Atenção odontológica no Programa Saúde da Família (PSF)de Campos de Goytacazes - RJ após um ano de implantação: a visão dos atores sociais envolvidos

Pós-graduação em Odontologia Preventiva e Social - FOA

O Mal-estar no Trabalho: a culpa como mal-estar e a culpa do mal-estar

The present work is a reflexive-theoretically research that intends, by the light of Psychoanalytic and Freudo-Marxim theories, to think about the work malaise - effect of a repressive civilization -, and the sublimation possibilities, in the context of the discussions about the conflict individual-civilization. The work favors the essential thing for the human race's representations. Current researches indicate the importance of thinking the work in the process physical and mental health/illness, as well as the subjectivity of the human race in the present time. However, the organizations of work, using reductionist views, with the psychiatric-medical Knowledge/power as accomplice, have a tendency to disregard their responsibilities in the "production" of the illnesses in the workers. Freud, by the neurosis's understanding, showed that in the individual-civilization conflict the first one pays a high price: the constant malaise (the guilt as malaise). While who detains the guilt, in the social sense of the word (the guilt of malaise), is the human culture, intermediated by the organizations, defenders of the minority's interests that hold the manners of production/exploration. According to Freud, the growth of the feeling of guilt is inevitable, considering the necessity of the drives repression to cultural progress through displeasure work. However, Reich and Marcuse theorize an exit for the Freudian pessimism about the conflict between the individual and the civilization. Freud didn't consider properly the nature socio-historical of the Reality Principle, understanding it like universal. Therefore, the level of repression would have a specific socio-economic class: surplus value for a minority and more repression for the great mass. A less repressive Reality Principle might provide a fair progress of the humanity. It's in the list of discussion the possibility of the work in social and psychological conditions that allow the reduction of worker's malaise in the civilization's breast.

Percepción de un grupo de mujeres acerca del hecho de ser portadoras del VPH

Background: The possibility to acquire sexually transmitted diseases generates bio-psycho-social conflicts affecting daily life of women. Objective: To investigate the knowledge of women on the concept of being infected by the human papilloma virus (HPV) and to understand the significance they attributed to their condition as HPV carriers. Material and method: It is a qualitative study in which ten women were interviewed, after the result of a cytopathological exam suggesting HPV. Data were collected at the Center of Health School of the Universidade Estadual Paulista -UNESP-Brazil. Results: The significant items were: deception and preoccupation about the cure, since they indicate that it is very deceptive to be infected with an incurable disease by a person whom they trust; the method of having sexual relations and being infected again; the necessity of care and of being optimistic to face the disease and the threat of cervix cancer originating anxiety. Discussion: Orientations made by health professionals were efficacious to clarify the relationship with cancer development. It is possible to understand the necessity of assistance orientations and the opportunity to hear them, offering individualized quality care. This study also offers important elements to reinforce the educational role of health professionals, principally those referring to sexually transmitted infection and cancer, seeking prevention and early treatment with the offered information. However, there is no desire of finishing the subject regarding perception, thus there is much to discover about diseases related to human papilloma virus. Key words: women carriers of HPV, feelings attributed by women.

