ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Resumo: Nas décadas de 1960 e 1970, a implementação de regimes autoritários na América Latina teve uma ampla repercussão nas pesquisas e debates em ciências sociais. As obras de Ruy Mauro Marini e Guillermo O’Donnell sobre o estado e o autoritarismo latino-americanos reúnem alguns desses impactos na produção do conhecimento social, em face de seu compromisso com o destino das sociedades em que se inseriam, embora a partir de princípios teóricos e perspectivas políticas distintos, heterogêneos e, por vezes, conflitantes. Essa contraposição teórica ganha relevância atualmente, dado o retorno de ideias e práticas autoritárias em nossas realidades sociais.

Abstract: The implementation of authoritarian regimes in Latin America in the 60’s and 70’s had a wide repercussion on research and debates in social sciences. The works of Ruy Mauro Marini and Guillermo O’Donnell on Latin American state and authoritarianism bring together some of these impacts on the production of social knowledge, in view of their commitment to the destiny of the societies in which they were inserted, although from distinct, heterogeneous, and sometimes conflicting theoretical principles and political perspectives. This theoretical opposition gains relevance today, given the return of authoritarian ideas and practices in our social realities.

Resumen: En las décadas de 1960 y 1970, la implantación de regímenes autoritarios en América Latina tuvo una amplia repercusión en la investigación y el debate en las ciencias sociales. Los trabajos de Ruy Mauro Marini y Guillermo O’Donnell sobre el estado y el autoritarismo latinoamericanos reúnen algunos de estos impactos en la producción del conocimiento social, en vista de su compromiso con el destino de las sociedades en las que se insertaban, aunque desde principios teóricos y perspectivas políticas distintos, heterogéneos y a veces conflictivos. Esta oposición teórica adquiere relevancia hoy en día, dado el retorno de ideas y prácticas autoritarias en nuestras realidades sociales.

Resumo: A justificativa para obter proteção para as elites da Amazônia na expectativa de integração ao modelo desenvolvimento brasileiro pode ser reconhecido no Plano de Emergência da SPVEA. Os planejadores de 1950 seguiram desacreditando as formas extrativistas, enquanto acreditavam na capacidade de intervenção do estado nacional para debelar os entraves. Destacando grandes problemas como educação, saúde, transportes, produção agropecuária e financiamento apontam uma série de medidas para modernizar as relações sociais e econômicas; no entanto, as tentativas sob o vigor do empreendimento capitalista só encontraram sua efetivação com a política de subsídios diretos e de renúncia fiscal da ditadura civil-militar, nas quais as elites regionais tiveram que se contentar com a condição de sócio minoritário, restando mobilizar a denúncia desse projeto enquanto tentava melhorar sua posição nesta empreitada. O corpus de fonte documental para essa investigação está fixado nos discursos das elites sobre desenvolvimento econômico nos Relatório dos governadores do Pará e Amazonas, nas legislações e notícias de jornais justapostas como um cinerama para justificar o descredenciamento das formas econômicas extrativistas.

Abstract: The justification for obtaining protection for the Amazonian elites in the expectation of integration with the Brazilian development model can be recognized in the Emergency Plan SPVEA. The planners of 1950 continued to discredit extractive forms while believing in the national state’s ability to intervene to overcome the barriers. Highlighting major problems such as education, health, transportation, agricultural production and financing point to a series of measures to modernize social and economic relations; nevertheless, attempts under the vigor of the capitalist enterprise only found its effectiveness with the policy of direct subsidies and fiscal renunciation of the civil-military dictatorship, in which the regional elites had to settle for the condition of minority partner, remaining to mobilize the denounce this project while trying to improve its position in this endeavor. The corpus of documentary source for this investigation is fixed in the discourses of the elites about economic development in the Report of the governors of Pará and Amazonas, in the laws and news of newspapers juxtaposed as a cinerama to justify the discrediting of extractive economic forms.

