efeitos contratransferenciais da psicoterapia fazem pensar nos processos críticos da situação de crise psíquica e no desejo de “saber de si”. A escuta analítica possibilitou o saber de si. Considera-se que a noção de crise psíquica contribui com a investigação sobre a psicoterapia psicanalítica no hospital.

This paper is the result of a post-doctoral research. It debates the notion of psychic crisis according to Pierre Fédida. The authors discuss the case of a hospitalized HIV/AIDS patient, in which the countertransference effects of psychotherapy suggest the critical processes of the psychic crisis situation and the desire to “know about oneself”. The analytical process enabled the patient to do so. The paper considers that the notion of psychic crisis contributes to research concerning psychoanalytic psychotherapy in the hospital.

Cet article, résultat d'une recherche postdoctorale, aborde la notion de crise psychique selon Pierre Fédida. Il s'agit du cas d'une patiente atteinte du VIH/SIDA, hospitalisée, dont les effets contre-transférentiels de la psychothérapie font penser aux processus critiques de la situation de crise psychique et au désir de «savoir de soi¼. L'écoute analytique a permis le savoir de soi. On considère que la notion de crise psychique contribue à la recherche sur la psychothérapie psychanalytique à l'hôpital.

Este artículo, resultado de una investigación post-doctoral, aborda la noción de la crisis psíquica según Pierre Fédida. Se relaciona al caso de una paciente con VIH-SIDA, hospitalizada, en la que los efectos contratransferenciales de la psicoterapia sugieren procesos críticos de la situación de crisis psíquica y el deseo de “saber de sí misma”. El proceso de escucha analítica le permitió saber de sí misma. Se considera que la noción de crisis psíquica contribuye a la investigación sobre la psicoterapia psicoanalítica en el hospital.

Dieser Beitrag ist das Ergebnis eines Postdoc Forschungsprojektes, der Pierre Fédidas Begriff der psychischen Krise erörtert, am Beispiel einer mit HIV-Aids infizierten Patientin, die in einem Krankenhaus interniert ist. Die gegenübertragenden Wirkungen der Psychotherapie führten zur Reflexion über die kritischen Prozesse der psychischen Krisensituation und des Wunsches, sich selbst zu verstehen. Das analytische Zuhören ermöglichte es der Patientin, sich selbst zu verstehen. Wir kamen zum Schluss, dass die Definition der psychischen Krise zur Untersuchung der psychoanalytischen Psychotherapie im Krankenhaus beiträgt.

本论文是作者的博士后研究课题的部分结果。目的是探讨法国心理分析学家皮埃尔•费迪达(Pierre Fédida)有关心理危机的概念。作者考察了一个特殊病例。病人感染了艾滋病毒HIV-AIDS，住院治疗。在心理分析疗程中，在反移情作用(contratransferências)下，心理分析师见证了一整个心理危机的过程和病人“认识自己”的欲望。分析师通过聆听病人的叙述，使得病人实现了解自我的欲望。作者认为，研究心理危机的概念有助于心理分析疗法在医院的临床应用。.

Association of polymorphisms in 5-HTT (SLC6A4) and MAOA genes with measures of obesity in young adults of Portuguese origin.

OBJECTIVES: To investigate the association of polymorphisms in SLC6A4 and MAOA genes with overweight (including obesity). MATERIAL AND METHODS: Young adults (n = 535) of Portuguese origin were genotyped for the SLC6A4 polymorphisms 5-HTTLPR and STin2 and a MAOA VNTR. BMI and body fat percentage were measured and a questionnaire was used to assess individual's sport practicing habits. RESULTS: In whole study sample, haplotype-based analysis revealed significant association with overweight/obesity for the individual 5-HTTLPR/Stin2 haplotype L10 (p = 0.04). In men, the MAOA 3R genotype was nominally associated with body fat (p = 0.04). In inactive individuals, overweight/obesity was found significantly associated with 5-HTTLPR L-allele (p = 0.01) and nominally associated with STin2 10-allele (p = 0.03). A significant association was also found testing for all haplotype effects (χ(2 )= 8.7; p = 0.03). CONCLUSIONS: We found some evidences for the association of SLC6A4 and MAOA genes with measures of obesity. Our results suggest physical inactivity accentuates the influence of SLC6A4 polymorphisms on obesity risk.

