Transtornos de ansiedade: histórico, aspectos clínicos e classificações atuais / Anxiety disorders: history, clinical features, and current classifications

Objetivos: contribuir para a compreensão do desenvolvimento histórico do conceito de ansiedade, das classificações dos transtornos ansiosos e suas manifestações clínicas, bem como para a atualização sobre o processo de avaliação diagnóstica. Métodos: todas as edições das classificações da Organização Mundial de Saúde (OMS) - CID e da Associação Psiquiátrica Americana (APA) - DSM foram examinadas, além de livros-texto de referência de psiquiatria clínica, de publicações sobre a história e a evolução desses diagnósticos e de publicações produzidas pelas equipes responsáveis pela revisão das classificações atuais. Resultados: entende-se por ansiedade um estado afetivo normal, como um sintoma ou um termo para nomear um grupo de transtornos mentais. Nas primeiras e subsequentes edições das classificações da OMS e da APA, entre 1948 e 1975, os quadros ansiosos faziam parte do grupo das psiconeurose/neuroses. A partir do DSM-III (1980), o grupo das neuroses foi fragmentado em diversos outros, entre os quais os transtornos de ansiedade, o que foi seguido pela CID-10 (1992), apesar de alguma distinção na composição dos subtipos. Para as últimas versões, houve um empenho de compatibilização entre as duas, contudo restaram diferenças: o DSM-5 (2013) adota critérios diagnósticos; a CID-11 (2019) utiliza descrições clínicas e diretrizes diagnósticas, além de abordagens dimensionais para alguns transtornos. Conclusão: ocorreram modificações nas classificações psiquiátricas atuais, no grupo dos transtornos de ansiedade, que precisam ser disseminadas e agregadas a estratégias de formação e qualificação profissionais, incrementando habilidades diagnósticas e permitindo uma comunicação mais uniforme e precisa na prática clínica.

Objectives: to contribute to the understanding of the historical development of the concept of anxiety, the classifications of anxiety disorders and their clinical manifestations, as well as to update on the diagnostic evaluation process. Methods: all editions of the classifications of the World Health Organization (WHO) - ICD and the American Psychiatric Association (APA) - DSM were examined, in addition to reference textbooks on clinical psychiatry, publications on the history and evolution of these diagnoses, and scientific articles produced by the teams responsible for reviewing the current classifications. Results: anxiety is understood as a normal affective state, as a symptom, or as a term to name a group of mental disorders. In the first and subsequent editions of the WHO and APA classifications, between 1948 and 1975, anxiety disorders were part of the psychoneuroses/neuroses group. As of DSM-III (1980) onwards, the neuroses group was fragmented into several others, including anxiety disorders, which was followed by ICD-10 (1992), despite some different choices of subtypes. For the latest versions, there was a compatibility effort between them. However, differences remained: DSM-5 (2013) adopts diagnostic criteria; ICD-11 (2019) uses clinical description and diagnostic guidelines, in addition to dimensional approaches for some disorders. Conclusion: modifications have occurred in current psychiatric classifications, in the group of anxiety disorders, which need to be disseminated and added to professional training and qualification strategies, increasing diagnostic skills and providing for more uniform and accurate communication in clinical practice.

Novel gold(I) complexes with 5-phenyl-1,3,4-oxadiazole-2-thione and phosphine as potential anticancer and antileishmanial agents.

The current anticancer and antileishmanial drug arsenal presents several limitations concerning their specificity, efficacy, costs and the emergence of drug-resistant cells lines, which encourages the urgent need to search for new alternatives. Inspired by the fact that gold(I)-based compounds are promising antitumoral and antileishmanial drug candidates, we synthesized novel gold(I) complexes containing phosphine and 5-phenyl-1,3,4-oxadiazole-2-thione and evaluated their anticancer and antileishmanial activities. Synthesis was performed by reacting 5-phenyl-1,3,4-oxadiazole-2-thione derivatives with chloro(triphenylphosphine)gold(I) and chloro(triethylphosphine)gold(I). The novel compounds were characterized by infrared, Raman, 1H, 13C nuclear magnetic resonance, high-resolution mass spectra, and x-ray crystallography. The coordination of the ligands to gold(I) occurred through the exocyclic sulfur atom. All gold(I) complexes were active at low micromolar or nanomolar range with IC50 values ranging from <0.10 to 1.66 µM against cancer cell lines and from 0.9 to 4.2 µM for Leishmania infantum intracellular amastigotes. Compound (6-A) was very selective against murine melanoma B16F10, colon cancer CT26.WT cell lines and L. infantum intracellular amastigotes. Compound (7-B) presented the highest anticancer activity against both cancer cell lines while the promising antileishmanial lead was compound (6-A). Tiethylphosphine gold(I) complexes were more active than the conterparts triphenylphosphine derivatives for both anticancer and antileishmanial activities. Triethylphosphine gold(I) derivatives presented antimony cross-resistance in L. guyanensis demonstrating their potential to be used as chemical tools to better understand mechanisms of drug resistance and action. These findings revealed the anticancer and antileishmanial potential of gold(I) oxadiazole phosphine derivatives.

Spontaneous dissection of the celiac trunk: report of three cases and review of the literature / Dissecção espontânea do tronco celíaco: relato de três casos e revisão de literatura

Spontaneous dissection of the celiac trunk is quite an uncommon medical condition, with few case reports in the medical literature. Sudden epigastric abdominal pain is the most common complaint reported by patients, but due to the rarity of this disease in clinical practice and the nonspecific nature of its symptoms, a high degree of clinical suspicion is needed to establish diagnosis. However, improvements in imaging techniques are facilitating diagnosis of this clinical entity, increasing its detection rate. The ideal treatment has not yet been fully established in the literature and the available therapeutic strategies are conservative medical treatment, surgical revascularization or endovascular intervention. In this article we report on three cases of spontaneous dissection of the celiac trunk and conduct a review of the literature on this disease...

A dissecção espontânea do tronco celíaco é uma condição médica incomum, com poucos relatos de casos publicados na literatura médica. A dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes; porém, devido à raridade dessa doença na prática clínica e à inespecificidade de seus sintomas, é necessário um alto grau de suspeição para o estabelecimento do seu diagnóstico. Nesse contexto, o aperfeiçoamento das técnicas de exames de imagem vem possibilitando o diagnóstico desta entidade clínica com maior facilidade, aumentando a sua taxa de detecção. O tratamento ideal ainda não está completamente bem estabelecido na literatura, sendo que as estratégias terapêuticas disponíveis são o tratamento médico conservador, a revascularização cirúrgica e a intervenção endovascular. Neste artigo, nós relatamos três casos de dissecção espontânea do tronco celíaco e realizamos uma revisão de literatura sobre esta doença...