Resumo Introdução: A colocação de cateteres intra-auriculares (IAC) tem surgido como uma técnica life-saving nos doentes em hemodiálise (HD) com exaustão de acessos vasculares. Objetivo: Analisar as complicações decorrentes da colocação de IAC, assim como a sobrevivência dos doentes e do acessos vascular após este procedimento. Métodos: Os autores analisaram retrospetivamente sete doentes com exaustão de acessos vasculares para HD, sem alternativa imediata de terapêutica substitutiva renal, submetidos a colocação de IAC entre Janeiro de 2004 e Dezembro de 2015. Resultados: Os sete doentes foram submetidos à colocação de doze IAC. A hemorragia (6/7) e as infeções (3/7) foram as principais complicações no pós-operatório imediato. Dois (2/7, 29%) doentes faleceram por complicações precoces e 5/7 tiveram alta com cateter funcionante. A complicação tardia mais frequente foi a exteriorização acidental do cateter em todos os doentes, seguida da trombose e infeção relacionada com o cateter, na mesma proporção (2/5). Durante o seguimento, dois dos cinco doentes faleceram por complicações associadas com o acesso vascular. Após a falência do IAC, um doente foi transferido para diálise peritoneal e outro foi submetido a transplantação renal. Apenas um doente permanece em HD após o terceiro IAC, com uma sobrevivência de 50 meses. A sobrevivência média dos doentes após colocação de IAC foi de 19 ± 25 (0-60) meses e a patência média do IAC foi de 8 ± 11 (0-34) meses. Conclusão: A colocação de um IAC para HD esteve associado a riscos significativos e mortalidade elevada. Contudo, quando as terapêuticas de substituição renal alternativas estão esgotadas, ou como uma ponte para outras modalidades, esta opção deve ser considerada.

Abstract Introduction: Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. Objective: To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. Methods: The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center. Results: Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0-34) months. Conclusion: Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.

Abstract Relations between church and state were worn in clashes of worldviews in the course of the nineteenth century, resulting in the breaking of the covenant throne-altar, with a progressive increase in the search for the autonomy of the Church. However, this tension between the two powers had not yet overflowed during the 40s and 50s, particularly in the Amazon. They shared the members of the Catholic Church from the state management exercise by means of elections and confirmation in the regular functions of public bookkeeping in the parish books, as in the provision of pastoral and symbolic services. This study aims to demonstrate the intervention of D. José Afonso de Moraes Torres, continuer in the Diocese of Pará the feature of conservative Catholicism in tune with the Holy See, in line with the introduction of ultramontanism of theses underway in Brazil. This pastoret took care of deploying Catholic reform measures to give greater emphasis to the sacraments, as evidenced by his performance when he was a member of the national parliament.

Resumo As relações entre Estado e Igreja foram desgastadas nos embates das visões de mundo no decorrer do século XIX, resultando na ruptura da aliança trono-altar, com um progressivo aumento da busca pela autonomia da Igreja. Durante os anos 40 e 50 essa tensão entre os dois poderes ainda não havia transbordado, particularmente na Amazônia. Partilhavam os membros da Igreja católica do exercício de gestão do Estado por meio dos pleitos eleitorais e da confirmação nas funções regulares de escrituração pública nos livros de paroquia, quanto na oferta dos serviços pastorais e simbólicos. O presente trabalho visa demonstrar a intervenção de D. José Afonso de Moraes Torres, continuador na diocese do Pará, da feição do catolicismo conservador em sintonia com Santa Sé, em consonância com a introdução das teses do ultramontanismo em curso no Brasil. Esse pastorado cuidou de implantar medidas de reforma da católica prestando maior acento aos sacramentos, como fica evidente em sua atuação quando foi membro do parlamento nacional.

Objective: Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I). Methods: The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM. Results: The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations. Conclusions: This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one’s own experience, which could result in psychotic symptoms.

Resumo Os equipamentos urbanos comunitários têm um grande potencial de ordenamento urbano. Através deles é possível criar ambientes urbanos de maior qualidade socioespacial e uma coerente distribuição espacial. Para isso, as diferentes maneiras de planejamento para implantação desses equipamentos necessitam ser compreendidas, tanto em seus aspectos qualitativos como técnicos. Esse artigo, por meio de literatura técnica e científica, explora diferentes critérios que podem ser utilizados para implantação de equipamentos urbanos comunitários de educação. São abordadas características do entorno, dimensionamento da capacidade, raio de influência, acessibilidade, circulação e a relação desses equipamentos com a sustentabilidade urbana. O artigo conclui ser fundamental o planejamento criterioso de equipamentos urbanos comunitários visando um melhor desenvolvimento do meio urbano e facilitar a gestão pública.