Alterações bioquímicas e toxicológicas de agricultores familiares da região do Alto Jacuí, Rio Grande do Sul / Biochemical and toxicological changes among family farmers from the Alto Jacui region, Rio Grande do Sul state, Brazil

Objetivos: Avaliar possíveis alterações de marcadores bioquímicos e toxicológicos oriundas da exposição aos agroquímicos em trabalhadores rurais da região do Conselho Regional de Desenvolvimento Alto Jacuí, no Rio Grande do Sul. Métodos: Foram incluídos agricultores que tinham contato com pesticidas há mais de cinco anos e um grupo de indivíduos saudáveis, não expostos a agrotóxicos, recrutados na comunidade. Os agricultores foram submetidos a provas de função hepática e renal e atividade da enzima butirilcolinesterase. Foram ainda determinados os níveis de substâncias reativas ao ácido tiobarbitúrico (TBARS), proteínas carboniladas (PCs) e glutationa reduzida (GSH), sendo os resultados destes parâmetros de estresse oxidativo comparados entre o grupo de agricultores expostos aos agrotóxicos e o grupo controle. Resultados: Participaram do estudo 106 agricultores com exposição a pesticidas e 103 indivíduos saudáveis, sem contato com agrotóxicos. Os valores obtidos para os parâmetros hepáticos e renais avaliados encontravam-se normais, enquanto a atividade da butirilcolinesterase estava diminuída. Os níveis plasmáticos dos parâmetros de estresse oxidativo dos agricultores estavam aumentados em relação ao grupo controle: TBARS 9,51 vs. 6,719 nmol MDA/mL (p=0,0422); PCs 11,78 vs. 9,23 nmol carbonil/mg proteína (p=0,0337); GSH 0,7180 vs. 0,3649 µmol GSH/mL (p<0,0001). Verificou-se que 51,62% dos agricultores utilizavam equipamentos de proteção individual, 8,06 % faziam uso eventual e 40,32 % não faziam uso de nenhum tipo de proteção. Conclusões: Os trabalhadores rurais avaliados apresentaram alterações que indicam estresse oxidativo, evidenciando a importância do monitoramento das condições de saúde dos mesmos, bem como do incentivo à utilização de equipamentos de proteção individual.

Aims: To evaluate possible changes in biochemical and toxicological markers in rural workers exposed to pesticides in the Alto Jacui region, Rio Grande do Sul, Brazil. Methods: The study included 106 farmworkers exposed to pesticides for over five years and 103 healthy individuals, not exposed to pesticides, selected from the community. The farmworkers were submitted to liver and kidney function tests and to butyrylcholinesterase measurements. The levels of thiobarbituric acid reactive substances (TBARS), protein carbonyls (PCs), and reduced glutathione (GSH) were also determined, and the results of these oxidative stress parameters were compared with the group of pesticide-exposed farmworkers and the control group. Results: The evaluated hepatic and renal parameters were within the reference values whereas butyrylcholinesterase activity was found to be low. The plasma levels of oxidative stress parameters in exposed farmworkers were higher than in the control group: TBARS 9.51 vs. 6.179 nmol MDA/mL (p=0.0422); PCs 11.78 vs. 9.23 nmol carbonyl/mg protein (p.0.0337); GSH 0.7180 vs. 0.3649 µmol GSH/mL (p<0.0001). Personal protective equipment was worn by 51.62% of the farmworkers, but 8.06% wore it occasionally, and 40.32% did not wear any protective clothing or gear. Conclusions: Rural workers presented changes that indicate oxidative stress, thus highlighting the importance of monitoring their health conditions, as well as encouraging the use of personal protective equipment.

