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Mexico present high rate of violence against women, which comes from the partner. The risk level assessment of intimate partner violence allows providing security measures to the victims and reducing the re-victimization. The aim was to validate the Severe Intimate Partner Violence Risk Prediction Scale (EPV-R) in the urban context of Chihuahua, Mexico. Methods. The scale was applied in 591 victims of violence, classified into two groups: severe and non-severe violence. An experts committee included three new items: psychological violence, economic violence and aggressor links with organized crime. The Internal consistency, the inter-observer concordance, the discriminative capacity of each of the items and the diagnostic efficacy were analyzed. All test were performed at the 95% of confidence level. Results. Adequate internal consistency (Cronbach's alpha of 0.79) and good agreement between inter-observers (Kappa coefficient 0.79, p < 0.001; Intraclass Correlation Coefficient = 0.96, p = 0.001) were found. Of all 23 items, 20 showed adequate association capacity between severe and non-severe violence groups (p < 0.05), five items presented high capacity, 6 items moderated capacity and 11 items showed low capacity, assigning them a value of 3, 2 and 1 points respectively. The total score mean of the scale was higher in severe group than non-severe group, 22.7 ± 5.9 vs 12.1 ± 7.2 respectively (t = 14.6, p = 0.001). After several cutoff scores tested, a value of 21 combine the best sensitivity, specificity and diagnostic efficacy of the instrument with 70%, 87% and 79% respectively; also, an AUC of 0.86 was found (p = 0.001). From this viewpoint, three levels of severe violence risk were determined: low (0-8), moderate (9-20) and high (20-36). Conclusion. The EPV-R is a reliable and valid instrument to estimate the risk of serious violence against the couple in the urban context of Chihuahua, Mexico.

Background Excitotoxicity is a central pathological pathway in many neurological diseases with blood–brain barrier (BBB) dysfunction. Kainate, an exogenous excitotoxin, induces epilepsy and BBB damage in animal models, but the direct effect of kainate on brain endothelial cells has not been studied in detail. Our aim was to examine the direct effects of kainate on cultured cells of the BBB and to test three anti-inflammatory and antioxidant drugs used in clinical practice, simvastatin, edaravone and dexamethasone, to protect against kainate-induced changes. Methods Primary rat brain endothelial cell, pericyte and astroglia cultures were used to study cell viability by impedance measurement. BBB permeability was measured on a model made from the co-culture of the three cell types. The production of nitrogen monoxide and reactive oxygen species was followed by fluorescent probes. The mRNA expression of kainate receptors and nitric oxide synthases were studied by PCR. Results Kainate damaged brain endothelial cells and made the immunostaining of junctional proteins claudin-5 and zonula occludens-1 discontinuous at the cell border indicating the opening of the barrier. The permeability of the BBB model for marker molecules fluorescein and albumin and the production of nitric oxide in brain endothelial cells were increased by kainate. Simvastatin, edaravone and dexamethasone protected against the reduced cell viability, increased permeability and the morphological changes in cellular junctions caused by kainate. Dexamethasone attenuated the elevated nitric oxide production and decreased the inducible nitric oxide synthase (NOS2/iNOS) mRNA expression increased by kainate treatment. Conclusion Kainate directly damaged cultured brain endothelial cells. Simvastatin, edaravone and dexamethasone protected the BBB model against kainate-induced changes. Our results confirmed the potential clinical usefulness of these drugs to attenuate BBB damage.

This study evaluated the inoculation of Meyerozyma guilliermondii and Bacillus licheniformis, separately or in co-culture, in wet-processed conilon coffee. Wet fermentation was conducted for 48 h. Mesophilic bacteria, lactic acid bacteria, yeasts, and filamentous fungi were counted during fermentation. The inoculation of B. licheniformis and M. guilliermondii stimulated the multiplication of lactic acid bacteria. Acetic, citric, lactic, oxalic, malic, succinic, tartaric acids, glucose, and fructose were identified in all treatments at different concentrations. Methyl salicylate, 2-heptanol, 2-nonanol, and heptanone were found during fermentation. Methylpyrazine, 2,6-dimethylpyrazine, 2,5-dimethylpyrazine, and 3-ethyl-2,5-dimethylpyrazine identified after roasting assigned notes of "almond" and "chocolate" to the beverages. All treatments were classified as "premium," with the B. licheniformis treatment receiving the highest score. Bacillus licheniformis obtained better performance in fermentation, increasing coffee score and producing volatile compounds that provided positive sensory notes to the beverage.

Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure 30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation

Background A first-dose of various vaccines provides acceptable protection against infections by SARS-CoV-2 and evolution to the most severe forms of COVID-19. The recombinant adenovirus (rAd)-based vaccine, Gam-COVID-Vac (Sputnik V), was proven efficacious but information about effectiveness in the real-world setting is lacking. The aim of our study was to investigate the association between the rollout of the first component (rAd26) of Gam-COVID-Vac and PCR-positive tests, hospitalisations and deaths. Methods We conducted a retrospective cohort study which analyzed individuals aged 60-79 who self-registered in the online vaccination system of the Province of Buenos Aires, Argentina, from December 29, 2020 to March 21, 2021. Exclusion criteria were having a previous positive RT-PCR or antigen tests for SARS-CoV-2, having received other vaccines, or two doses of any vaccine. Proportions of new laboratory-confirmed SARS-CoV-2 infections, hospitalisations and deaths until 83 days of vaccination were compared between vaccinated and unvaccinated subjects. Vaccine effectiveness for the three outcomes was calculated as (1–OR) × 100. Kaplan-Meier cumulative incidence curves were constructed. Findings During the study period 415995 registered subjects received the first component of Gam-COVID-Vac; 40387 belonged to the 60-79 age group, and were compared to 38978 unvaccinated. Vaccine effectiveness for preventing laboratory-confirmed infections was 78•6% [CI95% 74·8 - 81·7]; and for reducing hospitalizations and deaths was, respectively, 87·6% [CI95% 80·3 - 92·2] and 84·8% [CI95% 75·0 - 90·7]. Effectiveness was high across all subgroups. Interpretation Similarly to other vaccines, the administration of one dose of Gam-COVID-Vac was effective for a wide range of COVID-19–related outcomes., Facultad de Ciencias Médicas

Objective To analyze the factors associated with mental distress among health workers who cared for patients with a suspected or confirmed diagnosis of coronavirus disease 2019 (COVID-19). Methods A cross-sectional analytical study of national scope, carried out between in the second quarter of 2020. A total of 437 health professionals, who filled out an electronic form about sociodemographic data, occupational aspects, psychosocial characteristics of work and mental distress. Multiple logistic regression was performed to analyze the covariables associated with mental distress. Results There was a predominance of workers on the nursing team (65.0%), female (71.0%), from Southeastern region of the country (68.6%) and with no morbidities (36.2%). The prevalence of mental distress was 61.6%. Job strain was reported by 24% of participants, and the perception of low support from coworkers was described by 52.9%. The final multiple regression model showed that mental distress was associated with females (odds ratio - OR: 1.93; 95%CI: 1.22-3.07), age up to 40 years (OR: 1.64; 95%CI: 1.07-2.52), weekly working hours equal or over 60 hours (OR: 1.87; 95%CI: 1.15-3.11), job strain (OR: 2.45; 95%CI: 1.41-4.40) and low support from co-workers (OR: 3.47; 95%CI: 2.26-5.38). Conclusion Six out of ten participants presented mental distress, which was associated to both individual characteristics and factors related to the work carried out during the pandemic. There is an urgent need to map services that have such characteristics, to outline actions to promote mental health and prevent emotional distress at different levels of health care.

