Employing deuterium kinetic isotope effects to uncover the mechanism of (R)-3-hydroxybutyrate dehydrogenase.

Short-chain dehydrogenases/reductases (SDR) form a large enzyme superfamily playing important roles in health and disease. Furthermore, they are useful tools in biocatalysis. Unveiling the nature of the transition state for hydride transfer is a crucial undertaking toward defining the physicochemical underpinnings of catalysis by SDR enzymes, including possible contributions from quantum mechanical tunneling. Primary deuterium kinetic isotope effects can uncover the contribution from chemistry to the rate-limiting step and potentially provide detailed information on the hydride-transfer transition state in SDR-catalyzed reactions. For the latter, however, one needs to determine the intrinsic isotope effect: that which would be measured if hydride transfer were rate determining. Alas, as is the case for many other enzymatic reactions, those catalyzed by SDRs are often limited by the rate of isotope-insensitive steps, such as product release and conformational changes, which masks the expression of the intrinsic isotope effect. This can be overcome by the powerful yet underexplored method of Palfey and Fagan via which intrinsic kinetic isotope effects can be extracted from pre-steady-state kinetics data. SDRs are ideal systems to which this method can be applied. We have employed this approach to elucidate the transition states for hydride transfer catalyzed by NADH-dependent cold- and warm-adapted (R)-3-hydroxybutyrate dehydrogenase. Experimental conditions which simplify the analysis are discussed.

Archetype and epigenetics - approximations: contributions of epigenetics to the clinical practice of analytical psychology.

In this paper we address the question of epigenetics by evidencing some mechanisms related to gene expression, which, we understand, can in a way be used as metaphors for movements occurring during the psychotherapeutic process. The possibility of a dialogue between epigenetics and analytical psychology begins with the hereditary and archetypal question and takes shape in the dimension of the analytical encounter. Through the Jungian attitude model, we propose a way of moving between the two sciences. This paper provides a brief review of the concept of archetype, covering recent publications. It then describes the main mechanisms of epigenetics and, finally, addresses the analytical process and presents the authors' proposal to consider the archetypal expression in the light of epigenetics.

Dans cet article nous étudions la question de l'épigénétique en montrant quelques mécanismes en lien avec l'expression d'un gène. Nous pensons que, d'une certaine manière, ces mécanismes peuvent être utilisés en tant que métaphores des mouvements qui se produisent durant le processus thérapeutique. La possibilité d'un dialogue entre l'épigénétique et la psychologie analytique commence par la question héréditaire et archétypale, et prend forme dans la dimension de la rencontre analytique. A travers le modèle de l'attitude Jungienne nous proposons une manière de circuler d'une science à l'autre. Cet article offre un bref examen du concept d'archétype, couvrant les publications récentes. Il décrit ensuite les mécanismes principaux de l'épigénétique et s'occupe finalement du processus analytique en présentant la proposition de l'auteur qui est de considérer l'expression archétypale à la lumière de l'épigénétique.

En este trabajo abordamos el tema de la epigenética al evidenciar algunos mecanismos relacionados con la expresión genética, la cual puede ser utilizada como metáforas para los movimientos que suceden durante el proceso terapéutico. La posibilidad de un diálogo entre epigenética y psicología analítica comienza con la pregunta sobre la herencia y el arquetipo y toma forma en la dimensión del encuentro analítico. A través del modelo de actitud analítica, proponemos una forma de movimiento entre dos ciencias. El presente trabajo ofrece una breve revisión del concepto de arquetipo, abarcando publicaciones recientes. Luego describe los mecanismos principales de la epigenética y finalmente, aborda el proceso analítico y presenta la propuesta de las autoras de considerar la expresión arquetípica a la luz de la epigenética.

Neste artigo, abordamos a questão da epigenética evidenciando alguns mecanismos relacionados à expressão gênica, que, entendemos, podem de certa forma ser usados como metáforas para movimentos que ocorrem durante o processo terapêutico. A possibilidade de um diálogo entre epigenética e psicologia analítica começa com a questão hereditária e arquetípica e toma forma na dimensão do encontro analítico. Através do modelo de atitude junguiana, propomos uma maneira de nos mover entre duas ciências. Este artigo fornece uma breve revisão do conceito de arquétipo, abrangendo publicações recentes. Em seguida, descreve os principais mecanismos da epigenética e, finalmente, aborda o processo analítico e apresenta a proposta do autor de considerar a expressão arquetípica à luz da epigenética.

