Síndrome de microdeleção 2q32 em paciente da Amazônia ocidental / 2q32 microdeletion syndrome in a patient from the western Amazon

Introdução: As deleções intersticiais envolvendo a região 2q31q32 são reconhecidas como um transtorno clínico, envolvendo diversas manifestações como deficiência intelectual, retardo no crescimento, distúrbios comportamentais e dismorfologias faciais. Os números reduzidos de relatos de pacientes acometidos por essa síndrome contribui para que as correlações genótipos-fenótipos sejam difíceis de se fazer. Relato de caso: Paciente com inversão do braço longo do cromossomo 2 [46, XX,inv(2)(q21q33)]. Apresentou ao exame físico dismorfológico fronte proeminente, epicanto, ponte nasal baixa, filtro nasolabial longo e lábio superior fino. Ao exame neurológico, apresentava hipotonia. Discussão: Uma correta interpretação cromossômica pode não só identificar a síndrome de microdeleção como também, descartar ou confirmar possíveis diagnósticos diferenciais, deixando evidente a necessidade e a importância de se reconhecer e documentar os casos (AU).

Introduction: Interstitial deletions involving the 2q31q32 region are recognized as a clinical disorder involving several manifestations, such as intellectual disability, growth retardation, behavioral disorders, and facial dysmorphologies. The reduced number of reports of patients affected by this syndrome contributes to the difficulty of making genotype-phenotype correlations. Case report: Patient with inversion of the long arm of chromosome 2 [46, XX,inv(2)(q21q33)]. On physical examination, he had a prominent forehead, epicanthus, low nasal bridge, long nasolabial philtrum and thin upper lip. Neurological examination showed hypotonia. Discussion: A correct chromosomal interpretation can identify the microdeletion syndrome and rule out or confirm possible differential diagnoses, highlighting the need and importance of recognizing and documenting cases (AU).

Síndrome de Claude: III par incompleto y ataxia contralateral / Claude syndrome: Incomplete third cranial nerve palsy and contralateral ataxia

Resumen Los accidentes cerebrovasculares mesencefálicos son poco frecuentes y por lo general están acompañados de otras lesiones concomitantes. La presencia simultánea de signos ipsi y contrala terales obliga a pensar en un síndrome alterno por compromiso del tronco encefálico. La resonancia magnética nuclear es el estudio de elección para caracterizar y localizar la lesión. Presentamos el caso de un hombre de 71 años que sufrió parálisis del tercer par derecho y hemiataxia izquierda, cuadro infrecuente, conocido como síndrome de Claude.

Abstract Midbrain strokes are rare and are usually accompanied by other concomitant injuries. The simultaneous presence of ipsi and contralateral signs makes it necessary to think of a brainstem syndrome due to involvement of the brainstem. Mag netic nuclear resonance is the study of choice to characterize and locate the lesion. We report the case of a 71-year-old man who presented right third cranial nerve palsy and hemiataxia, a rare condition known as Claude's syndrome.

Naringin alleviates early brain injury in rats with subarachnoid hemorrhage / 国际生物医学工程杂志

Objective:To investigate the effects of naringin on early brain injury in rats with subarachnoid hemorrhage and its possible mechanism of action.Methods:Rats were randomly divided into the sham operation group, the model group, and the naringin group. Each group had 8 rats. The SAH model was established by intravascular perforation, and then rats in the model group and the naringin group were administered 0.9% NaCl or naringin 40 mg/kg by intraperitoneal injection after 0.5 h. SAH score, neurological function score, cerebral edema, and blood-brain barrier permeability were detected. The level of NAD + and nflammatory factors were detected by ELISA. The expression of poly(ADP-ribose) polymerase-1 (PARP-1), apoptosis inducing factor (AIF), and protease-activated receptor (PAR) proteins was detected by Western Blot. The expression of PARP-1 mRNA was detected by quantitative real-time fluorescence PCR (qRT-PCR). Neuronal apoptosis was detected by an immunofluorescence assay. Results:Compared with the model group, naringin treatment improved neurological function ( P<0.01), reduced cerebral edema and Evans blue exudation (all P<0.01), increased the content of NAD + ( P<0.001), reduced IL-1β, IL-6 and TNF-α levels (all P<0.001), and reduced the expression of PARP-1/AIF pathway-related proteins in vivo (all P<0.001). In addition, naringin could inhibit neuronal apoptosis in early brain injury after SAH. Conclusions:Naringin can improve the early brain injury after SAH, which may be achieved by inhibiting the PARP-1/AIF pathway.

Vitamin D Modulates PAR-4 Expression in an in Vitro Model of Osteoarthritis

Abstract Osteoarthritis (OA) encompasses degeneration of articular cartilage, subchondral bone erosions and sclerosis. Chondrocyte apoptosis and an oxygen-deprived microenvironment are essential factors in OA pathogenesis. PAR-4 (Prostate apoptosis response-4) is a pro-apoptotic protein implicated in many pathologies as well as in chondrocyte cell death mechanism. Vitamin D supplementation has been identified as a therapeutic tool for a variety of inflammatory pathologies. In the present manuscript, we investigated whether first, PAR-4 expression is influenced by chondrocytes in a model of OA, in vitro, and second, whether vitamin D modulates PAR-4 expression in the same model. To test our hypothesis, we used the primary culture of murine chondrocytes isolated from the femoral and tibial condyles of wistar rats. The expression of the pro-inflammatory effect interleukin IL-1β was evaluated in the presence and absence of vitamin D. Western blot and immunofluorescence analysis confirmed protein expression. In the normoxia condition, the chondrocytes expressed PAR-4 in the cell nucleus, and in the hypoxic condition, PAR-4 was expressed in the cell cytoplasm. We disclosed that the treatment with Vitamin D decreased PAR-4 (p= 0.0137) and caspase-3 (p= 0.0007) expression. Thus, the results suggested that PAR-4 and caspase-3 proteins could be potential targets for OA.However, we believe that research is needed to identify the mechanisms implicated in the regulation of PAR-4 in OA.