Epidemiological and clinical studies suggest that asthma is associated with adverse cardiovascular outcomes, but its mechanism is uncertain. 5-Hydroxytryptamine (5-HT) is a mediator involved in asthma and in cardiovascular functioning. Thus, in the present study, we explored whether allergic sensitization in guinea pigs modifies 5-HT-induced contractile responses and 5-HT2A receptor expression in thoracic aorta rings. We found that sensitization produced a significant increase of 100 µM 5-HT-induced contractions of aorta rings (~27 % greater contraction than in non-sensitized animals, p

Objective To know what hospital managers and safety leaders in Ibero-American countries are doing to respond effectively to the occurrence of adverse events (AEs) with serious consequences for patients. Design Cross-sectional international study. Setting Public and private hospitals in Ibero-American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Portugal and Spain). Participants A convenience sample of hospital managers and safety leaders from eight Ibero-American countries. A minimum of 25 managers/leaders from each country were surveyed. Interventions A selection of 37 actions for the effective management of AEs was explored. These were related to the safety culture, existence of a crisis plan, communication and transparency processes with the patients and their families, attention to second victims and institutional communication. Main Outcome Measure Degree of implementation of the actions studied. Results A total of 190 managers/leaders from 126 (66.3%) public hospitals and 64 (33.7%) private hospitals participated. Reporting systems, in-depth analysis of incidents and non-punitive approaches were the most implemented interventions, while patient information and care for second victims after an AE were the least frequent interventions. Conclusions The majority of these hospitals have not protocolized how to act after an AE. For this reason, it is urgent to develop and apply a strategic action plan to respond to this imperative safety challenge. This is the first study to identify areas of work and future research questions in Ibero-American countries.

The blood–brain barrier (BBB) is a dynamic and complex interface between the blood and the central nervous system regulating brain homeostasis. Major functions of the BBB include the transport of nutrients and protection of the brain from toxic compounds. This review summarizes the most important transport pathways contributing to the nutrition of the brain. Carrier-mediated transport selectively delivers small molecules like sugars, amino acids, vitamins, and trace elements. Large biomolecules, lipoproteins, peptide and protein hormones cross the BBB by receptor-mediated transport. Active efflux transporters participate in the brain efflux of endogenous metabolites as well as toxins, xenobiotics and drugs. Dysfunction in the transport of nutrients at the BBB is described in several neurological disorders and diseases. The BBB penetration of neuroprotective nutrients, especially plant polyphenols and alkaloids, their potential protective effect on brain endothelium and the interaction of nutraceuticals with active efflux transporters at the BBB are discussed. In vitro BBB models to examine nutrient transport are also presented.

Trabalho enviado em 07 de setembro de 2016. Aceito em 16 de outubro de 2016. DOI: 10.12957/rdc.2016.25461 Resumo O presente artigo tem o objetivo apresentar perspectivas do direito publico contemporâneo sobre a velha questao da relacao entre direito constitucional e direito administrativo. Busca demonstrar, neste proposito, a necessidade de superar a relacao pendular de dominância que se estabeleceu entre ambas as disciplinas juridicas. Apresenta um novo paradigma para a analise da relacao entre os dois campos do direito publico, fundado na percepcao de que um nao pode atuar de forma solitaria ou dominante com relacao ao outro. Argumenta que tal relacao deve ser simbiotica, sob o risco de gerar um direito constitucional incapaz de cumprir suas promessas e uma burocracia insensivel a suas obrigacoes e compromissos em dado regime constitucional. O texto discorre sobre um contexto historico, politico e social que corrobora a necessidade de avancar academicamente no equilibrio entre direito constitucional e direito administrativo. E aponta duas abordagens que podem colaborar com esse projeto. De um lado, a tentativa de criar categorias de direito constitucional aptas a encontrar concretude na pratica burocratica e, do outro, estudos normativos e empiricos que tratem a burocracia como uma fiadora das promessas constitucionais. Por fim, faz uma breve descricao do “constitucionalismo administrativo” norte-americano indicando caminhos para que a Administracao Publica possa se engajar na interpretacao constitucional. Palavras-Chave: direito publico; direito administrativo; direito constitucional; relacao simbiotica; constitucionalismo administrativo. Abstract This article aims to present contemporary public law perspectives on the relationship between constitutional law and administrative law. It advocates the need to overcome the pendulous relationship of dominance historically established between those disciplines. The text proposes a new paradigm to analyze the relationship between those two fields. This new paradigm is based on the perception that one cannot act alone or can dominate the other. As a consequence, it is argued that this relationship must be seen as a symbiotic one, otherwise there is a risk of producing a constitutional law unable to fulfill its promises and a bureaucracy insensitive to its obligations and commitments within the constitutional system. The Brazilian historical, political and social context is presented in order to demonstrate an urgent need to advance academically with a symbiotic perspective of the relationship between constitutional law and administrative law. In this scenario, two approaches are suggested. The first is an attempt to design a catalogue of constitutional rights able to be effective in bureaucratic practice and, the second, the conduction of normative and empirical studies on the bureaucracy’s role as a guarantor of constitutional promises. Finally, the text presents American legal literature called "administrative constitutionalism" in order to inspire future studies on how Public Administration can engage in constitutional interpretation. Keywords: public law; administrative law; constitutional law; symbiotic relationship; administrative constitutionalism