Abstract Urban Community Facilities have a huge potential for urban development. With them, it is possible to create urban environments with higher socio-spatial quality and a coherent spatial distribution. For this reason, the different ways of planning the implementation of Urban Community Facilities need to be understood, both in their qualitative and technical aspects. This article, through a review of technical and scientific literature, explores different criteria that can be used in the implementation of Urban Community Education Facilities. It approaches characteristics of the surroundings, capacity measurement, sphere of influence, accessibility, circulation and the relationship between these facilities and urban sustainability. The article concludes that the careful planning of Urban Community Facilities is essential to ensure a better development of the urban environment and to facilitate public management.

Objective: Patients with chronic hepatitis C (CHC) have a poorer quality of life than those with other chronic liver diseases. However, some of the factors that determine health-related quality of life (HRQOL) in these patients, such as the degree of liver fibrosis, are still controversial. Therefore, the aim of the present study was to investigate the impact of CHC on HRQOL by conducting clinical, psychiatric, and sociodemographic evaluations. Methods: One hundred and twenty-four consecutive patients attending a referral center for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview, the Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Multiple linear regression analyses were used to quantify independent associations between HRQOL and the clinical, psychiatric, and sociodemographic variables of interest. Results: Reduced HRQOL was independently associated with major depressive disorder (MDD) and with elevated levels of alanine aminotransferase, but was not associated with hepatic cirrhosis. Conclusions: MDD rather than the grade of liver fibrosis was strongly associated with HRQOL impairment in patients with CHC. These findings highlight that, in patients with CHC, the psychological effects of the disease deserve more attention and the implementation of integrated medical, psychiatric, and psychological care may be helpful.

The aim of this study is to present an updated view of the writings on the endophenotype model for bipolar disorder using analytical methodologies. A review and analysis of networks was performed through descriptors and keywords that characterize the composition of the endophenotype model as a model of health. Information was collected from between 1992 and 2014, and the main thematic areas covered in the articles were identified. We discuss the results and question their cohesion, emphasizing the need to strengthen and identify the points of connection between etiological factors and characteristics that make up the model of endophenotypes for bipolar disorder.

El objetivo de este trabajo es presentar una visión actualizada de los escritos del modelo endofenotipo para el trastorno bipolar, el uso de las metodologías analíticas. Se realizó una revisión de este tipo de literatura y un análisis de las redes a través de descriptores y palabras clave que caracterizan la composición del modelo endofenotipo como modelo de salud. El momento de la recolección de la información se produjo entre los años 1992-2014, la identificación de las principales áreas temáticas incluidas en los artículos. Se discuten los resultados para la consolidación del modelo de endofenotipos, cuestionando la cohesión y haciendo hincapié en la necesidad de fortalecer e identificar los puntos de conexión entre los factores etiológicos y características que conforman el modelo de endofenotipos para el trastorno bipolar.

O objetivo do presente estudo é o de apresentar uma visão atualizada sobre a produção bibliográfica do modelo de endofenótipo para o transtorno bipolar, recorrendo às metodologias analíticas. Foi realizada para tal uma revisão da literatura e uma análise de redes por meio de descritores e palavras-chaves, que caracterizam a composição do modelo de endofenótipo como um modelo de saúde. O período de recolha das informações ocorreu entre os anos de 1992-2014, identificando nos principais artigos os âmbitos temáticos abordados. Discutem-se os resultados obtidos para a consolidação do modelo de endofenótipos, questionando a coesão e ressaltando a necessidade de reforçar e identificar os pontos de ligação entre os fatores etiológicos e as características que compõe o modelo de endofenótipos para o transtorno bipolar.

O objetivo do presente estudo é o de apresentar uma visão atualizada sobre a produção bibliográfica do modelo de endofenótipo para o transtorno bipolar, recorrendo às metodologias analíticas. Foi realizada para tal uma revisão da literatura e uma análise de redes por meio de descritores e palavras-chaves, que caracterizam a composição do modelo de endofenótipo como um modelo de saúde. O período de recolha das informações ocorreu entre os anos de 1992-2014, identificando nos principais artigos os âmbitos temáticos abordados. Discutem-se os resultados obtidos para a consolidação do modelo de endofenótipos, questionando a coesão e ressaltando a necessidade de reforçar e identificar os pontos de ligação entre os fatores etiológicos e as características que compõe o modelo de endofenótipos para o transtorno bipolar.

The aim of this study is to present an updated view of the writings on the endophenotype model for bipolar disorder using analytical methodologies. A review and analysis of networks was performed through descriptors and keywords that characterize the composition of the endophenotype model as a model of health. Information was collected from between 1992 and 2014, and the main thematic areas covered in the articles were identified. We discuss the results and question their cohesion, emphasizing the need to strengthen and identify the points of connection between etiological factors and characteristics that make up the model of endophenotypes for bipolar disorder.