Comportamento e seleção pelas consequências: a análise do comportamento no Brasil entre o dogma e a ciência / Behavior and selection by consequences: behavior analysis in Brazil - between dogma and science / Comportement et sélection par conséquences: l'analyse comportementale au Brésil - entre dogme et science / El comportamiento y la selección por consecuencias: el análisis del comportamiento en Brasil entre el dogma y la ciência

Resumo Considerando-se as recentes discussões sobre a definição de comportamento e do modelo de seleção por consequências conduzidas por pesquisadores brasileiros, discutimos a necessidade de maior participação das contribuições da análise experimental do comportamento no debate de conceitos da área e mais interação da área com outros sistemas em Psicologia. Criticamos o isolamento em relação à produção de conhecimento de outras áreas e a adoção de figuras de autoridade a partir da qual se possa fazer a avaliação das novidades da área. Para tanto, a análise do contexto no qual Skinner propôs seu modelo de seleção por consequências precisa ser feita para clara compreensão das contribuições mais importantes dessa proposta. Mostramos que a discussão sobre a distinção operante-respondente e a pertinência da noção de metacontingências são exemplos de revisão conceitual feita com base em dados e articulação entre áreas de pesquisa com epistemologias e metodologias diferentes, mas possíveis de serem articuladas.

Abstract Based on recent discussions about the definition of behavior and the selection by consequences approach conducted by Brazilian researchers, this essay discusses the need for greater participation of the contributions from experimental behavior analysis this debate and more interaction of the field with other systems in Psychology. The paper criticizes its isolation with respect to knowledge production in other areas and the adoption of authority figures from which novelties in the field can be evaluated. Hence, Skinner's model of selection by consequences must be analyzed in context for a clear understanding of its most important contributions to Psychology. The essay argues that discussions on the operant-responder distinction and about metacontingencies are examples of conceptual revision based on data and articulation between areas of research with different epistemologies and methodologies.

Résumé A partir des récentes discussions sur la définition du comportement l'approche de la sélection par conséquences menées par des chercheurs brésiliens, cet éssai discute la nécessité d'une plus grande participation des contributions de l'analyse expérimentale du comportement à ce débat et d'une plus grande interaction du domaine avec d'autres systèmes de la psychologie. L'article critique son isolement par rapport à la production de connaissances dans d'autres domaines et l'adoption de figures d'autorité à partir desquelles les nouveautés dans le domaine peuvent être évaluées. Ainsi, le modèle de séléction par conséquences de Skinner doit être analyser en context pour une compréhension claire de ses contributions les plus importantes à la psychologie. L'essai soutien que les discussions sur la distinction opérant-répondeur est un exemple de révision conceptuelle basée sur les données et l'articulation entre des domaines de recherche avec des épistémologies et des méthodologies différentes.

Resumen Desde la perspectiva de discusiones recientes sobre la definición de conducta y el modelo de selección por consecuencias realizadas por investigadores brasileños, en este ensayo discutimos la necesidad de una mayor participación de los aportes del análisis experimental de la conducta en el debate de conceptos en el área y una mayor interacción del área con otros sistemas en Psicología. Criticamos el aislamiento en relación a la producción de conocimiento de otras áreas y la adopción de una figura de autoridad a partir de la cual se evalúe las novedades en el área. Por tanto, el análisis del contexto en el que Skinner propuso su modelo de selección por consecuencias debe realizarse para una clara comprensión de los aportes más importantes de esta propuesta. La discusión sobre la distinción operante-respondedor es un ejemplo de revisión conceptual basada en datos y articulación entre áreas de investigación con diferentes epistemologías y metodologías, pero posibles de articularlas.

Profesora Alicia Evarista Fernández Hernández, educadora por excelencia / Professor Alicia Evarista Fernández Hernández, educator par excellence

Se tiene presente el principio martiano de que "Educar es depositar en cada hombre toda la obra humana, es ponerlo a nivel de su tiempo, es preparar al hombre para la vida", por eso, esta semblanza es un homenaje a la ilustre académica Alicia Evarista Fernández Hernández, quien con 12 años edad comenzó su labor como educadora al incorporarse a la Campaña de Alfabetización y a otras tareas asignadas por la Revolución; martiana ferviente, educadora por excelencia, ha transmitido durante más de cuatro décadas sus experiencias y sus doctrinas de amor y sabiduría a distintas generaciones de estudiantes de Enfermería, Medicina, profesores, profesionales de la salud de Cuba y otros pueblos del mundo. Es objetivo de esta semblanza referir los aspectos más relevantes de su magistral obra educativa, académica y revolucionaria, apoyados en testimonios, revisión de documentos, entrevistas a familiares y compañeros, que, sin dudas, describen de modo fehaciente su trayectoria como estudiante, enfermera, profesora, académica e investigadora. Alicia Fernández constituye un referente teórico-práctico, ejemplo de dedicación, altruismo y un modelo de conducta a seguir por las nuevas generaciones de galenos, enfermeros, profesores y otros profesionales de la salud que se forman integralmente en las universidades de las Ciencias Médicas cubanas(AU)

We keep in mind Marti's principle that "to educate is to deposit all human work in each man, to put him at the level of his time, and to prepare him for life"; therefore, this semblance is a tribute to the illustrious academician Alicia Evarista Fernández Hernández who began her work as an educator at the age of twelve by joining the literacy campaign and other tasks assigned by the Revolution. She has been a passionate defender of Marti's ideas and an educator par excellence who has passed her experiences and doctrines of love and wisdom to different generations of nursing and medical students, professors and other health professionals from Cuba and other peoples of the world for more than four decades. The objective of this semblance is to present the most relevant aspects of her masterful educational, academic and revolutionary work supported by evidence, document reviews, and interviews with family members and colleagues which undoubtedly describe her career as a student, nurse, professor, academician, and researcher. Alicia Fernández is a theoretical and practical referent, an example of dedication and altruism, and a behavior model to the new generations of doctors, nurses, professors and other health professionals who are fully trained in the Cuban universities of Medical Sciences(AU)