La perspectiva de los jóvenes universitarios tomará la delantera, si no en el gobierno, en el ámbito académico y de la opinión pública libre. Los universitarios encarnan fidedignamente las legítimas aspiraciones de un gran sector social capaz de instrumentar los cambios que reclama con presteza la consolidación democrática; esto es, una democracia creadora de las condiciones necesarias para el despegue de la clase media, no de cuanto imponga, como siempre, dicha componenda entre la partidocracia y los poderes fácticos, entre el corporativismo y el clientelismo.

Public administration’s ruling in the 1988 Brazilian Constitution. Thirty years by now: disputes, defeats and achievements Passados 30 anos de vigência do capítulo dedicado à disciplina da administração pública na Constituição de 1988, o artigo passa em revista sua trajetória. Investiga a origem histórica do capítulo, o contexto de sua aplicação e alguns dos principais processos de disputa que o marcaram. Discorre sobre êxitos e fracassos em sua efetivação, a partir de uma perspectiva realista e, ao mesmo tempo, critica o discurso retórico-normativista da Constituição, até aqui predominante na academia e nos tribunais. Thirty years after the promulgation of the 1988 Constitution, the article examines the trajectory of the constitutional chapter dedicated to rule the Public Administration. It investigates the chapter’s historic origin, the contexts in which it is applied and some of the main dispute episodes concerning its application. At last, the article discusses the achievements and failures in its enforcement, from a realistic perspective and, at the same time, critical to the normative-rhetorical speech about the Constitution, which has hitherto prevailed in the academy and in the courts.

Aims Although 5-hydroxytryptamine (5-HT) contracts airway smooth muscle in many mammalian species, in guinea pig and human airways 5-HT causes a contraction followed by relaxation. This study explored potential mechanisms involved in the relaxation induced by 5-HT. Main methods Using organ baths, patch clamp, and intracellular Ca 2+ measurement techniques, the effect of 5-HT on guinea pig airway smooth muscle was studied. Key findings A wide range of 5-HT concentrations caused a biphasic response of tracheal rings. Response to 32 μM 5-HT was notably reduced by either tropisetron or methiothepin, and almost abolished by their combination. Incubation with 10 nM ketanserin significantly prevented the relaxing phase. Likewise, incubation with 100 nM charybdotoxin or 320 nM iberiotoxin and at less extent with 10 μM ouabain caused a significant reduction of the relaxing phase induced by 5-HT. Propranolol, L-NAME and 5-HT 1A , 5-HT 1B /5-HT 1D and 5-HT 2B receptors antagonist did not modify this relaxation. Tracheas from sensitized animals displayed reduced relaxation as compared with controls. In tracheas precontracted with histamine, a concentration response curve to 5-HT (32, 100 and 320 μM) induced relaxation and this effect was abolished by charybdotoxin, iberiotoxin or ketanserin. In single myocytes, 5-HT in the presence of 3 mM 4-AP notably increased the K + currents ( I K(Ca) ), and they were completely abolished by charybdotoxin, iberiotoxin or ketanserin. Significance During the relaxation induced by 5-HT two major mechanisms seem to be involved: stimulation of the Na + /K + -ATPase pump, and increasing activity of the high-conductance Ca 2+ -activated K + channels, probably via 5-HT 2A receptors.