El objetivo de este trabajo es presentar una visión actualizada de los escritos del modelo endofenotipo para el trastorno bipolar, el uso de las metodologías analíticas. Se realizó una revisión de este tipo de literatura y un análisis de las redes a través de descriptores y palabras clave que caracterizan la composición del modelo endofenotipo como modelo de salud. El momento de la recolección de la información se produjo entre los años 1992-2014, la identificación de las principales áreas temáticas incluidas en los artículos. Se discuten los resultados para la consolidación del modelo de endofenotipos, cuestionando la cohesión y haciendo hincapié en la necesidad de fortalecer e identificar los puntos de conexión entre los factores etiológicos y características que conforman el modelo de endofenotipos para el trastorno bipolar.

Objective: Evaluate the esthetic perception and attractiveness of the smile with regard to the buccal corridor in different facial types by brachyfacial, mesofacial and dolichofacial individuals. Material and Methods: The image of a smiling individual with a mesofacial type of face was changed to create three different facial types with five different buccal corridors (2%, 10%, 15%, 22% and 28%). To achieve this effect, a photo editing software was used (Adobe Photoshop, Adobe Systems Inc, San Francisco, CA, EUA). The images were submitted to evaluators with brachyfacial, mesofacial and dolichofacial types of faces, who evaluated the degree of esthetic perception and attractiveness by means of a visual analog scale measuring 70 mm. The differences between evaluators were verified by the Mann-Whitney test. All statistics were performed with a confidence level of 95%. Results: Brachyfacial individuals perceived mesofacial and dolichofacial types of faces with buccal corridor of 2% as more attractive. Mesofacial individuals perceived mesofacial and dolichofacial types of faces with buccal corridor of 2%, 10% and 15% as more attractive. Dolichofacial individuals perceived the mesofacial type of face with buccal corridor of 2% as more attractive. Evaluators of the female sex generally attributed higher scores than the male evaluators. Conclusion: To achieve an enhanced esthetic smile it is necessary to observe the patient’s facial type. The preference for narrow buccal corridors is an esthetic characteristic preferred by men and women, and wide buccal corridors are less attractive.

Background: Sensorimotor deficits are an important phenomenological facet observed in patients with bipolar disorder (BD). However, there is little research on this topic. We hypothesize that the MPraxis test can be used to screen for motor impairments in BD aiming movements. Method: The MPraxis, which is a quick and easy-to-apply computerized test, measures sensorimotor control. During the test, the participant must move the computer mouse cursor over an ever-shrinking green box and click on it once. We predict that the MPraxis test is capable of detecting differences in sensorimotor performance between patients with BD and controls. We assessed 21 euthymic type I BD patients, without DSM-IV-TR Axis I comorbidity, and 21 healthy controls. Results and conclusions: Compared to the controls, the patients with BD presented a lower response time in their movements in all conditions. Our results showed sensorimotor deficits in BD and suggested that the MPraxis test can be used to screen for motor impairments in patients with euthymic BD.

PURPOSE: To perform a quantitative assessment of different types of pelvic ureter tissues with chronic dilation in adults, using stereological methods. METHODS: We analyzed fragments of dilated pelvic ureters obtained from 6 patients aged between 35 and 67 years (mean, 46 years) who underwent ureteral reimplantation surgery for different reasons. The obstruction duration ranged from 27 to 180 days (mean, 93 days). The control group included fragments of normal pelvic ureters obtained during nephrectomy in 7 kidney transplant donors (age: range, 25-51 years; mean, 36 years). The volumetric density of collagen in the ureter, elastic fibers, and smooth muscle fibers was assessed. RESULTS: The volumetric density (Vv) of collagen showed no significant difference between the two groups (control: 45.3 ± 6.1; dilated: 40.8 ± 6.9; P = 0.23). A statistically significant increase in Vv of elastic fibers was observed in the dilated ureters (control: 18.4 ± 1.2; dilated: 24.6 ± 5.4; P = 0.03). A statistically significant increase in the Vv of smooth muscle fibers was observed in the dilated ureter (control: 42.0 ± 6.0; dilated: 56.2 ± 6.1; P = 0.001). CONCLUSION: The chronically dilated pelvic ureters had significantly more elastin and smooth muscle contents than the controls.