HUMANistic Caring: An approach for meeting the care needs of Filipino gay and lesbian older persons

@#Quality care is a basic human right and a core foundation for a patient's health, recovery, and well-being. In the current Philippine context, gay and lesbian older persons face gender-care disparities in the caring dynamism. Until now, their care needs are not articulated in the country's basic nursing curriculum. Consequently, the care approach is incongruent, biased, and risky. In response to this gender-care disparity, participatory action research (PAR) was used to identify this cohort's care needs and their meaning by developing a nursing care hub called the ‘Gay Care Center’ for older gays and lesbians. This paper focuses on describing: (a) the current situation of nursing care among the gay and lesbian older persons; (b) the meaning of care needs from their perspective; and (c) the Gay Care Center's tailored approach and services to meet their care needs. Multiple sources were utilized to collect data: focus group discussions, in-depth interviews, and observations. Data were then analyzed using Mayring's qualitative content analysis. Findings revealed that caring practices for older gays and lesbians could only be effective, satisfying, and holistic when the meaning of their individual needs are sensitively listened to, understood, and met. This led to the coined term HUMANistic caring, a new approach that emerged as their preferred mode of care. It is recommended that extensive gender-care training be conducted among gerontological nurses, and this be incorporated in the nursing curriculum to ensure that the provision of care is safe, respectful, humane, and just.

Mutação de novo no gene DEAF1 e sua relação com o autismo: estudo de caso / De novo mutation in the DEAF1 gene and its relation to autism: a case study / Mutación de nuevo en el gen DEAF1 y su relación con el autismo: estudio de caso

Objetivo: Analisar as implicações, impactos e o desenvolvimento de um indivíduo diagnosticado com TEA e portador da mutação de novo no gene DEAF1, a partir das várias perspectivas de intervenções realizadas. Método: Trata-se de um estudo descritivo com histórico dos tratamentos, resultados laboratoriais e genéticos mais recentes do paciente. Resultados: Sintomas notados aos 2 anos e diagnóstico específico aos 5. Aos 8 anos teve a primeira crise convulsiva tônico-clônica e o Eletroencefalograma alterado. Após obteve o diagnóstico molecular confirmado. Possuía epilepsia refratária de difícil controle, que houve piora com uma tentativa do uso de derivados canabinoides em conjunto com estimulação elétrica transcraniana. No momento, com os tratamentos, atendimentos multidisciplinares, dieta de exclusão de alérgenos e medicações de controle individual, diminuíram a intensidade das crises epiléticas e houve melhor controle do seu estado geral. Conclusão: Este estudo descreve como a mutação de novo no gene DEAF1 está relacionada com o TEA e com o comprometimento do desenvolvimento neurocognitivo. As terapias e métodos devem respeitar cada paciente na sua individualidade.

Objective: To analyze the implications, impacts and development of an individual diagnosed with ASD and carrying a de novo mutation in the DEAF1 gene, from the various perspectives of interventions performed. Method: This is a descriptive study, with the patient's history of treatments, and most recent laboratory and genetic results.Results: Symptoms were noticed at 2 years old and specific diagnosis at 5. At 8 years old he had his first tonic-clonic seizure and the electroencephalogram was altered. After, it was obtained the confirmed molecular diagnosis. He had refractory epilepsy that was difficult to control and aggravated with an attempt to use cannabinoid derivatives in conjunction with transcranial electrical stimulation. At the moment, treatments, multidisciplinary care, allergen exclusion diet and individual control medications, reduced the intensity of epileptic seizures and there was better control of his general condition. Conclusion: This study describes how the de novo mutation in the DEAF1 gene is related to ASD and neurocognitive development impairment. Therapies and methods must respect each patient in their individuality.

Objetivo: Analizar las implicaciones, impactos y desarrollo de un individuo diagnosticado de TEA y portador de una mutación de novo en el gen DEAF1, desde las distintas perspectivas de las intervenciones realizadas. Método: Este es un estudio descriptivo, con el historico de tratamientos del paciente y los resultados genéticos y de laboratorio más recientes. Resultados: Los síntomas se notaron a los 2 años y el diagnóstico específico a los 5. A los 8 años tuvo su primera crisis tónico-clónica y se alteró el electroencefalograma. Posteriormente se obtuvo el diagnóstico molecular confirmado. Tenía epilepsia refractaria que era difícil de controlar y se agravaba con un intento de utilizar derivados cannabinoides junto con estimulación eléctrica transcraneal. En el momento, los tratamientos, la atención multidisciplinar, la dieta de exclusión de alérgenos y los medicamentos de control individual, redujeron la intensidad de las crisis epilépticas y hubo un mejor control de su estado general. Conclusión: Este estudio describe cómo la mutación de novo en el gen DEAF1 se relaciona con el TEA y el deterioro del desarrollo neurocognitivo. Las terapias y los métodos deben respetar a cada paciente en su individualidad.

Linguagem e relação com os outros: contribuições da fenomenologia de Merleau-Ponty para a psicoterapia infantil / Lenguaje y relación con otros: contribuciones de la fenomenología de Merleau-Ponty a la psicoterapia infantil / Langage et relation avec l'autre: contributions de la phénoménologie Merleau-Ponty à la psychothérapie pour enfants / Language and relationship with the others: contributions from Merleau-Ponty's phenomenology to child psychotherapy

Resumo O objetivo deste ensaio teórico é discutir a noção de linguagem e a relação com os outros na fenomenologia de Merleau-Ponty como possível fundamento para a psicoterapia humanista-fenomenológica com crianças. Para Merleau-Ponty, a linguagem se apresenta como experiência viva e intersubjetiva, e o reconhecimento de si e de outrem pela criança não se daria na intelecção, mas pela dimensão experiencial. O psicoterapeuta escuta a criança naquilo que ela tem a dizer e sua participação se dá como reconhecimento e afetação diante da linguagem infantil. A relação se constitui numa dupla reversibilidade: reconhecimento do outro pela criança em sua própria experiência de corpo e dos sentimentos manifestos acerca de outrem; e afetação do encontro vivenciado tanto pelo psicoterapeuta como pela criança. Concluímos que esta proposta representa uma fecunda contribuição para a psicoterapia humanista-fenomenológica com crianças ao privilegiar a compreensão da criança para além dos estereótipos e noções cristalizadas de infância.