Contratransferência e enquadre psicanalítico em Pierre Fédida / Countertransference and the psychoanalytic setting in Pierre Fédida

Objetivamos sublinhar o fecundo e complexo pensamento de Fédida sobre a técnica psicanalítica, tratando da articulação das noções de contratransferência e de enquadre no dispositivo clínico psicanalítico. Sua concepção de contratransferência tem como modelo implícito a relação fictícia mãe-bebê, na qual a mãe é uma receptora capaz de ressonância com o estado psíquico da criança para ativação da linguagem e consequente alívio de seu sofrimento. Ele identifica na contratransferência uma função que regula a "experiência intersubjetiva" analista-paciente e tem a função de para-excitação, que se rege em nível pré-consciente capaz de nomeação. Isso é o que sustenta o enquadre analítico como espaço de potência, que engendra a situação analítica. Destacamos o estilo evocativo da escrita de Fédida, que mobiliza o pensar e o insigth, próprio da metapsicologia freudiana. Desse modo, suas elaborações contribuem, significativamente, para maior compreensão da psicoterapia psicanalítica.(AU)

The objective here is to discuss Pierre Fedida’s broad and complex thinking regarding psychoanalytic technique through an articulation of the notions of countertransference and setting in the psychoanalytic clinic. The model implicit in Fedida’s conception of countertransference is the fictitious mother-baby relationship, where the mother is a receiver able to be in resonance with the child’s psychic state. As a result, she can activate the baby’s language and consequently alleviate its suffering. Fedida sees in the countertransference a function that regulates the "intersubjective experience" between analyst and patient and has a function of para-excitation, governed at a pre-conscious level of naming. This is what sustains the analytic setting as a space of potency that engenders an analytic situation. We also call attention to the evocative style of Fedida’s writing, as it mobilizes thinking and insight proper to Freudian metapsychology. In short, his work has contributed significantly to a broader understanding of psychoanalytic psychotherapy.(AU)

Contratransferência e enquadre psicanalítico em Pierre Fédida / Countertransference and the psychoanalytic setting in Pierre Fédida

Objetivamos sublinhar o fecundo e complexo pensamento de Fédida sobre a técnica psicanalítica, tratando da articulação das noções de contratransferência e de enquadre no dispositivo clínico psicanalítico. Sua concepção de contratransferência tem como modelo implícito a relação fictícia mãe-bebê, na qual a mãe é uma receptora capaz de ressonância com o estado psíquico da criança para ativação da linguagem e consequente alívio de seu sofrimento. Ele identifica na contratransferência uma função que regula a "experiência intersubjetiva" analista-paciente e tem a função de para-excitação, que se rege em nível pré-consciente capaz de nomeação. Isso é o que sustenta o enquadre analítico como espaço de potência, que engendra a situação analítica. Destacamos o estilo evocativo da escrita de Fédida, que mobiliza o pensar e o insigth, próprio da metapsicologia freudiana. Desse modo, suas elaborações contribuem, significativamente, para maior compreensão da psicoterapia psicanalítica.

The objective here is to discuss Pierre Fedida’s broad and complex thinking regarding psychoanalytic technique through an articulation of the notions of countertransference and setting in the psychoanalytic clinic. The model implicit in Fedida’s conception of countertransference is the fictitious mother-baby relationship, where the mother is a receiver able to be in resonance with the child’s psychic state. As a result, she can activate the baby’s language and consequently alleviate its suffering. Fedida sees in the countertransference a function that regulates the "intersubjective experience" between analyst and patient and has a function of para-excitation, governed at a pre-conscious level of naming. This is what sustains the analytic setting as a space of potency that engenders an analytic situation. We also call attention to the evocative style of Fedida’s writing, as it mobilizes thinking and insight proper to Freudian metapsychology. In short, his work has contributed significantly to a broader understanding of psychoanalytic psychotherapy.

[Penetrating keratoplasty indications in "Hospital das Clínicas-UNICAMP"]. / Indicações para ceratoplastia penetrante no Hospital das Clínicas-UNICAMP.

