A relativa legitimidade da depressão na atualidade: contribuições para uma ética psicanalítica do sujeito

This article is based on the author's clinical practice in the area of public health, and discusses depression as it is known today. Essentially, the author questions the practice of labeling depression as a psychopathological condition. The author also questions today’s trend of seeing a subject’s suffering as a "malaise," or a “disorder.” The possibility is brought up of understanding it as a "demand for analysis." Finally, the article is meant as a contribution to the ethics of psychoanalysis focused on the subject and the possibilities of psychoanalysis in subjectivating this "malaise."

Evidências à intervenção de enfermagem controle de infecção da classificação das intervenções de enfermagem: orientação e ensino sobre a lavagem das mãos

Pós-graduação em Enfermagem - FMB

Princípios de redução das fraturas panfaciais: revisão de literatura

Are called panfacial fractures when the upper, middle and lower facial thirds present fractures concurrently. In clinical practice, came to imply the involvement of two facial thirds. Panfacial fractures are usually accompanied by other systemic lesions that impair the patient's life and therefore require primary treatment. Almost invariably are associated with damage to soft tissues and severe losses of bone structures which may lead to severe facial deformations and malocclusions. The panfacial fractures treatment is complex because often there isn’t a stable bone structure to guide the reduction of various fractures. Several orders of treatment have been proposed, but they are variations of the two classical approaches "bottom to top and inside-out" and "top to bottom and out-inside". The aim of this paper is to discuss the principles of management and panfacial fractures treatment, emphasizing the sequence of fracture reduction and highlighting its indications, advantages and disadvantages, through literature review and reports of surgical clinic cases. We conclude that the exact sequence of fracture reduction is not as important as developing a treatment plan that allows accurate positioning of the fractured segments.

Controle da placa bacteriana dentária e suas formas de registro

Dental plaque is the principal etiological agent of periodontal disease, one of oral diseases more prevalent in the world. Due existence of relation between periodontal disease and oral hygiene, on the point of periodontal view, it was developed a growing interesting by experimental research and by clinical investigations. The knowledge of problem, its extension, severity, hypothetic cause is so valuable to establish prevention, control and treatment acts. In this form, the use of plaque index becomes more and more often, being valuable the determination of discriminatory power of them. The aim of this work was to describe and analyze principal forms to register of dental plaque aiming to subsidize the researcher and dental surgeon on adoption of most adequate method for their case. Data bases: Medline, Lilacs and BBO were consulted without limit to identify the format of register of each index described on literature. It was observed the use of Oral Hygiene Index on diverse ways like: clinical evaluation of dental plaque, in products evaluation works and dental Office; patients monitoring; instruction about hygiene and oral hygiene technique. It was noted that dental plaque indexes are useful and allows the register of different forms point out the importance of its use on clinical and researches practice.

Odontologia baseada em evidência: etapas e métodos de uma revisão sistemática

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise integrada entre dados de expressão global de transcritos codificadores e de miRNAs em carcinomas de células escamosas de laringe

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

MicroRNoma do carcinoma de pâncreas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A efetividade de grupos de pais para o tratamento de problemas internalizantes e o papel do comportamento do supervisor na formação de terapeutas analítico-comportamentais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Células-tronco na neurorrafia látero-terminal: estudo experimental em ratos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação do efeito do pré e pós-condicionamento em modelo de isquemia renal transitória: estudo comparativo experimental em ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Dor femoropatelar: uma contribuição considerando aspectos da dor e sua influência em parâmetros eletromiográficos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Construção e Evidências Psicométricas de uma Escala de Avaliação da Percepção Visual

Este estudo teve como objetivo construir e conhecer os parâmetros psicométricos de um instrumento para análise da percepção visual de adultos. Para a construção da escala participaram 295 adultos saudáveis, sem déficits cognitivos ou perceptivo-visuais. Nesta etapa foi formulada uma escala tetrafatorial constituída por 20 itens que avaliam quatro dimensões referentes à percepção visual: constância da forma, figurafundo, posição e relação espacial. Para obter evidências de validade foi utilizada uma amostra de 183 voluntários com boa saúde física e mental e acuidade visual normal ou corrigida. Os dados obtidos relatam a existência de concordância interjuízes, adequação semântica e significância no teste-reteste do instrumento. Os coeficientes de fidedignidade variaram de 0,84 a 0,93. Os quatro fatores esperados foram encontrados, cada um contendo 5 itens, e juntos explicaram 57,52% da variância do constructo. O instrumento apresentou parâmetros psicométricos adequados, o que pode justificar sua utilidade em pesquisas básicas e na prática clínica.

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

Summary of the II Brazilian Guideline Update on Acute Heart Failure 2009/2011

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

Práticas baseadas em evidências publicadas no Brasil: identificação e reflexão na área da prevenção em saúde humana

Revisão integrativa de estudos brasileiros sobre práticas baseadas em evidências (PBE) acerca da prevenção em saúde humana, publicados em periódicos Web of Science/JCR, de outubro de 2010 a abril de 2011. O objetivo foi identificar as especialidades que mais realizaram estes estudos, seus enfoques e abordagens metodológicas. A partir de critérios de inclusão, foram selecionados 84 trabalhos publicados majoritariamente em periódicos de saúde pública, focalizando a atenção primária e abrangendo também questões clínicas e diversas especialidades. Variaram também os enfoques de prevenção e as abordagens metodológicas, predominando a revisão sistemática sem metanálise. Os resultados indicam que não há uma única maneira de conceituar e praticar a PBE na prevenção e sua aplicação pode não ser apenas para obtenção de prova irrefutável para instrumentalizar ações de intervenção. Constitui um campo infindável de conhecimentos, em construção, para análise e maior compreensão de fenômenos em saúde.