A autolesão não suicida na adolescência é um evento frequente e está associada a tentativas subsequentes de suicídio ou ao suicídio completo, sugerindo que esse comportamento e aspectos psicológicos relacionados a ele possam estar na mesma trajetória de risco. As regras legais determinam a obrigação do médico notificar casos suspeitos ou confirmados de automutilação às autoridades de saúde. No entanto, não se trata apenas de cumprir com os requisitos legais; o médico deve estar ciente dessa possibilidade, conhecendo os mecanismos aplicados pelos adolescentes, sabendo os motivos que possam desencadear esse comportamento prejudicial e, consequentemente, adotar medidas preventivas eficazes. De maneira geral, os adolescentes relatam que a autolesão alivia o sentimento de angústia, culpa ou vergonha, sendo uma maneira de autopunição. Embora a autolesão não-suicida geralmente resulte em alívio momentâneo da angústia, frequentemente leva a consequências negativas a longo prazo. Este estudo narrativo teve como objetivo mostrar os principais tópicos relacionados a este grave e prevalente problema.

Introduction: Hematologic malignancies, including lymphomas and leukemias, may be treated with autologous or allogeneic bone marrow transplantation. However, these approaches can increase the risk of infection, sepsis, graft-versus-host disease, and nephrotoxicity, possibly resulting in acute kidney injury (AKI). Objective: To evaluate AKI in patients with lymphomas or leukemia submitted to bone marrow transplantation (BMT). Method: Retrospective, observational cohort study of cases from a database of 256 patients (53.9% males) hospitalized for BMT between 2012 and 2014 at a cancer hospital in Sao Paulo, Brazil. Of these, 79 were selected randomly for analysis. Demographic data, length of hospitalization, and associated morbidities were recorded. AKI was identified according to Kidney Diseases Improving Global Outcomes (KDIGO) criteria. Results: The most frequent diagnoses for the 79 cases were non-Hodgkin’s lymphoma (30.4%), acute myeloid leukemia (26.6%), and Hodgkin’s lymphoma (24.1%). The probability of 100 days-survival after BMT was 81%, and three years after BMT was 61%. In-hospital mortality was significantly higher among patients who presented AKI during hospitalization (p<0.001). However, there was no difference in overall life expectancy (p=0.770). Conclusion: A significant prevalence of AKI was found in patients with leukemia or lymphoma while they were hospitalized for BMT, resulting in significantly increased rates of in-hospital mortality. The presence of AKI during hospitalization was not associated with a subsequent reduction in life expectancy.

The caregivers fabrication, induction, or exacerbation of disease has been known as Munchausen syndrome by proxy since the last century, although this name is currently considered inappropriate. For this study, we will adopt this second designation. Child abuse is not a recent problem, nor is it easy to identify. The perpetrator can practice multiple forms of aggression, but one of them assumes importance not only because of the immediate or late consequences but also because the aggressor, in most cases, is the mother. This study aimed to broadly address the syndrome with information about the diagnosis and medical and legal conduct, according to literature data.

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