The objective of this article is to examine the multiple meanings attributed to the notion of analytical neutrality. Such a word was used for the first time by Strachey in the English translation of the text “Observations on Transference-Love” and emerged in post-Freudians and Ego psychologists’ clinical discussions about abstinence and countertransference. A subsequent investigation into the history of Brazilian’s psychoanalytical movement demonstrates, through news items and published reports of the Amílcar Lobo Case, analyst candidate involved with political torture, that the notion of neutrality was employed to conceal the omission of national and international institutions towards State violence during the military dictatorship. We defend the importance of interlacing both theoretical and sociopolitical perspectives to consider the issue of neutrality with appropriate complexity.

El objetivo de este artículo es examinar los múltiples sentidos atribuidos a la noción de neutralidad analítica. Tal palabra fue usada por primera vez por Strachey en la traducción inglesa del texto “Observaciones sobre el amor de trasferencia” y emergió en las discusiones clínicas de los post-freudianos y psicólogos del ego sobre la abstinencia y la contratrasferencia. Una investigación subsiguiente sobre la historia del movimiento psicoanalítico brasileño, mediante los artículos y relatos del caso Amílcar Lobo, analista-candidato enzarzado con la tortura política, que la noción de neutralidad fue empleada para ocultar la omisión de las instituciones nacionales e internacionales frente a la violencia estatal de la dictadura militar. Defendimos la importancia de entrelazar ambas perspectivas teórica y sociopolítica para considerar la cuestión de la neutralidad con la debida complejidad.

L’objectif de cet article est d’examiner les multiples sens attribués à la notion de neutralité analytique. Tel mot a été utilisé par la première fois dans la traduction anglaise faite par Strachey du text “Observations sur l’amour de transfert”, et a emergé dans les discussions cliniques sur l’abstinence et le contre-transfert chez les post-freudiens et les psychologues de l’ego. Ensuite, une investigation sur l’histoire du mouvement psychanalytique brésilien démontre, par le biais des nouvelles et récits du Cas Amílcar Lobo, celui-ci candidat à la position de psychanalyste et impliqué dans des cas de torture politique, que la notion de neutralité a été employé pour occulter l’omission des institutions nationaux et internationaux face à la violence de l’État pendant la dictature militaire. On défend l’importance d’entrelacer tous les deux perspectives téoriques et sociopolitiques pour approcher la question de la neutralité politique avec la complexité requise.

O objetivo deste artigo é examinar os múltiplos sentidos atribuídos à noção de neutralidade analítica. Tal palavra foi usada pela primeira vez por Strachey na tradução inglesa do texto “Observações sobre o amor transferencial” e emergiu nas discussões clínicas dos pós-freudianos e psicólogos do ego sobre abstinência e contratransferência. Em seguida, uma investigação sobre a história do movimento psicanalítico brasileiro demonstra, mediante notícias e relatos do Caso Amílcar Lobo, candidato a analista envolvido com a tortura política, que a noção de neutralidade foi empregada para ocultar a omissão das instituições nacionais e internacionais frente à violência de Estado durante a ditadura militar. Defendemos a importância de entrelaçar ambas as perspectivas teórica e sociopolítica para considerar a questão da neutralidade com a devida complexidade.

RESUMO: Apresentamos nesse artigo os primeiros resultados de uma pesquisa de pós-doutorado desenvolvida no Programa de Pós-graduação em Teoria Psicanalítica da UFRJ, que tem, como campo de intervenção do psicanalista, os movimentos sociais populares. A hipótese de trabalho sustentada é a de que a presença do psicanalista junto a tais movimentos favorece a sublimação, um destino da pulsão diferente do recalque e das perversões e pode servir como meio de decolonização dos laços sociais e de tratamento do gozo racista. Através da apropriação das novas tecnologias digitais, movimentos de base popular e de transformação social e política constroem novos modos de transmissão de um uso particular da língua, da cultura e das invenções singulares para enfrentamento do colonialismo e da necropolítica. A subversão do sujeito pode ser testemunhada pela amplificação de vozes que encontram ressonância na pólis, rompendo o silenciamento histórico imposto pelo jugo da raça, que reduz sujeitos a objetos-dejeto do capital.