A Liga de Assistência Médico-Social (LAMS) do Centro Acadêmico “Rocha Lima” (CARL) surgiu em 1961, sendo posteriormente dividida, em 1994, em três frentes de atuação: Puericultura, Saúde Reprodutiva e Geriatria. Ao longo de sua existência, a LAMS tem desenvolvido atividades diversas envolvendo ensino médico, pesquisa e assistência, com enfoque na atenção à saúde de populações de diferentes faixas etárias: crianças, jovens e idosos.

Norethisterone (NET) and its metabolite 5alpha-norethisterone (5alpha-NET) are competitors for the androgen receptor. The sensitivity of the rat vas deferens to the contractile action of methoxamine and serotonin is regulated by hormonal and anatomical factors. The aim of this study was to evaluate the ability of NET and 5alpha-NET to induce the androgen-regulated contractile response to methoxamine and serotonin in the epididymal and prostatic portions of rat vas deferens. Adult male rats either intact, castrated or steroid-treated castrated were used. The contractility was recorded isometrically, and non-cumulative concentration-response curves to either methoxamine or serotonin were obtained. NET and 5alpha-NET partially restored the sensitivity to methoxamine and serotonin in the epididymal portion of castrated rats. The maximal responses to both agonists were significantly higher than those observed in castrated rats, and significantly lower than the responses observed in either intact or androgen-treated castrated rats. The prostatic portion was less responsive to both agonists than the epididymal portion, in all groups but castrated rats, as castration induced sensitivity to both agonists. NET and 5alpha-NET displayed a partial though similar androgenic activity in the rat vas deferens. These results contrast with previous reports where a decrease of androgenic effect due to the 5alpha-reduction of NET has been found.

Se presenta un caso de Panencefalitis Esclerosante sub aguda post sarampión (PEESA), el primero en nuestro medio corroborado por técnicas de inmuno histoquímica y con el cual deseamos llamar la atención en varios puntos

La enfermedad de Tay-Sachs es la forma más común de neurolipidosis hereditaria, transtorno familiar que se presenta en judíos del este de Europa en una proporción de 1 en 360 casos y en no judíos en 1 en 6000 nacidos vivos. Se debe a una deficiencia de laisoenzima BN –acetil hexosaminidasa, que produce una acumulación de gangliosido GM 2 intraneuronal (1).

Para decidir la instalación de un tratamiento anticonvulsivante a largo plazo es necesario y esencial establecer el diagnóstico de epilepsia; esto no significa que no podamos usar este tipo de medicamentos en otras patologías pero como veremos en el desarrollo del artículo, el uso está normado de acuerdo a las entidades planteadas.

El Síndrome de Rett (SR) fue descrito inicialmente en 1966 por Andreas Rett. Comprende una involución mental progresiva de inicio antes de los dos años acompañada de pérdida de contacto social y movimientos estereotipados de las manos, apraxia /ataxia de la marcha y crisis de hiperventilación, presentándose exclusivamente en mujeres (1).

Se presenta el caso de una niña de 12 años de edad con siete meses de evolución de signos focales e hipertensión endocraneana progressiva. Con ayuda de la TAC se diagnosticó tumoración quística gigante compatible a hidatidosis cerebral. Se realizó craneotomía y extirpación del quiste sin complicaciones. La hidatidosis cerebral es rara, su diagnóstico es clínico-tomográfico y el tratamiento siempre es quirúrgico. Case report of a 12 years old female child who developed in the last seven months focal neurological signs and progressive intracranial hypertension. CT scan showed a giant cystic tumor, and cerebral hydatidosis has been diagnosed. The hydatic cyst was surgically removed without complications. Cerebral hydatidosis is rare, its diagnosis is clinical and tomographic, and the treatment is always surgical.