Resumen Este ensayo teórico tiene como objetivo discutir la noción del lenguaje y la relación con otros en la fenomenología de Merleau-Ponty como una posible base para la psicoterapia humanista-fenomenológica con niños. Para Merleau-Ponty, el lenguaje se presenta como una experiencia viva e intersubjetiva y el reconocimiento de uno mismo y del otro por parte del niño no ocurre en la intelección, sino en la dimensión experiencial. El psicoterapeuta escucha al niño en lo que tiene que decir y su participación se lleva a cabo como reconocimiento y afectación frente al lenguaje infantil. La relación constituye una doble reversibilidad: el reconocimiento del otro por parte del niño en su propia experiencia del cuerpo y de los sentimientos manifiestos sobre los demás; y la afectación del encuentro, experimentado tanto por el psicoterapeuta como por el niño. Se concluye que esta propuesta representa una contribución fructífera a la psicoterapia humanista-fenomenológica con niños al privilegiar la comprensión del niño más allá de los estereotipos y las nociones cristalizadas de la infancia.

Résumé Cet essai théorique vise à discuter la notion de langage et la relation avec les autres dans la phénoménologie de Merleau-Ponty, en tant que fondement possible d'une psychothérapie humaniste-phénoménologique pour les enfants. Pour Merleau-Ponty, le langage est une expérience vivante et intersubjective, et la reconnaissance de soi et de l'autre par l'enfant ne se ferait pas par l'intellection, mais par la dimension expérientielle. Le psychothérapeute écoute l'enfant dans ce qu'il a à dire et sa participation se produit comme une reconnaissance et une affectation face au langage des enfants. La relation constitue une double réversibilité : la reconnaissance de l'autre par l'enfant dans sa propre expérience corporelle et les sentiments qu'il manifeste à l'égard de l'autre ; et l'affectation de la rencontre, vécue à la fois par le psychothérapeute et par l'enfant. Nous concluons que cette proposition représente une contribution fructueuse à la psychothérapie humaniste-phénoménologique pour enfants en privilégiant la compréhension de l'enfant au-delà des stéréotypes et des notions cristallisées de l'enfance.

Abstract Our article aims at discussing the notion of language and the relationship with others in Merleau-Ponty's phenomenology as a possible foundation for humanistic-phenomenological psychotherapy with children. For Merleau-Ponty, language presents itself as a living and intersubjective experience and the recognition of oneself and others by the child would not occur in intellection, but through the experiential dimension. The psychotherapists listen to the child and their participation occurs as recognition and affectation in the face of children's language. The relationship constitutes a double reversibility: recognition of the other by the child in his own experience of the body and of the manifest feelings about others; affectation of the encounter, experienced by both the psychotherapist and the child. We conclude that this proposal represents a fruitful contribution to humanistic-phenomenological psychotherapy with children by privileging the child's understanding beyond stereotypes and crystallized notions of childhood.

Hémosidérose du système nerveux central: apport diagnostique de l'Imagerie par Résonnace Magnétique / Hemosiderosis of the central nervous system: diagnostic contribution of Magnetic Resonnace Imagery

Introduction. L'hémosidérose du système nerveux central est une pathologie rare liée au dépôt d'hémosidérine à la surface du cerveau, des nerfs crâniens et de la moelle épinière secondaire à un saignement chronique. Nous rapportons un cas d'hémosidérose du système nerveux central chez une patiente jeune dans un tableau de méningite. A travers notre observation nous voulons décrire l'apport diagnostique de l'Imagerie par Resonnace Magnétique dans cette pathologie. Observation. Patiente de 39ans, sans antécédents particuliers, avait consulté au service des urgences pour des céphalées d'apparition brutale associées à des nausées. Le scanner cérébral objectivait un discret effacement des sillons corticaux et une sinusite sphénoïdale. L'Imagerie par Resonnace Magnétique cérébrale et médullaire objectivait un dépôt d'hémosidérine en hyposignal T2 Echo de gradient au niveau du cortex cérébral et de la moelle épinière. Le bilan étiologie du saignement chronique était négatif à l'angio-Imagerie par Resonnace Magnétique du polygone de Willis. La glycorachie était à 1,5g/l pour une glycémie à 5,6g/l (hypoglycorachie), la protéinorachie était à 2,43g/l sans bactériémie mais présence de 590 éléments dont 72% de lymphocytes et 27% de polynucléaires neutrophiles. Conclusion. L'Imagerie par Resonnace Magnétique est une technique indispensable au diagnostic de l'hémosidérose cérébro-méningée.