ABSTRACT: We present in this article the first results of a post-doctoral research developed in the Graduate Program in Psychoanalytic Theory at UFRJ, which has, as a field of intervention of the psychoanalyst, popular social movements. The working hypothesis is that the presence of the psychoanalyst with such movements favors sublimation, a destination of the drive different from repression and perversions and can serve as a means of decolonizing social ties and treating racist jouissance. Through the appropriation of new digital technologies, grassroots movements and social and political transformation build new modes of transmission of a particular use of language, culture and unique inventions to face colonialism and necropolitics. The subversion of the subject can be witnessed by the amplification of voices that find resonance in the polis, breaking the historical silencing imposed by the yoke of race, which reduces subjects to capital waste objects.

Resumo Objetivo: Descrever as facilidades e dificuldades na promoção do direito à saúde de crianças com síndrome congênita do vírus zika (SCZ). Materiais e métodos: Estudo qualitativo realizado nos serviços onde as crianças com SCZ são acompanhadas, no município de Feira de Santana, Bahia, Brasil. Para a coleta de dados, foram utilizadas a entrevista semiestruturada e a observação sistemática. Os participantes foram constituídos de três grupos: grupo I (sete responsáveis das crianças com SCZ); grupo II (seis profissionais de saúde e dos serviços sociais) e grupo III (oito gestores dos serviços de saúde). Utilizou-se a análise de conteúdo temática. Resultados: Emergiram duas categorias empíricas: Facilidades na promoção do direito à saúde, que diz respeito ao direito à saúde ser uma garantia legal, à existência de profissionais comprometidos, ao acesso à informação, à priorização do acesso, à disponibilização de transporte e à existência de uma rede de apoio familiar; Dificuldades na promoção do direito à saúde, que foram a demanda/procura por serviços/consultas/ exames ser maior que a oferta, o tempo destinado para as atividades de estimulação precoce e a sua frequência de realização ser menor que a necessária, a inexistência de um espaço de referência para o atendimento interprofissional, a inclusão escolar, o transporte insuficiente, a aquisição de cadeira de rodas, órteses e próteses. Conclusões: A descrição das facilidades e dificuldades na promoção do direito à saúde de crianças com SCZ poderá contribuir para o acesso aos serviços e às práticas de saúde, mediante uma política de saúde efetiva e adequada à realidade apresentada, colaborando para uma maior qualidade de vida.

Resumen Objetivo: Describir las facilidades y dificultades para la promoción del derecho a la salud de los niños con síndrome congénito asociado a la infección por el virus Zika (SCZ). Materiales y métodos: Estudio cualitativo realizado en servicios de acompañamiento a niños con SCZ en la ciudad de Feira de Santana, Bahía, Brasil. Para la recolección de información se utilizaron entrevistas semiestructuradas y el método de observación sistemática. Los participantes fueron organizados en tres grupos: grupo I (siete cuidadores de niños con SCZ), grupo II (seis profesionales del servicio social y de la salud) y grupo III (ocho directores de servicios de salud). En el análisis de resultados se empleó la técnica de análisis de contenido temático. Resultados: Dos categorías empíricas surgieron de este trabajo. La primera de ellas, denominada Facilidades para promover el derecho a la salud, se refiere al derecho a la salud como garantía jurídica, la existencia de profesionales comprometidos, el acceso a información, la priorización de este acceso, la disponibilidad de transporte y la existencia de una red de apoyo familiar. La segunda, Dificultades para promover el derecho a la salud, comprende la demanda/búsqueda de servicios/consultas/exámenes mayor a la oferta, el tiempo destinado a actividades de estimulación temprana que tiene una frecuencia de ejecución inferior a la requerida, la inexistencia de un espacio de referencia para atención interprofesional, falta de inclusión escolar, una oferta de transporte insuficiente y barreras para la adquisición de sillas de ruedas, órtesis y prótesis. Conclusiones: La descripción de las facilidades y dificultades para promover el derecho a la salud de los niños con SCZ contribuirá a mejorar el acceso a los servicios y prácticas de salud mediante la creación de una política de salud efectiva frente a la realidad actual, contribuyendo así a una mejor calidad de vida.