Se presentan setenta niños diagnósticados de MEC TBC entre enero de 1982 y diciembre de 1991. El análisis demostró una ocurrencia de 9.4 casos por año, siendo los escolares el grupo etáreo más afectado así como el contacto tuberculoso, el hacinamiento y la desnutrición los antecedentes más importantes. El tiempo con compromiso de conciencia transcurrido previo a la hospitalización fue el factor que determinó el estadío clínico de ingreso y la condición de alta. La letalidad encontrada fue de 14.3%.

Estudo exploratório, de caráter descritivo e de abordagem quantitativa, alicerçado nas categorias "processo de trabalho", "cargas de trabalho" e "desgaste" em um hospital de ensino em Curitiba, região sul do Brasil. Neste artigo, são caracterizadas as cargas e os desgastes vivenciados em um hospital universitário, captados pelo estudo prévio intitulado "Sistema de monitoramento da saúde do trabalhador de enfermagem" (SIMOSTE). Os resultados demonstram que o gênero feminino foi o mais acometido (85,9%); os profissionais mais afetados foram os auxiliares de enfermagem (53,1%). O maior número de afastamentos ocorreu por doenças do sistema osteoarticular (25,2%) e, dentre as cargas apresentadas, as mais expressivas foram as mecânicas e fisiológicas, com 33,06%, cada. Estes resultados poderão subsidiar estratégias de intervenção nas políticas direcionadas à saúde do trabalhador, para assegurar uma melhor qualidade de vida a este profissional e, por consequência, promover melhorias na qualidade da assistência prestada ao usuário. Estudio exploratorio, descriptivo y cuantitativo, basado en el proceso de trabajo, las cargas de trabajo y el desgaste en un hospital universitario en Curitiba, sur de Brasil. En este artículo se caracteriza la carga y el estrés experimentado en un hospital universitario, planteada por un estudio previo titulado "Sistema de vigilancia de la salud de los trabajadores de enfermería". Los resultados muestran que las mujeres (85,9%) y los auxiliares de enfermería eran los profesionales más afectados (53,1%). El mayor número de ausencia del trabajo se debieron a enfermedades del sistema musculoesquelético (25,2%) y entre los cargos presentados, los más significativos fueron el mecánico y el fisiológico con el 33,06% cada uno. Estos resultados pueden apoyar las estrategias de intervención en las políticas dirigidas a la salud de los trabajadores, para garantizar una mejor calidad de vida a este trabajo y promover mejoras en la calidad de la atención prestada al usuario. This is an exploratory, descriptive and quantitative study, based on the following categories: work process, workloads and fatigue in a teaching hospital in Curitiba in the southern region of Brazil. The article characterizes the load and stress experienced in a university hospital, based on a previous study entitled "System for monitoring the health of nursing workers" (SIMOSTE). The results show that females were the most affected (85.9%) and the most affected professionals were nursing assistants (53.1%). The highest number of sick leaves was due to diseases of the osteoarticular system (25.2%) and the most significant loads were mechanical and physiological with 33.06% each. These results may support intervention strategies in the policies directed toward the workers' health to ensure a better quality of life and consequently improve the quality of care provided to the user.