Proteolytic activity of Triatoma infestans saliva associated with PAR-2 activation and vasodilation

Triatoma infestans (Hemiptera: Reduviidae) is a hematophagous insect and the main vector of Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae). In the present study, the authors investigated whether a serine protease activity from the saliva of T. infestans has a role in vasomotor modulation, and in the insect-blood feeding by cleaving and activating protease-activated receptors (PARs). Methods T. infestans saliva was chromatographed as previously reported for purification of triapsin, a serine protease. The cleavage activity of triapsin on PAR peptides was investigated based on FRET technology. Mass spectrometry was used to analyze the sites of PAR-2 peptide cleaved by triapsin. NO measurements were performed using the DAN assay (2,3-diaminonapthalene). The vasorelaxant activity of triapsin was measured in vessels with or without functional endothelium pre-contracted with phenylephrine (3 µM). Intravital microscopy was used to assess the effect of triapsin on mouse skin microcirculation. Results Triapsin was able to induce hydrolysis of PAR peptides and showed a higher preference for cleavage of the PAR-2 peptide. Analysis by mass spectrometry confirmed a single cleavage site, which corresponds to the activation site of the PAR-2 receptor. Triapsin induced dose-dependent NO release in cultured human umbilical vein endothelial cells (HUVECs), reaching a maximum effect at 17.58 nM. Triapsin purified by gel-filtration chromatography (10-16 to 10-9 M) was applied cumulatively to mouse mesenteric artery rings and showed a potent endothelium-dependent vasodilator effect (EC30 = 10-12 M). Nitric oxide seems to be partially responsible for this vasodilator effect because L-NAME (L-NG-nitroarginine methyl ester 300 µM), a nitric oxide synthetase inhibitor, did not abrogate the vasodilation activated by triapsin. Anti-PAR-2 antibody completely inhibited vasodilation observed in the presence of triapsin activity. Triapsin activity also induced an increase in the mouse ear venular diameter. Conclusion Data from this study suggest a plausible association between triapsin activity mediated PAR-2 activation and vasodilation caused by T. infestans saliva.(AU)

Perspectivas da enfermagem sobre o protocolo da sepse materna: análise à luz da teoria da complexidade / Perspectivas de enfermería en el protocolo de la sepsis materna: análisis a la luz de la teoría de la complejidad / Nursing perspectives on the maternal sepsis protocol: Analysis from the complexity theory

Objetivo: analisar as perspectivas da equipe de enfermagem sobre a implementação do protocolo da sepse materna à luz da teoria da complexidade. Método: estudo descritivo com abordagem qualitativa fundamentada no pensamento complexo de Edgar Morin. Foi realizada entrevista individual com 13 profissionais de enfermagem que atuam no setor obstétrico, entre julho e agosto de 2017, em um hospital do Nordeste, Brasil. Resultados: evidenciaram-se dificuldades na identificação adequada da sepse materna, atraso no início do antibiótico, falta de comunicação entre categorias profissionais e no alinhamento de condutas, o que prejudica a linha de cuidado à paciente obstétrica com sepse. Conclusões: há perspectiva positiva quanto à empregabilidade do protocolo; no entanto, evidenciamse fragilidades com a necessidade de novas reflexões acerca da complexidade dos cuidados implementados, do papel dos profissionais e da comunicação dentro da equipe de saúde.

Objetivo: analizar las perspectivas del personal de enfermería sobre la implementación del protocolo de sepsis materna a la luz de la teoría de la complejidad. Método: estudio descriptivo con enfoque cualitativo basado en el pensamiento complejo de Edgar Morin. Se realizaron entrevistas individuales con 13 profesionales de enfermería que trabajan en el sector obstétrico, entre julio y agosto de 2017, en un hospital del noreste de Brasil. Resultados: se apuntaron dificultades en la identificación adecuada de la sepsis materna, retraso en el inicio de los antibióticos, falta de comunicación entre las categorías profesionales y una alineación de las conductas, lo que afecta la línea de atención de pacientes obstétricas con sepsis. Conclusiones: existe una perspectiva positiva en cuanto a la empleabilidad del protocolo; sin embargo, las debilidades son evidentes, con la necesidad de nuevas reflexiones sobre la complejidad de la atención implementada, los roles profesionales y la comunicación dentro del equipo de salud.

Objective: To study the perspectives of nursing staff on the implementation of maternal sepsis protocol from complexity theory. Method: Descriptive study with a qualitative approach based on Edgar Morin's Complex Thought. individual interviews were conducted, between July and August 2017, with 13 nursing professionals working in the obstetric area at a hospital in northeast Brazil. Results: Difficulties in adequate identification of maternal sepsis, delayed antibiotic initiation, lack of communication between professionals, and a weak alignment of conducts were observed, issues that impair the line of care for obstetric patients with sepsis. Conclusions: There is a positive perspective regarding the use of the protocol. However, some weaknesses are evident, establishing the need for new reflections on the complexity of the implemented care, professional roles, and communication within the health team.

Asunción Toledo del Rey, ejemplo de maestra y enfermera revolucionaria / Asunción Toledo del Rey, example of revolutionary teacher and nurse

Se tiene presente el principio martiano de que el elogio oportuno fomenta el mérito; por eso, esta semblanza es un homenaje a la profesora consultante Asunción Toledo del Rey, quien desde edad temprana se incorporó a las disímiles tareas asignadas por la Revolución; martiana, educadora por excelencia, ha transmitido durante más de cuatro décadas sus doctrinas de amor y sabiduría a distintas generaciones de estudiantes de Enfermería de Cuba y otros pueblos del mundo. Es objetivo de esta semblanza referir los aspectos más relevantes de su obra educativa y revolucionaria, apoyados en testimonios, revisión de documentos, entrevistas a familiares y compañeros, que, sin dudas, describen de modo fehaciente su trayectoria como estudiante, enfermera y profesora. Asunción Toledo del Rey constituye un referente teórico-práctico, un ejemplo a seguir por todas las generaciones de estudiantes de Enfermería que se forman integralmente en las universidades de las Ciencias Médicas cubanas(AU)

Bearing in mind the principle of José Martí that "timely praise encourages the merit" we present this biographical sketch as a tribute to the Consultant Professor Asunción Toledo del Rey who performed different tasks assigned by the Revolution since she was very young. She is a supporter of the ideas of José Martí and an educator par excellence that has conveyed her doctrines of love and wisdom to many generations of Nursing students in Cuba and other countries in the world for more than four decades. The aim of this biographical sketch is to highlight the most relevant aspects of her educational and revolutionary work, which is supported by evidences, document reviews and interviews to relatives and co-workers who, undoubtedly, irrefutably describe her career as a student, nurse and professor. Asunción Toledo del Rey is a theoretical and practical referent and an example to be followed by all generations of Nursing students who receive a comprehensive education and training in our Cuban universities of medical sciences(AU)