Abstract Objective: To describe the facilities and difficulties in promoting the right to health of children with Congenital Zika Virus Syndrome (CZS). Materials and methods: Qualitative study carried out in follow-up services for children with CZS in the city of Feira de Santana, Bahia, Brazil. Semi-structured interviews and systematic observation were used for data collection. Participants were gathered in three groups: Group I (seven caregivers of children with CZS), group II (six health and social services professionals), and Group III (eight health service managers). Thematic content analysis was used for data analysis. Results: Two empirical categories emerged in this research: Facilities for promoting the right to health, which includes the right to health as a legal assurance, the existence of committed professionals, access to information, prioritized access to health services, the availability of transportation, and the existence of a family support network; and Difficulties for promoting the right to health, which concerns a demand/search for services/consultations/exams that is greater than the supply, the time allocated to early stimulation activities and their frequency being lower than necessary, lack of a reference space for interprofessional care, unsatisfactory school inclusion, insufficient transportation supply, and barriers to the purchasing of wheelchairs, orthotics and prostheses. Conclusions: The description of the facilities and difficulties for promoting the right to health of children with CZS could contribute to the access to health services and practices, through an effective health policy to the reality presented, thus fostering a better quality of life for this population.

SUMMARY OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.

RESUMO Objetivo: Avaliar a eficácia de um mindfulness treatment (MT, tratamento baseado em atenção plena) para a cessação ou redução do tabagismo e compará-la à da terapia cognitivo-comportamental (TCC). Métodos: Ensaio clínico controlado randomizado realizado em um único centro, com 113 pacientes divididos em dois grupos: MT (n = 54) e TCC (n = 59). As intervenções consistiram em oito sessões de 90 min cada. O desfecho primário foi a cessação do tabagismo 16 semanas após o início do programa. Os desfechos secundários foram a redução da média de cigarros fumados/dia em 16 semanas após o início do programa, bem como a cessação do tabagismo e redução do número de cigarros fumados/dia na última sessão do programa. Os participantes deveriam comparecer a ≥ 50% das sessões para que fossem incluídos na análise do desfecho primário. Foi também realizada uma análise por intenção de tratamento. Resultados: Não houve diferença entre os grupos quanto ao desfecho primário (30,4% no grupo MT vs. 31,6% no grupo TCC, p = 0,68) ou às taxas de abstinência imediata (47,8% no grupo MT vs. 36,8% no grupo TCC, p = 0,47). Ambos os tratamentos foram igualmente eficazes na redução do número de cigarros fumados/dia na última sessão do programa [redução de 93,33% (0-100%) no grupo MT e de 70% (33,3-100%) no grupo TCC, p = 0,92] e em 16 semanas após o início do programa [redução de 57,1% (0-100%) no grupo MT e de 70% (25-100%) no grupo TCC, p = 0,49]. Conclusões: A MT parece ser tão eficaz quanto a TCC para a cessação ou redução do tabagismo e pode ser uma opção para o tratamento do tabagismo no Brasil. [Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação: RBR-3w2scz (http://www.ensaiosclinicos.gov.br)]