O texto discorre sobre algumas das principais discussões acerca da regulação estatal de novas tecnologias digitais disruptivas. Inovações disruptivas impõem aos Estados os desafios de decidir quando, por que e até onde regular, além da definição do melhor desenho regulatório para cada caso. Além das justificativas tradicionais para intervenção estatal, a regulação de novas tecnologias deve atuar especialmente para promover e preservar a inovação, assegurando a livre concorrência, condição para que a inovação ocorra. Nesse sentido, a regulação inicial de novas tecnologias deve se deter aos domínios da garantia da segurança do usuário e do respeito às liberdades fundamentais. Quanto ao momento de regular, verifica-se que, se a intervenção ocorrer logo que a nova tecnologia surge, pode se revelar prematura; se, por outro lado, aguardar a consolidação da inovação, pode ser tardia, especialmente diante da resistência à regulação do mercado já estabelecido (dilema de Collingridge). O desenho regulatório a ser adotado deve ser capaz de conjugar ferramentas de regulação forte e fraca que permitam a adaptação e o aprendizado diante de uma realidade velozmente mutável. The article discusses some of the key debates on the regulation of new disruptive digital technologies. Disruptive innovations face governments with the challenges of deciding when, why and how to regulate, as well as designing the best regulatory framework for each case. Besides the traditional justifications for state intervention, regulation of new technologies should serve especially to promote and preserve innovation while ensuring free competition, a requirement for innovation to occur. In this sense, the initial regulation of new technologies must be detained to the areas regarding the guarantee of user’s safety and the respect of fundamental freedoms. As to when to regulate, it appears that the intervention that occurs as soon as the new technology emerges may be proved premature; on the other hand, allowing the innovation’s stabilization may be proved delayed, especially in the face of a consolidated market’s resistance to regulation (Collingridge dilemma). The regulatory framework to be adopted should be able to combine stronger and weaker regulatory tools, allowing adaptation to and learning from a fast changing reality.

The human papillomavirus (HPV) is a virus, transmitted through sexual contact, with potential to become carcinogenic for the uterine cervix, making the infected women a problem for the public health. This research had a qualitative focus, with reference to the Existential phenomenology by Martin Heidegger, with the intention of understanding the feelings of women infected by HPV, after getting the positive test results. Were subjected to this research 14 women HPV positive. We based our research on these questions: What does HPV positive mean for you? Tell me the experience that you had since you knew you were infected until today. The feelings mentioned by the women were: suffering, desperation, frustration, guilt, preoccupation, embarrassment and fear. Knowing these feelings made possible to better understand the process that these infected women went through after the diagnosis, and the meaning of what is to live with HPV. The results showed that health professionals should make some improvements as for the care to women infected by HPV, going beyond the services restricted to the rationality of biomedical sciences. It showed to be necessary be-with-the-other and rediscover the depth of the human beings role in their daily life, in order to intervene with quality in health care.

Ponderando as abordagens adotadas sobre incapacidade e as lacunas da politica de reabilitacao profissional, o presente estudo tem como objetivo compreender o fenomeno retornar ao trabalho apos afastamento por Disturbios Osteomusculares Relacionados ao Trabalho. Trata-se de uma pesquisa qualitativa fenomenologica, com abordagem da fenomenologia existencial heideggeriana, que enseja compreender a experiencia vivida a partir do sujeito e sua existencia. Entre junho e julho de 2011, foram entrevistadas seis trabalhadoras de enfermagem, de um Hospital Escola, na cidade de Sao Paulo, que estavam vivenciando o processo de retorno ao trabalho apos afastamento por Disturbios Osteomusculares Relacionados ao Trabalho. Para tanto, as trabalhadoras de enfermagem responderam a questao norteadora: Como esta sendo para voce retornar ao trabalho apos o periodo de afastamento? O mundo-vivido das trabalhadoras de enfermagem e marcado pela incapacidade tanto resultante da dor intensa quanto pelo proprio processo de adoecer. Estas modificacoes sao relatadas como perdas existenciais que acompanham as trabalhadoras no curso da doenca. O processo de retorno ao trabalho e muito complexo, e necessita da iniciativa e atuacao de varios atores para que este seja um processo saudavel, que nao desencadeie ou piore a incapacidade.

The first peruvian pediatric case of Neuro-Behcet, who had seizures, hemiparesis and a magneic nuclear resonance with a pseudotumoral imagine is here presented (Rev Med Hered 1996; 7: 178-181).