Rabies in Experimentally Infected Bears, Ursus spp., with Epizootiologic Notes

Ten black bears, Ursus americanus Pallas, and three brown bears, U. arctos Linnaeus, were inoculated with rabies virus from naturally infected foxes in Alaska. The bears were more resistant than canine species, requiring at least 1,000 MLD50 of virus for infection. Low titres or negative results were obtained in salivary glands titrated in mice. Clinical course of the disease, post mortem findings, and microscopic lesions are described. Microscopic lesions were more· severe in brown bears, in which the inflammatory response was distinguished by the presence of numerous eosinophils in the perivascular infiltrate and among cells diffusely infiltrating the parenchyma. In both species, inclusion bodies were found only in the Purkinje cells of the cerebellum. Rabies is discounted as a factor in unprovoked attacks by bears on man at high latitudes. The epizootiology of rabies in a region where bears are numerous is discussed, with the conclusion that rabid foxes usually do not excrete sufficient quantities of virus in the saliva to infect bears. German title: Tollwut bei experimentell infizierten Bären, Ursus spp., mit epizootiologischen Anmerkungen German abtract: Zehn Schwarzbären, Ursus americanus Pallas, und drei Braunbären, U. arctos Linnaeus, wurden mit einem von Füchsen in Alaska isolierten Feldstamm des Tollwutvirus infiziert. Die Untersuchungsergebnisse lassen erkennen, daß Bären eine größere Resistenz gegenüber Tollwutinfektion aufweisen als hundeartige Karnivoren, und zwar konnten sie nicht mit weniger als 1000 MLD50 des Tollwutvirus infiziert werden. Das Virus war selten nachweisbar in den Speicheldrüsen der tollwuterkrankten Bären. Klinik und Pathologie der Tollwut bei Bären wurden kurz beschrieben. Die im Gehirn vorkommenden entzündlichen Veränderungen waren bei Braunbären besonders schwer und unterschieden sich durch die Häufigkeit der eosinophilen Leukozyten in den perivasculären und Gewebs-Infiltraten. Bei beiden Arten wurden Einschlußkörperchen nur in den Purkinje-Zellen beobachtet. Die Epizootiologie der Tollwut auf der Alaska-Halbinsel, wo Bären häufig vorkommen, wurde besprochen. Die Ergebnisse deuten an, daß Füchse wenig Virus mit dem Speichel ausscheiden, und selten soviel, daß es für die Infektion von Bären ausreicht. French title: La rage expérimentale chez les ours, Ursus spp., avec observations épizootiologiques French abstract: Dix ours noirs, Ursus americanus Pallas, et trois ours bruns, U. arctos Linnaeus, ont été inoculés avec de virus rabique provenant des renards infectés naturellement dans l'Alaska. Les ours Ont été plus résistants au virus que des espèces canines, et pour produire l'infection chez les ours, au moins 1000 MLD50 ont été requis. La titration des glandes salivaires chez des souris a données des titres peu éléves ou des résultats négatifs. La course clinique de la maladie, les observations des autopsies, et les lésions microscopiques sont decrites. Les lésions microscopiques les plus sévères ont été observées chez les ours bruns, dans lesquels la réponse inflammatoire a été distinguée par la présence de nombreux éosinophiles dans l'infiltration périvasculaire et parmi les cellules infiltrées diffusément dans Ie parenchyme. Chez les deux espèces des ours, des corps d'inclusion ont été trouvés seulement dans les cellules de Purkinje du cervelet. On a discuté l'épizootiologie de la rage dans une région où des ours sont nombreux, avec la conclusion qu'il y a dans la salive des renards rabiques une quantité de virus insuffisante pour infecter les ours. é ó í á ú Spanish title: Rabia en osos, Ursus spp., infectados experimentalmente, con anotaciones epizootológicas Spanish abstract: Diez osos negros, Ursus americanus Pallas, y tres osos pardos, U. arctos Linea, se infectaron con una estirpe campal de virus rábico aislada de zorros en Alasca. Los resultados de la experiencia permiten reconocer que los osos presentan una resistencia mayor frente a la infección rábica que los carnívoros cánidos, pues no se pudieron infectar con menos de 1.000 DML50 de virus rábico. El virus era muy raras veces identificable en las glándulas salivales de los osos enfermos de rabia. Se describen sucintamente la clínica y patología de la rabia en los osos. Las modificaciones inflamatorias en el cerebro eran muy graves en el oso pardo y se distinguían por la frecuencia de los leucocitos eosinófilos en los infiltrados perivasculares e hísticos. En ambas especies solo se hallaron corpúsculos de inclusión en las células de Purkinje. Se discute la epizootología de la rabia en la península de Alasca, donde es frecuente Ia presencia de osos. Los resultados señalan que los zorros eliminan poco virus con la saliva y casi nunca en cantidad tal que fuese suficiente para infectar los osos.

Tra Letteratura e Psicoanalisi: traduzione del saggio “Zapiski Sumasšedšego” Nezakončennoe Proizvedenie L. N. Tolstogo di Nikolaj Osipov

Ce travail de recherche se base sur la traduction d’un texte littéraire du russe vers l’italien. Il s’agit d’un essai du psychanalyste N. E. Osipov, intitulé « Zapiski sumasšedšego », nezakončennoe proizvedenie L. N. Tolstogo (“Les mémoires d’un fou”, œuvre inaccomplie de L. N. Tolstoï ). Cet essai est une analyse de la vie et de la maladie de l’auteur des Mémoires du point de vue psychanalytique. En effet, Osipov fut l’un des représentants plus importants du mouvement psychanalytique en Russie. C’était un psychanalyste et il est considéré comme l’un des pionniers de la psychanalyse russe. En effet, il a joué un rôle très important en faveur de la diffusion des œuvres de Freud et de la psychanalyse dans son pays. En traduisant les œuvres de Freud, il a introduit la théorie et la langue psychanalytiques en Russie, surtout, parmi les intellectuels. Ce travail de recherche se compose de trois chapitres principaux. Dans le premier, les thèmes abordés sont : la naissance et la diffusion de la psychanalyse en Russie ; la vie et les œuvres psychanalytiques et littéraires de Osipov ; l’analyse du texte Les mémoire d’un fou. A l’intérieur du deuxième chapitre, on trouve la traduction italienne du texte de Osipov susmentionné. Enfin, le troisième chapitre contient une analyse du travail de traduction, c’est-à-dire une analyse des difficultés rencontrées et des choix de traduction effectués pour les surmonter, en utilisant plusieurs moyens comme des dictionnaires, des ouvrages spécialisés, même en langue originale, et des sites internet sur le thème de la psychanalyse. Le travail a été rédigé en italien, mais il contient beaucoup de citations en langue originale (russe) des textes utilisés pour la recherche. Il en résulte un apport très important pour comprendre la diffusion de la discipline psychanalytique en Russie et le rôle important joué par le psychanalyste Osipov de ce point de vue.