ABSTRACT Objective: To evaluate the efficacy of a mindfulness-based treatment (MBT) for smoking cessation or reduction and compare it with that of cognitive behavioral therapy (CBT). Methods: This was a single-center randomized controlled clinical trial including 113 patients divided into two groups: MBT (n = 54) and CBT (n = 59). The interventions comprised eight 90-min sessions. The primary outcome was smoking cessation at 16 weeks after program initiation. Secondary outcomes included reduction in the mean number of cigarettes smoked/day at 16 weeks after treatment initiation, as well as smoking cessation and reduction in the number of cigarettes smoked/day at the last program session. Participants had to attend ≥ 50% of the sessions to be included in the primary outcome analysis. An intention-to-treat analysis was also performed. Results: There was no difference between the groups regarding the primary outcome (30.4% in the MBT group vs. 31.6% in the CBT group, p = 0.68) or immediate abstinence rates (47.8% in the MBT group vs. 36.8% in the CBT group, p = 0.47). Both treatments were equally effective in reducing the number of cigarettes smoked/day at the last program session (a reduction of 93.33% [0-100%] in the MBT group and of 70% [33.3-100%] in the CBT group, p = 0.92) and at 16 weeks after program initiation (a reduction of 57.1% [0-100%] in the MBT group and of 70% [25-100%] in the CBT group, p = 0.49). Conclusions: MBT appears to be as effective as CBT for smoking cessation or reduction and can be an option for the treatment of tobacco use disorders in Brazil (Brazilian Registry of Clinical Trials identifier: RBR-3w2scz [http://www.ensaiosclinicos.gov.br])

SUMMARY OBJECTIVE: To investigate sleep alterations and associated factors in pregnant diabetic women (n=141). METHODS: Sleep profile, sociodemographics and clinical information were collected. Poor sleep quality (Pittsburgh Sleep Quality Index >5) and excessive daytime sleepiness (Epworth Sleepiness Scale ≥10), sleep duration (h), sleep latency (min), frequent sleep interruption and short sleep (≤6 h) were assessed in type 1 diabetes mellitus (16.3%), type 2 diabetes mellitus (25.5%) and gestational diabetes mellitus (58.2%). RESULTS: Poor sleep quality was found in 58.8% of patients and daytime sleepiness in 25.7%, regardless of hyperglycemia etiology. No correlation existed between daytime sleepiness and poor sleep quality (Pearson correlation r=0.02, p=0.84). Short sleep duration occurred in 1/3 of patients (31.2%). Sleep interruptions due to frequent urination affected 72% of all and sleep interruptions due to any cause 71.2%. Metformin was used by 65.7% of type 2 diabetes mellitus and 28.7% of gestational diabetes mellitus. In gestational diabetes mellitus, parity number was independently associated with poor sleep quality (p=0.02; OR=1.90; 95%CI 1.07-3.36) and metformin use was also independently associated with poor sleep quality (p=0.03; OR=2.36; 95%CI 1.05-5.29). CONCLUSIONS: Our study originally shows that poor sleep quality and excessive daytime sleepiness are frequent in diabetic pregnancy due to different etiologies. Interestingly, only in gestational diabetes mellitus, metformin therapy and higher parity were associated with poor sleep quality.

ABSTRACT Effects of four feeding regimes on the development and feed intake, survival, productivity, and growth of Macrobrachium amazonicum larvae were investigated. Larvae were fed from stage II to IX, as follows: Artemia nauplii + inert diet during the entire larval cycle (AIn); Artemia nauplii for the entire larval cycle + inert diet from stage V onward (A/AIn); Artemia nauplii until stage IV + inert diet from stage IV onward (A/In); and only inert diet for the entire larval cycle (In). Each feeding regime (treatment) was carried out in three 50-L rectangular black tanks, set up in a recirculating system, filled with 10 salinity brackish water, and stocked at 81.8±0.8 larvae/L. The larval stage index, occurrence of Artemia nauplii and/or inert feed into the digestive tract, survival (number of larvae and postlarvae), productivity (number of postlarvae/L), and weight gain (mg) were evaluated. Larval development was similar in treatments AIn, A/Ain, and A/In, but was delayed in treatment In. Artemia nauplii were ingested by larvae irrespective of developmental stages, while inert feed was ingested only from stage III onward. Survival and productivity were higher in treatment AIn and decreased according to the number of days larvae were fed Artemia nauplii. Macrobrachium amazonicum larvae are omnivorous and polytrophic, but live feed is essential in the first stages and act as a complementary diet in the last half of larval cycle. There is a potential for inert diet to replace Artemia in the last phase of development if the nutrient composition matches larvae requirements. The combination of Artemia nauplii and inert diet during all larval cycles is the best management to maximize productivity.