Parálisis del nervio motor ocular externo luego de anestesia neuroaxial combinada epidural-espinal / Paralysis of the external oculomotor nerve after combined epidural-spinal neuroaxial anesthesia

Introducción: El abordaje del espacio subaracnoideo fue descrito por Quincke en el 1891. En la actualidad es práctica común para la realización de la anestesia neuroaxial subaracnoidea en las pacientes obstétricas. Las complicaciones descritas, asociadas a esto, son varias. Dentro de estas, la parálisis del nervio abducens o VI par no es frecuente y en ocasiones, no está relacionada a la punción ya que se produce días después del evento. Objetivo: Revisar la información relacionada con la complicación de parálisis del VI par. Presentación del caso: Paciente de 33 años de edad, femenina, de profesión médico, con antecedentes personales de migraña, historia de anestesia neuroaxial epidural sin complicaciones, que para la realización de una cesárea de segmento arciforme y salpinguectomia parcial bilateral, recibió una anestesia combinada peridural-espinal. El transoperatorio transcurre con estabilidad hemodinámica, hizo cefalea al tercer día del posoperatorio, que la atribuyó al antecedente de migraña y fue tratada sin evaluación por anestesiología con dipirona. A los 10 días de operada hace desviación de la mirada y diplopia, se diagnostica parálisis del VI par. Fue tratada por Neurología y se plantean varios diagnósticos diferenciales. Los estudios imagenológicos resultan negativos, se trató con vitaminas y se produjo remisión a las 6 semanas. Conclusiones: El diagnóstico de esta complicación es necesario ya que puede pasar inadvertida la relación con la anestesia y, por tanto, ser mal conducido su tratamiento(AU)

Introduction: The approach to the subarachnoid space was described by Quincke in 1891. It is now a common practice to perform subarachnoid neuroaxial anesthesia in obstetric patients. The complications described, associated with this, are several. Within these, the paralysis of the abducens nerve or sixth pair is not frequent and sometimes is not related to the puncture, since it occurs days after the event. Objective: To review the information related to the complication of paralysis of the sixth pair. Case presentation: A 33-year-old female patient, a physician, with a personal history of migraine, a history of epidural neuroaxial anesthesia without complications, who underwent combined epidural-spinal anesthesia for performing a cranial segment cesarean section and bilateral partial salpingectomy. The transoperative period runs with hemodynamic stability. There was headache three days after surgery, which was attributed to the migraine history and the patient was treated, without evaluation by anesthesiology, with dipyrone. At 10 days after surgery, the eyes are diverted and diplopia is manifested, paralysis of the sixth pair is diagnosed. She was treated by neurology and several differential diagnoses were proposed. Imaging studies are negative. She was treated with vitamins and remission occurred at six weeks. Conclusions: The diagnosis of this complication is necessary, since the relationship with anesthesia may go unnoticed and, therefore, its treatment may be poorly conducted(AU)

PXR: a center of transcriptional regulation in cancer

Pregnane X receptor (PXR, NR1I2) is a prototypical member of the nuclear receptor superfamily. PXR can be activated by both endobiotics and xenobiotics. As a key xenobiotic receptor, the cellular function of PXR is mostly exerted by its binding to the regulatory gene sequences in a ligand-dependent manner. Classical downstream target genes of PXR participate in xenobiotic responses, such as detoxification, metabolism and inflammation. Emerging evidence also implicates PXR signaling in the processes of apoptosis, cell cycle arrest, proliferation, angiogenesis and oxidative stress, which are closely related to cancer. Here, we discussed, in addition to the characterization of PXR , the biological function and regulatory mechanism of PXR signaling in cancer, and its potential for the targeted prevention and therapeutics.

Influence of integrated crop management practices on yield, PAR interception, resource-use-efficiency and energetics in pigeonpea in North Indian Plains

Aim: The aim of the present study was to assess the influence of different integrated crop management (ICM) practices on productivity, resource-use efficiency and energetics of pigeonpea crop so as to overcome various production- and climatic-vulnerabilities in Indo-Gangetic Plains Region (IGPR). Methodology: A study was conducted during Kharif 2017 in pigeonpea under pigeonpea–wheat cropping system at IARI, New Delhi, India to assess the influence of nine different ICM modules [Conventional tillage (CT) based: 04 (ICM1–ICM4); Conservation agriculture (CA) based: 04 (ICM5–ICM8); Organic agriculture based: 01 (ICM9)] on productivity, PAR interception, resource-use-efficiency and energetics in pigeonpea in randomized block design replicated thrice. Results: Pigeonpea seed yield was significantly higher in ICM7 (1.92 t ha-1) – a CA-based ICM module which was followed by ICM5, ICM8 and ICM6. In general, the CA based ICM modules showed an edge over CT based ICM modules with reference to growth, yield and PAR interception. The resource-use-efficiency indices like total water-use-efficiency (TWUE), irrigation water-use-efficiency (IWUE), economic water-productivity (WPE), partial factor productivity of applied nutrients (NPK) also exhibited same trend as that of seed yield with highest TWUE (2.96 kg ha-mm–1) and WPE (104.5 INR ha-mm–1) in ICM7 module. The energy output was highest in ICM7 (2, 23, 664 MJ ha-1) followed by ICM5, ICM8 and ICM6. The trend of energy-use-efficiency was ICM4>ICM2>ICM1>ICM3>ICM5>ICM7>ICM6>ICM8>ICM9, respectively. Interpretation: Conservation agriculture (CA) based modules like ICM7 can be recommended to the farmers for enhancing the plant growth, PAR interception, crop productivity, resource-use efficiency and energetics in pigeonpea alone or on pigeonpea-wheat cropping system basis in semi-arid Indo-Gangetic plains region (IGPR).

