Paraphilic disorder in the 21st century

The term paraphilia refers to the sexual preferences and conducts that divert from what is generally accepted for a certain society in a given historic and cultural period. It demonstrates the practices that involve the use of non-human objects, mandatory humiliation and sexual suffering or non-consensual involvement of sexual partners.

A paraphilic disorder is a paraphilia, which, presently, causes uneasiness and damages not only the patient but also others, as these behaviours exclude or damage the other affecting the patient's social relationships.

Paraphilias are only practiced by a small percentage of the world's population. However, the causes are only reported if there is a search for treatment or if there are any legal complications. By which is believed that the prevalence is higher than the number of diagnosed cases.

Although there are already a few paraphilia types registered, new forms of practice of this disturbance are emerging, mainly associated to the use of new technologies, as the Internet.

The authors propose to produce a bibliographic review concerning the concept of paraphilic disorders and its exhibition forms; identify therapeutic strategies; perform a time frame regarding paraphilias and analyze the influence that the new technologies have in paraphilic disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Alterations in the cholinesterase and adenosine deaminase activities and inflammation biomarker levels in patients with multiple sclerosis

Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the CNS that cause functional disability in young adults. It has unknown etiology characterized by the infiltration of lymphocytes and macrophages into the brain. The aim of this study was to evaluate the acetylcholinesterase (AChE) activity in lymphocytes and whole blood, as well as butyrylcholinesterase (BChE) and adenosine deaminase (ADA) activities in serum. We also checked the levels of nucleotides, nucleosides, biomarkers of inflammation such as cytokines (interleukin (IL)-1, IL-6, interferon (IFN)-γ, tumor necrosis factor-alpha (TNF-α) and IL-10) and C-reactive protein (CRP) in serum from 29 patients with the relapsing-remitting form of MS (RRMS) and 29 healthy subjects as the control group. Results showed that AChE in lymphocytes and whole blood as well as BChE, and ADA activities in serum were significantly increased in RRMS patients when compared to the control group (P<0.05). In addition, we observed a decrease in ATP levels and a significant increase in the levels of ADP, AMP, adenosine and inosine in serum from RRMS patients in relation to the healthy subjects (P<0.05). Results also demonstrated an increase in the IFN-γ, TNF-α, IL-1, IL-6 and CRP (P<0.05) and a significant decrease in the IL-10 (P<0.0001) in RRMS patients when compared to control. Our results suggest that alterations in the biomarkers of inflammation and hydrolysis of nucleotides and nucleosides may contribute to the understanding of the neurological dysfunction of RRMS patients.

Pattern of cytokine secretion by peripheral blood cells of patients with multiple sclerosis in Brazil

Autoimmune T cells play a key role as regulators and effectors of organ-specific autoimmune disease. In multiple sclerosis (MS), activated T cells specific for myelin components produce a plethora of inflammatory cytokines and mediators that contribute to myelin damage. The production of proinflammatory and regulatory cytokines by peripheral blood cells from patients with active and stable MS and healthy controls were examined. The results show that TNF alpha production was somewhat elevated in active MS with no significant increase in the level IFN gamma, whereas in the chronic phase the anti-inflammatory cytokines IL-10 and TGF beta increased, accompanied by a reduction in IFN gamma when stimulated by myelin basic protein. Multiple Sclerosis (2000) 6 293 - 299

Effects of Bothrops pirajai venom on the mouse extensor digitorum longus (EDL) muscle preparation

The effects of Bothrops pirajai snake venom on the mouse extensor digitorum longus (EDL) preparation were examined using myographic, histopathological and biochemical approaches. B. pirajai venom (10, 25 or 50 microg/ml) dose dependently and irreversibly blocked the contractile response of indirectly stimulated EDL muscle. Histopathological analysis of EDL muscle incubated with venom showed dose-dependent damage with a loss of the normal tissue structure and the appearance of highly dark, edematous fibers together with myofibrils in various stages of condensation. At high doses of venom (50 microg/ml), loss of muscle cells was observed. In non-stimulated EDL, B. pirajai venom (10 and 50 microg/ml) caused a time-dependent release of CK which was maximal after 120 min. These results suggest that a component(s) present in the B. pirajai venom has a direct myolytic action on the skeletal muscle.

Purification and amino acid sequence of MP-III 4R D49 phospholipase A2 from Bothrops pirajai snake venom, a toxin with moderate PLA2 and anticoagulant activities and high myotoxic activity

MP-III 4R PLA2 was purified from the venom of Bothrops pirajai venom (Bahia's jararacussu) after three chromatographic steps which started with RP-HPLC. The complete amino acid sequence of MP-III 4R PLA2 from Bothrops pirajai was determined by amino acid sequencing of reduced and carboxymethylated MP-III 4R and the isolated peptides from clostripain and protease V8 digestion. MP-III 4R is a D49 PLA2 with 121 amino acid residues and has a molecular weight estimated at 13,800 Da, with 14 half-cysteines. This protein showed moderate PLA2 and anticoagulant activity. This PLA2 does not have a high degree of homology with other bothropic PLA2-like myotoxins (approximately 75%) and nonbothropic myotoxins (approximately 60%). MP-III 4R is a new PLA2, which was isolated using exclusively analytical and preparative HPLC methods. Based on the N-terminal sequence and biological activities, MP-III 4R was identified as similar to piratoxin-III (PrTX-III), which was isolated by conventional chromatography based on molecular exclusion ion exchange chromatography. Clinical manifestations indicate that at the site of toxin injection, there may be pain of variable intensity, because animals continue to lick the limb. No clinical sign indicating general toxicity was noticed. Myotoxicity was observed in gastrocnemius muscle cells after exposure to MP-III 4R, with a high frequency (70%) of affected muscle fibers.

Fatal pulmonary hypertension and rheumatoid vasculitis

A 51 year old man with mild rheumatoid arthritis developed pulmonary hypertension in the absence of interstitial lung disease. A cutaneous vasculitis subsequently responded to immunosuppressive therapy, but the lung disease was refractory to treatment. In patients with rheumatoid arthritis, dyspnoea should be investigated at an early stage, even in the absence of obvious pleural or interstitial lung disease.

Balloon dilatation of a Waterston aortopulmonary anastomosis

Percutaneous balloon dilatation of a Waterston anastomosis was performed in a child who had had four shunt operations. Initially, the procedure was apparently successful, but pulmonary oedema developed and he died 12 hours after the procedure. Balloon dilatation of a Waterston anastomosis is technically possible and may prove to be an alternative to reoperation in certain patients. But further experience with the technique is necessary to determine the optimum size of the inflated balloon, and to avoid the risk of producing an excessive increase in pulmonary blood supply.

Amyloidosis localized to the lower respiratory tract: probable immunoamyloid nature of the tracheobronchial and nodular pulmonary forms

Seven patients with localized nodular pulmonary amyloidosis and four with tracheobronchial amyloidosis are presented and the pathological features described. The congophilia of these forms of amyloid is resistant to potassium permanganate, compatible with it representing immunoamyloid. This, together with the associated intense lymphocytic and plasma cell infiltration suggests a local inflammatory aetiology.