ABSTRACT Objective: To assess pain and function of the ankle in patients with injuries up to 1.5 cm diameter by the American Orthopaedic Foot and Ankle Society (AOFAS) score after arthroscopic treatment. Methods: The AOFAS scale was applied before and after arthroscopy, as well as the degree of subjective satisfaction of ambulatory patients. Patients with type I osteochondral injuries, acute trauma, using plaster, presenting lesions in other joints of the lower limbs and cognitive impairment that would prevent the application of the satisfaction questionnaire were excluded from the study. Statistical analysis was performed using unpaired t test with Welch correction, Mann Whitney test, and ANOVA, with Kruskal Wallis test and Dun test, considering p value lower than 0.05. Results: There was an increased AOFAS scores after arthroscopic treatment in 52 (94.5%) patients. The mean values of AOFAS score in 55 patients was 77.32 ± 6.67 points preoperative and 93.10± 8.24 points postoperative, with a mean variation of 15.8 points, p<0.001. Patients with stage II, III and IV injuries showed an increased AOFAS scores after arthroscopic treatment, p<0.001. No difference was found between medial and lateral injuries, p >0.05. Conclusion: Patients with stage II, III or IV osteochondral injuries of the talus of up to 1.5 cm diameter, whether medial or lateral, showed a significant improvement after arthroscopic treatment. Level of Evidence III, Retrospective Study.

R E S U M O Objetivos: Verificar a frequência e a gravidade das lesões que acometem praticantes amadores de corrida. Métodos: O estudo foi conduzido por meio de questionário aplicado a 204 corredores amadores. Foram excluídos do estudo menores de idade e pessoas sem prática de corrida. Número, tipo, topografia e grau de gravidade das lesões, além de idade e sexo, foram os dados coletados. Resultados: Observou-se predomínio de atletas do sexo masculino, idade média de 32,6 ± 9,3 anos com variação de 18 a 68 anos. As lesões foram classificadas como leves e afastaram o atleta da prática de corrida por menos de oito dias. Entorses, lesões bolhosas e escoriações foram as lesões mais frequentes, localizadas mais frequentemente nos membros inferiores, com predomínio nos pés. Conclusão: Na prática de corrida, entorses, lesões bolhosas e escoriações são frequentes,porém são leves e acometem mais os membros inferiores.

ABSTRACT OBJECTIVES: To determine the frequency and severity of injuries that affect amateur runners. METHODS: This study was conducted by means of a questionnaire applied to 204 amateur runners. Individuals who were under the age of 18 years and those who were unpracticed runners were excluded. The data gathered comprised the number, type, site and degree of severity of the injuries and the individuals' age and sex. RESULTS: It was observed that male athletes predominated. The mean age was 32.6 ± 9.3 years with a range from 18 to 68 years, and the injuries were classified as mild, keeping the athlete away from practicing running for fewer than eight days. Sprains, blisters and abrasions were the most frequent injuries, located most often on the lower limbs and predominantly on the feet. CONCLUSION: In practicing running, sprains, blisters and abrasions occur frequently, but are mild injuries. They mostly affect the lower limbs.