Biphosphonate-associated osteonecrosis of the maxilla. Case report and review of the literature

In recent years, a growing number of reports in the literature have linked osteonecrosis of the jaw bones with intravenously administered bisphosphonates prescribed for the treatment of hypercalcemia of malignancy due to bone lesions of multiple myeloma or bone metastases in patients with breast or prostate cancer. Furthermore, an association between chronic oral bisphosphonate use in patients with osteoporosis or Paget's disease, and bone necrosis in the mandible or maxilla has been demonstrated in numerous case reports and case series in the last couple of years. Therapeutically, osteonecrosis of the jaws seems to be difficult to treat surgically, often resulting in a recurring or even progressing lesion. In the present case report of a bisphosphonate-associated osteonecrosis of the maxilla in a patient with osteoporosis, the current literature will be discussed, and open research questions and potential problems for our daily dental practice routine will be addressed.

Das Burnout-Syndrom: eine medizinische Perspektive

The burnout syndrome is a heterogeneous concept mostly understood as a complex of symptoms, primarily exhaustion, in response to prolonged emotional and interpersonal stress at work. The prevalence of burnout is considerably high in Swiss primary care physicians. In spite of its vague definition, burnout is a serious stress disease with many associated medical problems and high economic costs. Previous recommendations for the psychosomatic management of patients with functional somatic syndromes also apply to burnout treatment. These are complemented by more specific interventions targeting job stress related factors. Relapse prevention focuses on early recognition of warning signs and is an ongoing process.

L’hépatite auto-immune

Autoimmune hepatitis is a systemic disease, difficult to diagnose due the high variability of the clinical presentation and some non specific histological features. The recent identification of additional autoantibodies used as serological markers, as well as simplified diagnostic criteria should help the primary care physician to advance with the diagnostic process. These progresses are crucial as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis, whereas immunosuppressive therapy leads to remission in a majority of cases.

[Collagenase injection in Dupuytren's disease, evaluation of the ultrasound assisted technique].

Since October 2011, the enzymatic lysis of Dupuytren's cord was introduced in Switzerland (Xiapex(®), Auxilium Pharmaceuticals, Pfizer). Here we present our first university experience and underline the major role of ultrasound during the injection. Between December 2011 and February 2013, 52 injections were performed to eliminate 43 Dupuytren's cords in 33 patients. The mean age of the patients was 64.4 ± 8.5 years. Complications were documented for each patient. Before, directly after and after a minimum of 6 months post-injection, the contracture of the treated joint was measured with use of a goniometer. The DASH score was evaluated after a minimum of 6 months and the patients were asked to subjectively evaluate the outcome of the treatment (very good, good, mild, poor) and whether they would reiterate it if necessary. Four skin defects, one lymphangitis, and one CRPS were responsible for a complication rate of 18%. There was no infection and no tendon rupture in the series. The mean MCP joint contracture was respectively 36.8 ± 27.4°, 3.5 ± 7.8° (gain of mobility compared to the preoperative situation 33.3°, P<0.001), and 8.4 ± 13.9° (gain 28.4°, P<0.001) respectively before, just after and at the long-term clinical control. The mean PIP joint contracture was respectively 36.5 ± 29.1°, 5.9 ± 6.7° (gain 30.6°, P<0.001), and 15.1 ± 13.8° (gain 21.4°, P<0.001) respectively before injection, just after and at the long-term clinical control. The DASH score decreased from 24 ± 14 to 7 ± 9 (P<0.001). Eighty-one per cent of the patients were satisfied or very satisfied of the treatment. All but two would reiterate the treatment if necessary. Ultrasound is able to target the injection of collagenase in order to reduce complications. The short-term results of this non-invasive therapy are very promising however comparison with conventional procedures is difficult as the long-term results are lacking.

Should we perform a screening ECG among asymptomatic adults?

The resting ECG is a safe, low cost and widely available in the clinical investigation of several cardiac symptoms. However, there is controversy regarding the use as a screening tool or routine cardiovascular (CV) risk assessment test among healthy asymptomatic adults. Two recent studies reported that ECG adds supplemental information in the estimation of coronary artery disease (CAD) risk in asymptomatic patients, especially in those with intermediate risk. However, we currently need more data on the impact of ECG on the prevention of clinical CV outcomes, especially in a randomized clinical trial, and on additional costs of testing and treatment. For the time being, routine ECG testing is not recommended for the prevention of CV events among healthy asymptomatic adults.