Objetivo: Determinar las causas mas frecuentes de parálisis cerebral (PC). Material y métodos: Estudio descriptivo realizado en Hospital Nacional Cayetano Heredia y el Hogar Clínica San Juan de Dios (Lima-Perú), entre noviembre 1990 y mayo de 1992. Se revisaron las historias clínicas de 102 pacientes con diagnósticos de PC y se revisó las etiologías. Resultados: En relación a edad gestacional hubieron 15 casos de prematuros (14.7%), 67(65%) a término y un postmaduro, en 19 no se tuvo la edad gestacional. El peso al nacer fue adecuado en 56(54.9%), bajo en 17(16.7%) y muy bajo en 7(6.9%). Se identificó la causa de PC en 73/102 casos (70%), siendo las causas más frecuentes las perinatales (59.3%), seguidas de las prenatales con 29.1% y las postnatales con 11.6%. En el grupo de causas prenatales, la mitad fueron malformaciones cerebrales congénitas entre las que destaca el quiste porencefálico, presente en la mitad de estos casos. En el grupo perinatal, la más frecuente fue asfixia (83%) asociada o no a otro factor metabólico. Hubieron además en este grupo 4 casos de hipoglicemia severa y 2 con encefalopatía hiperbilirrubinémica y PC distónica. Las causas postnatal más frecuente fue la meningoencefalitis bacteriana, en menores de un año de edad. Al correlacionar etiología y momento del daño, peso al nacer y tipo de PC se observa que, en los recién nacidos PT de bajo o muy bajo peso al nacer es mas frecuente la PC de tipo dipléjica y en todos el antecedente fue asfixia perinatal. Conclusiones: La baja frecuencia de PC dipléjica y la elevada frecuencia de causas perinatales (asfixia), marca nuestra diferencia con otras series y obedece en nuestra opinión, a los escasos recursos tecnológicos y las deficiencias en la atención a las gestantes y recién nacidos de nuestro sistema nacional de salud. (Rev Med Hered 1996; 7: 114-118). Objective: To determine the most frequent causes of cerebral palsy. Material and methods: A descriptive study of etiology in cerebral palsy (CP) is reported. We studied 102 cases of CP between November 1990 and May 1992 in two outpatient Neuropediatric Clinics associated to the Universidad Peruana Cayetano Heredia, Lima - Perú (Hospital Nacional Cayetano Heredia y Hogar Clínica San Juan de Dios). Results: The distribution of gestational age of our patients was 14.7% preterm, 67% fullterm and only one premature baby. The birth weight was more than 2,500 g in 54.9%, 1,500 g in 16.7% and less than 1500 in 6.9% of 97 cases. The cause was identified in 70% of patients, the more frequent etiology group was the perinatal one, with 59.3%, then the prenatal group with 29.1% and finally the postnatal 11.6%. In the prenatal group, almost 50% were congenital cerebral malformations; in the perinatal group the most frequent cause was perinatal asphyxia with or without other metabolic factor. We had 4 patients with severe hypoglycemia and two with dyskinetic PC related to kernicterus. Among the postnatal causes the most frequent was meningoencephalitis sequelae. We found, that in preterm newborns with low or very low birth weight the most comun type of CP was spastic diplegia and all of them with an hipoxic background. Conclusions: The high frequency of perinatal hypoxic cases and the low frequency of spastic diplegia are explained as a consequence of deficient conditions and poor technological resources for attention of mothers and newborns in our Public Healt System. (Rev Med Hered 1996; 7: 114-118).

INTRODUCTION Free-living amoeba infection is today a known and outgrowth disease, which is suspected when exists a special skin lesion. DEVELOPMENT Balamuthia mandrillaris is one of these amoebas recently categorized and identified as a cause of meningoecephalitis granulomatous and chronic. Human infection: until 1997 in Cayetano Heredia Hospital (Lima, Peru) was described 24 cases of Balamuthia mandrillaris infection, 10 under 15 years old. All had skin lesion and all died, 16 had conscious impairment, 8 intracranial hypertension and 8 seizures. CONCLUSIONS The free-living amoebas disease is now an outgrowth illness that depends on its worldwide distribution and association with immunocompromised host. The Balamuthia mandrillaris infection is a new form responsible for a fatal disease and clinical suspected is possible by the occurrence of skin lesion. Is very important to promove in Latin America collaborative studies in order to future actions.