OBJETIVO: Descrever as características de uma coorte de pacientes com colagenose pulmão dominante (CPD). MÉTODOS: Estudo retrospectivo de pacientes com doença pulmonar intersticial (DPI), anticorpo antinuclear (ANA) positivo (≥ 1/320), com ou sem autoanticorpos específicos, e com a presença de ao menos uma manifestação clínica sugestiva de doença do tecido conjuntivo (DTC). RESULTADOS: Dos 1.998 avaliados, 52 preencheram inicialmente os critérios para o diagnóstico de CPD: 37% eram homens; a média de idade ao diagnóstico era de 56 anos e a mediana do tempo de seguimento era de 48 meses. Durante o seguimento, 8 pacientes preencheram os critérios para um diagnóstico definitivo de DTC. Os 44 pacientes restantes formaram o grupo CPD, no qual as manifestações extratorácicas mais prevalentes foram artralgia, doença do refluxo gastroesofágico e fenômeno de Raynaud. Os autoanticorpos mais prevalentes nesse grupo foram ANA (89%) e anti-SSA (anti-Ro, 27%). A média de CVF no início e na última avaliação foi de 69,5% e 74,0% do predito, respectivamente (p > 0,05). Pneumonia intersticial não específica e pneumonia intersticial usual foram identificadas em 45% e 9% das TCARs, respectivamente; 36% das TCARs eram não classificáveis. Uma prevalência semelhante foi identificada na histologia. Dilatação esofágica difusa foi identificada em 52% das TCARs. Capilaroscopia subungueal foi realizada em 22 pacientes; 17 apresentavam um padrão de esclerodermia. CONCLUSÕES: No grupo CPD, houve predominância feminina, e os pacientes apresentaram alterações espirométricas leves ao diagnóstico, com diferentes padrões de DPI, em sua maioria não classificáveis, tanto em TCAR como na histologia. Estabilidade funcional foi identificada no seguimento. A dilatação esofágica em TCAR e o padrão de esclerodermia na capilaroscopia subungueal foram achados frequentes que poderiam servir como critérios diagnósticos.

OBJECTIVE: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). METHODS: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (≥ 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CTD). RESULTS: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. CONCLUSIONS: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria.

Brazil, a country of continental proportions, presents three profiles of malaria transmission. The first and most important numerically, occurs inside the Amazon. The Amazon accounts for approximately 60% of the nation’s territory and approximately 13% of the Brazilian population. This region hosts 99.5% of the nation’s malaria cases, which are predominantly caused by Plasmodium vivax (i.e., 82% of cases in 2013). The second involves imported malaria, which corresponds to malaria cases acquired outside the region where the individuals live or the diagnosis was made. These cases are imported from endemic regions of Brazil (i.e., the Amazon) or from other countries in South and Central America, Africa and Asia. Imported malaria comprised 89% of the cases found outside the area of active transmission in Brazil in 2013. These cases highlight an important question with respect to both therapeutic and epidemiological issues because patients, especially those with falciparum malaria, arriving in a region where the health professionals may not have experience with the clinical manifestations of malaria and its diagnosis could suffer dramatic consequences associated with a potential delay in treatment. Additionally, because the Anopheles vectors exist in most of the country, even a single case of malaria, if not diagnosed and treated immediately, may result in introduced cases, causing outbreaks and even introducing or reintroducing the disease to a non-endemic, receptive region. Cases introduced outside the Amazon usually occur in areas in which malaria was formerly endemic and are transmitted by competent vectors belonging to the subgenus Nyssorhynchus (i.e., Anopheles darlingi, Anopheles aquasalis and species of the Albitarsis complex). The third type of transmission accounts for only 0.05% of all cases and is caused by autochthonous malaria in the Atlantic Forest, located primarily along the southeastern Atlantic Coast. They are caused by parasites that seem to be (or to be very close to) P. vivax and, in a less extent, by Plasmodium malariae and it is transmitted by the bromeliad mosquito Anopheles (Kerteszia) cruzii. This paper deals mainly with the two profiles of malaria found outside the Amazon: the imported and ensuing introduced cases and the autochthonous cases. We also provide an update regarding the situation in Brazil and the Brazilian endemic Amazon.