PCSK9 inhibitors: emerging treatment to lower cholesterol?

The achievement rate of recommended low-density lipoprotein cholesterol (LDL-C) targets of < 1.8 mmol/l for secondary prevention in very high risk patients is difficult. Observational studies reported that loss of function mutation of the PCS9 was associated with LDL-C decrease level and reduction of cardiovascular events. Monoclonal antibodies to PCSK9 (REGN727 and AMG 145, PSCK9 inhibitors) have been tested in clinical studies of phase I and II and showed LDL-C level reduction of 60-70% compared to placebo. This approach appears safe and well-tolerated. The PCSK9 inhibitors are now tested in large phase III clinical studies to assess the long-term safety and efficacy of this new promising approach.

Recommendations for management of dyslipidemia in 2014

Benefit of statin treatment is well established for secondary prevention. For primary prevention, good data exist to support use of statins in high-risk groups. Less data are available for intermediate risk group and very few patients at low risk have been included in clinical trials. In this context, an individual approach based on a risk stratification using PROCAM score adjusted for Switzerland is recommended. Lifestyle measures should be tried first. We also discuss the new American guidelines and their related controversies. Secondary causes and familiar forms of dyslipidemias, for which a risk assessment cannot be performed using risk scores (first cardiovascular event between age 20 and 60), should not be overlooked.

[Smoking and digestive tract: a complex relationship. Part 1: Inflammatory bowel disease and cigarette smoking]

Little is known about the effects of smoking on inflammatory bowel diseases (IBD). However the co-occurrence of smoking and IBD often happens in ambulatory care. Smokers have a doubled risk of developing a Crohn's disease with a more active disease course. After quitting, a decrease in risk can be observed after only one year. An inverse relationship is found between smoking and ulcerative colitis. Smoking seems protective for the development of the disease and its course is less active among smokers. Smoking cessation transitorily increases the risk of developing ulcerative colitis. Nevertheless, continuing smoking cannot be justified among those patients given the risks of long-term extra-digestive effects. It is thus important to counsel all smokers with an IBD to quit smoking.

Étude de la migration des populations de lymphocytes B du sang de patients infectés par le virus d’immunodéficience humaine (VIH)

La dérégulation du compartiment de cellules B est une conséquence importante de l’infection par le virus de l’immunodéficience humaine (VIH-1). On observe notamment une diminution des nombres de lymphocytes B sanguins ainsi qu’une variation des fréquences relatives des différentes populations de lymphocytes B chez les individus infectés par rapport aux contrôles sains. Notre laboratoire a précédemment démontré l’implication des cellules dendritiques dans la dérégulation des lymphocytes B via la roduction excessive de BLyS/BAFF, un stimulateur des cellules B. De plus, lors l’études menées chez la souris transgénique présentant une maladie semblable au SIDA, et chez la souris BLyS/BAFF transgénique, l’infection au VIH-1 fut associée à une expansion de la zone marginale (MZ) de la rate. De façon intéressante, nous observons chez les contrôleurs élites une diminution de la population B ‘mature’ de la MZ. Il s’agit du seul changement important chez les contrôleurs élites et reflète possiblement un recrutement de ces cellules vers la périphérie ainsi qu’une implication dans des mécanismes de contrôle de l’infection. Pour tenter d’expliquer et de mieux comprendre ces variations dans les fréquences des populations B, nous avons analysé les axes chimiotactiques CXCL13-CXCR5, CXCL12-CXCR4/CXCR7, CCL20-CCR6 et CCL25-CCR9. L’étude longitudinale de cohortes de patients avec différents types de progression clinique ou de contrôle de l’infection démontre une modulation des niveaux plasmatiques de la majorité des chimiokines analysées chez les progresseurs rapides et classiques. Au contraire, les contrôleurs élites conservent des niveaux normaux de chimiokines, démontrant leur capacité à maintenir l’homéostasie. La migration des populations de cellules B semble être modulée selon la progression ou le contrôle de l’infection. Les contrôleurs élites présentent une diminution de la population B ‘mature’ de la MZ et une augmentation de la fréquence d’expression du récepteur CXCR7 associé à la MZ chez la souris, suggérant un rôle important des cellules de la MZ dans le contrôle de l’infection au VIH-1. De façon générale, les résultats dans cette étude viennent enrichir nos connaissances du compartiment de cellules B dans le contexte de l’infection au VIH-1 et pourront contribuer à élaborer des stratégies préventives et thérapeutiques contre ce virus.

Modélisation de l’activité électrique des oreillettes avant et après ablation par cathéter

- Réalisé au centre de recherche de l'hospital du Sacré-Coeur de Montréal. - Programme conjoint entre Université de Montréal et École Polytechnique de Montréal.