PURPOSE: To determine the main causes of penetrating keratoplasty indications at "Hospital das Clínicas-UNICAMP" (January, 1999 to December, 2003). METHODS: A non-comparative, retrospective series of case studies. The authors reviewed the files of 857 patients who underwent penetrating keratoplasty at "Hospital das Clínicas-UNICAMP" between 1999-2003 and classified them into different categories according to diagnostic indication for surgery. RESULTS: The age range was between 0-88 years (average 44 years +/-1.2). The main causes of penetrating keratoplasty were: keratoconus in 427 cases (49.82%); 152 cases (17.74%) of corneal ulceration (perforated or not); corneal graft failure in 87 cases (10.15%); bullous keratopathy, 72 cases (8.40%); Fuchs dystrophy in 59 cases (6.88%); trachoma complications in 28 cases (3.27%); other causes, 32 (3.74%). In children under 10 years of age, the main cause of penetrating keratoplasty indications was infectious ulcer (77.78%) and between 11-50 years of age, keratoconus was the main cause (71.65%). CONCLUSION: This study was composed of a young population, and the main causes of penetrating keratoplasty were keratoconus and therapeutic keratoplasty.

Indicações para ceratoplastia penetrante no Hospital das Clínicas-UNICAMP / Penetrating keratoplasty indications in \"Hospital das Clínicas-UNICAMP\"

OBJETIVO: Determinar as principais causas de indicação de transplante penetrante no Hospital das Clínicas-UNICAMP no período de janeiro de 1999 a dezembro de 2003. MÉTODOS: Estudo de série de casos, retrospectivo, não comparativo. Os autores revisaram os prontuários de 857 pacientes submetidos à ceratoplastia penetrante no Hospital das Clínicas-UNICAMP entre 1999-2003 e os classificaram em categorias diagnósticas de indicação para cirurgia. RESULTADOS: Dentre os 857 prontuários revisados a idade variou de 0-88 anos (média 44 anos±1,2). Dentre as principais causas de indicação de transplante de córnea encontramos: ceratocone em 427 casos (49,82 por cento); úlcera de córnea infecciosa perfurada ou não, 152 casos (17,74 por cento); falência de transplante prévio, 87 casos (10,15 por cento); ceratopatia bolhosa, 72 casos (8,40 por cento); distrofia de Fuchs, 59 casos (6,88 por cento); seqüela de tracoma, 28 casos (3,27 por cento); outras causas, 32 casos (3,74 por cento). Entre as crianças até 10 anos a principal causa de indicação de transplante foram as úlceras infecciosas (77,78 por cento) e entre 11-50 anos o ceratocone foi a principal causa (71,65 por cento). CONCLUSÕES: Este estudo foi composto por uma população jovem e as principais causas de indicação de transplante foram o ceratocone e os transplantes tectônicos.

PURPOSE: To determine the main causes of penetrating keratoplasty indications at "Hospital das Clínicas-UNICAMP" (January, 1999 to December, 2003). METHODS: A non-comparative, retrospective series of case studies. The authors reviewed the files of 857 patients who underwent penetrating keratoplasty at "Hospital das Clínicas-UNICAMP" between 1999-2003 and classified them into different categories according to diagnostic indication for surgery. RESULTS: The age range was between 0-88 years (average 44 years ±1.2). The main causes of penetrating keratoplasty were: keratoconus in 427 cases (49.82 percent); 152 cases (17.74 percent) of corneal ulceration (perforated or not); corneal graft failure in 87 cases (10.15 percent); bullous keratopathy, 72 cases (8.40 percent); Fuchs dystrophy in 59 cases (6.88 percent); trachoma complications in 28 cases (3.27 percent); other causes, 32 (3.74 percent). In children under 10 years of age, the main cause of penetrating keratoplasty indications was infectious ulcer (77.78 percent) and between 11-50 years of age, keratoconus was the main cause (71.65 percent). CONCLUSION: This study was composed of a young population, and the main causes of penetrating keratoplasty were keratoconus and therapeutic keratoplasty.