O pneumomediastino espontâneo é um evento incomum, cujo quadro clínico inclui dor pleurítica retroesternal, enfisema subcutâneo, dispneia e disfonia. O mecanismo fisiopatológico implicado é o surgimento de uma diferença de pressão entre os alvéolos e estruturas adjacentes, ocasionando ruptura alveolar com posterior dissecção da bainha peribroncovascular e infiltração do mediastino e do tecido subcutâneo pelo ar. Desencadeantes conhecidos incluem exacerbação aguda de asma e situações que exigem a realização de manobra de Valsava. Descrevemos e documentamos por imagens tomográficas a ocorrência de pneumomediastino após a realização de prova de função pulmonar em um paciente com pneumopatia intersticial induzida por bleomicina. Apesar de incomum, a associação entre provas de função pulmonar e síndromes de vazamento de ar tem sido relatada cada vez mais na literatura, e doenças pulmonares, como as pneumopatias intersticiais, contemplam alterações estruturais que facilitam a ocorrência da complicação.

Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.

Os cistos pulmonares na TCAR são caracterizados por áreas arredondadas de baixo coeficiente de atenuação no parênquima pulmonar com uma interface bem definida com o pulmão adjacente normal. As doenças pulmonares císticas mais comuns são linfangioleiomiomatose, histiocitose de células de Langerhans e pneumonia intersticial linfocítica. Em uma análise retrospectiva de achados de TCAR em 50 pacientes com diagnóstico de paracoccidioidomicose crônica residual, observou-se a presença de cistos pulmonares em 5 casos (10%), mostrando que pacientes com paracoccidioidomicose podem apresentar cistos pulmonares na TCAR. Portanto, essa infecção deve entrar no diagnóstico diferencial das doenças císticas pulmonares.

On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.

Recently, the curriculum and the educational methodologies associated with health sciences courses are being reviewed and adapted. Pre-clinical sciences, such as anatomy and embryology are as well subjected to those changes. In human embryology courses it is common to use models to represent the different phases of development to facilitate learning, since the students can see and touch the models, obtaining knowledge by analogies. The purpose of the present study was to investigate if the construction of models by the students during practical embryology classes would improve or facilitate their learning. One year after the classes, 60 students answered a questionnaire with nine objective questions, including spaces for suggestions and observations. The student's responses suggested that the construction of models contributed to their learning.

Recientemente, el plan de estudios y las metodologías educativas asociadas a los cursos de ciencias de la salud están siendo revisados y adaptados. Ciencias pre-clínicas tales como la Anatomía y la Embriología son también sometidas a cambios. En los cursos de Embriología Humana, es común el uso de modelos para representar las diferentes fases del desarrollo, y así facilitar el aprendizaje, ya que los estudiantes pueden ver y tocar los modelos, así se realiza la obtención de conocimientos por medio de analogías. El propósito del presente estudio fue investigar si la construcción de modelos por parte de los estudiantes, durante las clases prácticas de Embriología, mejora o facilita su aprendizaje. Después de un año, 60 estudiantes respondieron a un cuestionario con nueve preguntas objetivas, incluidos los espacios para sugerencias y observaciones. De acuerdo con las respuestas de los estudiantes, la construcción de modelos han contribuido a su aprendizaje.

Two new protease inhibitors (PIs), CmPI-II and AdKI were purified and characterized from mollusks Cenchritis muricatus and Aplysia dactylomela, respectively. They showed different specificities, CmPI-II for human neutrophil elastase (HNE) and AdKI for human plasma kallikrein (HPK). Purification procedures were established, rendering good yields and high purification degree. CmPI-II (UNIPROT: P84755) is a 5480 Da polypeptide of three disulphide bridges belong to the "non-classical"Kazal-type inhibitors. A new group was proposed according to the location of the CysI-CysV disulfide bridge. The presence of a basic residue at the inhibitor active site changed the pre-established requirement of a hydrophobic residue for elastase inhibition. The three-dimensional CmPI-II/HNE complex model contributes to explain the CmPI-II specificity for the enzyme. This is the first PI molecule isolated from C. muricatus. On the other hand, AdKI (2.9 kDa polypeptide) is an exception among invertebrate inhibitors in terms of inhibitory strength and selectivity against HPK. A new serine protease, AdSP, was also purified and characterized from the same extract, which could be the target for AdKI. CmPI-II and AdKI are the first inhibitors isolated from the phyllum Mollusca against ENH and HPK, respectively.