Sobre os gestos brutais: o trauma, a destruição e as formas de adoecimento psíquico / On brutal gestures: trauma, destruction, and forms of psychic illness / Sobre los gestos brutales: el trauma, la destrucción y las formas de enfermedad psíquica / Sur les gestes brutaux: traumatisme, destruction et formes de maladie psychique

Com base em uma experiência narrada por Milan Kundera, procuramos apresentar duas formas de adoecimento psíquico (por ativação e por passivação), e relacioná-las ao modelo proposto por Green para pensar os estados depressivos por passivação. Consideramos que a intrincação entre as pulsões de destruição e a libido, mesmo quando geradora de fantasias ou gestos brutais, pode revelar-se como tentativa episódica de defesa ativa em meio à predominância da passivação gerada pelo desamparo pós-traumático.

From an experience narrated by Milan Kundera, we try to present two forms of psychic illness (by activation and by passivation) and relate them to the model proposed by Green to think a depressive state due to passivation. We believe that the intricacy between the drives of destruction and the libido, even when it generates brutal fantasies or gestures, may prove to be an episodic attempt of active defense amid the predominance of passivation generated by posttraumatic helplessness.

A partir de una experiencia narrada por Milan Kundera, procuramos presentar dos formas de adicción psíquica (por activación y por pasivación), y relacionarlas al modelo propuesto por Green para pensar los estados depresivos por pasivación. Consideramos que la intrincación entre las pulsiones de destrucción y la libido, aun cuando generadora de fantasías o gestos brutales, puede revelarse como tentativa episódica de defensa activa en medio de la predominancia de la pasivación generada por el desamparo post-traumático.

À partir d'une expérience racontée par Milan Kundera, nous essayons de présenter deux formes de maladie psychique (par activation et par passivation) et de les relier au modèle proposé par Green pour penser à un état dépressif dû à la passivation. Nous pensons que la intrication des pulsions de destruction et de la libido, même si elle engendre des fantasmes ou des gestes brutaux, peut s'avérer être une tentative épisodique de défense active dans la prédominance de la passivation générée par le état de détresse post-traumatique.

Treatment of lateral rectus paralysis by transposition of superior rectus to lateral rectus / Tratamento de paralisia de reto lateral pela transposição do reto superior para o reto lateral

ABSTRACT Objective: To evaluate the results of the surgical technique described by Crouch in the correction of lateral rectal paralysis (LR) esotropia. Methods: A study conducted of six patients with VI cranial nerve palsy, with more than three months, and associated contracture of the medial rectus muscle. The causes of paralysis varied in traumatic, congenital and neuropathic. The patients underwent surgical correction, performed with a technique consisting of the instillation of the superior rectus muscle (SR) and its suture above the insertion of the LR muscle, completed with Foster´s suture (suture joining, 8mm of the muscle insertion, the body of the SR and LR). The patients were followed for six months. Results: Five patients presented preoperative deviation between 30 and 50 prismatic diopter (PD), and one patient presented a deviation greater than 100 PD, and therefore, the patient required surgical reintervention due to residual deviation. The other five patients presented postoperative orthoppy, with better visual acuity and no vertical deviations. Conclusion: The surgery proposed by Crouch has been shown to be a good alternative to conventional techniques, such as Carlson-Jampolsky surgery, being a technically simpler procedure with good results.

RESUMO Objetivo: Avaliar resultados da técnica cirúrgica descrita por Crouch na correção de esotropia por paralisia do reto lateral (RL). Métodos: Estudo realizado com seis pacientes diagnosticados com paralisia de IV par craniano, com mais de três meses, e com contratura associada do musculo reto medial. As causas da paralisia variaram em traumática, congênita e neuropática. Os pacientes foram submetidos à correção cirúrgica, realizada com técnica que consiste na desinserção do músculo reto superior (RS) e sua sutura acima da inserção do músculo RL, completada com ponto de Foster (sutura unindo, a 8mm da inserção muscular, o corpo do RS e RL). Os pacientes foram seguidos por seis meses. Resultados: Cinco pacientes apresentaram, no pré-operatório, desvio entre 30 e 50 dioptrias prismáticas (DP), e um paciente apresentava desvio maior que 100DP, sendo, portanto o paciente que necessitou de reintervenção cirúrgica, por desvio residual. Os outros cinco pacientes apresentaram ortotropia no pós-operatório, com melhor da acuidade visual e sem desvios verticais. Conclusão: A cirurgia proposta por Crouch demostrou-se uma boa alternativa às técnicas convencionais, como cirurgia de Carlson-Jampolsky, sendo um procedimento tecnicamente mais simples e com bons resultados.

Sustitución de nombre, uso cínico del lenguaje y constitución de subjetividad en adolescentes Hip Hop¹: un Otro name / Replacement of name, cynical use of language and constitution of subjectivity in adolescents Hip-Hop: Other name / Substituição do nome, uso cínico da linguagem e constituição da subjetividade em adolescentes Hip Hop: um Outro nome

Con el objetivo de encontrar evidencias sobre cómo se dan procesos de constitución de subjetividad en adolescentes que integran agrupaciones juveniles de ciudad (AJC), cómo dichas agrupaciones inciden en esos procesos constitutivos y como se las arreglan los adolescentes para resolver sus dilemas, realizamos una investigación-intervención de orientación clínica en Argentina y Colombia durante los años 2013-2016. Con la aplicación del método de intervención cínica a la investigación académica (MICAP) a través de espacios de habla, entrevistas de orientación clínica, y diarios (de bordo y clínico) conseguimos obtener discursos singulares de adolescentes integrantes AJC (48 en total). De esos discursos extrajimos salidas de constitución subjetiva que tienen los adolescentes. También obtuvimos, a través de observaciones y entrevistas semiestructuradas, discursos particulares que sobre adolescentes y jóvenes se tienen en algunas ciudades de esos países. Ambos discursos nos permitieron identificar que estos adolescentes presentan comportamientos distantes de las identidades cristalizadas que les ubican, por ejemplo, como consumistas, violentos, soñadores, negligentes, apolíticos, entre otros y que, para algunos, la resolución a los conflictos advenidos con la adolescencia y relacionadas con las dinámicas de las AJC se da a través de la sustitución de sus nombres es decir, elaborando nuevas nominaciones y con ellas realizando procesos de importancia en la constitución de su subjetividad como la identificación, la constitución de lazo social y la manifestación de divergencias con el mundo adulto. Presentamos aquí dos casos de sustitución de nombres con apodos que develaron tendencias cínicas, criticidad y actitudes contestarías ante el mundo adulto y el universo de las normas.

In order to find evidence on how subjectivity processes occur in adolescents that make up youth city groups (AJC), how these groupings influence such constitutive processes, and how adolescents can solve their dilemmas, we conducted an intervention-oriented clinical investigation in Argentina and Colombia during the years 2013-2015. With the application of the cynical intervention method to academic research (MICAP), through speech spaces, clinical guidance interviews and journals (board and clinical), we were able to obtain singular speeches from AJC adolescents (48 in total). From these discourses, we extract the subjective exits of these adolescents. We also obtained, through observations and semi-structured interviews, private speeches that adolescents and young people have in two cities of these countries. Both discourses allowed us to identify that these subjects present behaviors that are far from the crystallized identities that put them, for example, as consumers, violent, dreamy, negligent, apolitical, among others, and that for some, conflict resolution of adolescence and related to the dynamics of the AJC occurs through the substitution of their own names, that is, elaborating new appointments and with them performing processes of importance in the constitution of their subjectivity as the identification, the constitution of the social bond and the manifestation of divergences with the adult world. We present here two cases of substitution of names with nicknames that revealed cynical tendencies, criticality and defiant attitudes of the adult world and the universe of norms.

Com o objetivo de encontrar evidências sobre como ocorrem processos de constituição de subjetividade em adolescentes que compõem agrupamentos juvenis de cidade (AJC), como esses agrupamentos influenciam tais processos constitutivos e como os adolescentes conseguem resolver seus dilemas, realizamos uma investigação-intervenção de orientação clínica na Argentina e na Colômbia durante os anos 2013-2015. Com a aplicação do método de intervenção cínica à pesquisa acadêmica (MICAP), por meio de espaços de fala, entrevistas de orientação clínica e diários (de bordo e clínico), conseguimos obter discursos singulares de adolescentes membros de AJC (48 no total). A partir desses discursos extraímos as saídas subjetivas desses adolescentes. Também obtivemos, através de observações e entrevistas semiestruturadas, discursos particulares que adolescentes e jovens têm em duas cidades desses países. Ambos os discursos nos permitiram identificar que tais sujeitos apresentam comportamentos distantes das identidades cristalizadas que os colocam, por exemplo, como consumidores, violentos, sonhadores, negligentes, apolíticos, entre outros, e que, para alguns, a resolução de conflitos da adolescência e relacionada à dinâmica do AJC ocorre através da substituição de seus nomes próprios, isto é, elaborando novas nomeações e com elas realizando processos de importância na constituição de sua subjetividade como a identificação, a constituição do vínculo social e a manifestação de divergências com o mundo adulto. Apresentamos aqui dois casos de substituição de nomes com apelidos que revelaram tendências cínicas, criticidade e atitudes contestadoras do mundo adulto e do universo das normas.

Reforçando a contribuição social de gênero: a servidora pública qualificada versus a executiva / Fortalecemiento de la contribución social del género: la servidora pública cualificada frente a la ejecutiva / Enforcing the social contribution of gender: the qualified female public servant versus the female executive

Resumo Este estudo constitui uma abordagem quantitativa com base na análise de um modelo hipotético sobre o serviço público e sua relação com a construção social em torno do gênero. O universo da pesquisa consiste em mulheres altamente qualificadas que trabalham no serviço público e em empresas privadas de médio e grande portes no Brasil. A amostra final foi composta por 1.464 questionários válidos; destes, 18,6% de servidoras públicas. Foram testadas hipóteses para verificar a relação de dependência entre as variáveis: rendimento da mulher em relação ao seu par amoroso e o tipo de carreira; responsabilidade da mulher pelas atividades do lar e o tipo de carreira; rendimento em relação ao seu par amoroso e responsabilidade pelas atividades do lar; tempo de cuidado das mulheres com seus filhos e o tipo de carreira; motivadores do interesse em permanecer na carreira.

Resumen Este estudio proporciona un enfoque cuantitativo basado en el análisis de un modelo hipotético del servicio público y su relación con la construcción social en torno al género. El universo de la investigación se limita a las mujeres altamente calificadas que trabajan en el servicio público y en las empresas privadas medianas y grandes en Brasil. Son 1.464 cuestionarios válidos, el 18,6 % de estos respondidos por servidoras públicas. Se probaron hipótesis para determinar la relación de dependencia entre las siguientes variables: rendimiento de la mujer con relación a su compañero y el tipo de carrera; responsabilidad de la mujer para con las actividades del hogar y el tipo de carrera; rendimiento con relación a su pareja y responsabilidad con las actividades del hogar; tiempo dedicado por las mujeres al cuidado de sus hijos y el tipo de carrera; factores motivadores de su interés en permanecer en la carrera.

Abstract This quantitative approach study analyzes a hypothetical model for the public service and its relationship with the social construction around gender. The research universe was limited to highly qualified women working in the public service and medium and large private companies in Brazil. From 1,464 valid questionnaires, 18.6% were completed by public servants. Hypotheses were tested to verify the relationship of dependence between the variables: women's income in relation to their husbands' and the type of career; women's responsibility for household chores and the type of career; women's and their husbands' income in relation to mutual responsibility for household chores; time spent by women and their husbands with their children and the type of career; and motivators of interest in remaining in the career.