Allosteric Inhibition of Acinetobacter baumannii ATP Phosphoribosyltransferase by Protein:Dipeptide and Protein:Protein Interactions.

ATP phosphoribosyltransferase (ATPPRT) catalyzes the first step of histidine biosynthesis in bacteria, namely, the condensation of ATP and 5-phospho-α-d-ribosyl-1-pyrophosphate (PRPP) to generate N1-(5-phospho-ß-d-ribosyl)-ATP (PRATP) and pyrophosphate. Catalytic (HisGS) and regulatory (HisZ) subunits assemble in a hetero-octamer where HisZ activates HisGS and mediates allosteric inhibition by histidine. In Acinetobacter baumannnii, HisGS is necessary for the bacterium to persist in the lung during pneumonia. Inhibition of ATPPRT is thus a promising strategy for specific antibiotic development. Here, A. baumannii ATPPRT is shown to follow a rapid equilibrium random kinetic mechanism, unlike any other ATPPRT. Histidine noncompetitively inhibits ATPPRT. Binding kinetics indicates histidine binds to free ATPPRT and to ATPPRT:PRPP and ATPPRT:ATP binary complexes with similar affinity following a two-step binding mechanism, but with distinct kinetic partition of the initial enzyme:inhibitor complex. The dipeptide histidine-proline inhibits ATPPRT competitively and likely uncompetitively, respectively, against PRPP and ATP. Rapid kinetics analysis shows His-Pro binds to the ATPPRT:ATP complex via a two-step binding mechanism. A related HisZ that shares 43% sequence identity with A. baumannii HisZ is a tight-binding allosteric inhibitor of A. baumannii HisGS. These findings lay the foundation for inhibitor design against A. baumannii ATPPRT.

The Genes of Freedom: Genome-Wide Insights into Marronage, Admixture and Ethnogenesis in the Gulf of Guinea.

The forced migration of millions of Africans during the Atlantic Slave Trade led to the emergence of new genetic and linguistic identities, thereby providing a unique opportunity to study the mechanisms giving rise to human biological and cultural variation. Here we focus on the archipelago of São Tomé and Príncipe in the Gulf of Guinea, which hosted one of the earliest plantation societies relying exclusively on slave labor. We analyze the genetic variation in 25 individuals from three communities who speak distinct creole languages (Forros, Principenses and Angolares), using genomic data from expanded exomes in combination with a contextual dataset from Europe and Africa, including newly generated data from 28 Bantu speakers from Angola. Our findings show that while all islanders display mixed contributions from the Gulf of Guinea and Angola, the Angolares are characterized by extreme genetic differentiation and inbreeding, consistent with an admixed maroon isolate. In line with a more prominent Bantu contribution to their creole language, we additionally found that a previously reported high-frequency Y-chromosome haplotype in the Angolares has a likely Angolan origin, suggesting that their genetic, linguistic and social characteristics were influenced by a small group of dominant men who achieved disproportionate reproductive success.

Minimally invasive esophagectomy versus open esophagectomy: A systematic review and meta-analysis.

The paradigm of the treatment of esophageal cancer has been changing with the increasing use of minimally invasive esophagectomy (MIE) in detriment of open esophagectomy (OE). We aimed to perform a meta-analysis to evaluate and compare these two techniques in terms of mortality and associated complications. The literature search was conducted in MEDLINE and U.S. National Library of Medicine Clinical Trials, considering eligible articles since 2015 to 2020. Clinical trials and observational studies were included. We presented results as mean differences with 95% confidence intervals and calculation of heterogeneity associated to the included studies. Thirty-one articles were included with a total of 34,465 participants diagnosed with esophageal adenocarcinoma or squamous cell carcinoma. MIE had tendency towards a decrease in 30- and 90- day mortality after surgery, but no statistically significative results were found. Major cardiovascular and respiratory complications were less frequent in the MIE group, despite high heterogeneity. Also, MIE might contribute to a decrease of minor post-operative complications, to an increase need of a second surgical intervention, to a greater risk for vocal cord lesions; but these results were not statistically significant. Additionally, no differences were found concerning risk of wound infection and for local and systemic recurrence. MIE may be more beneficial than OE, but these findings should be considered carefully.

Transition States for Psychrophilic and Mesophilic (R)-3-Hydroxybutyrate Dehydrogenase-Catalyzed Hydride Transfer at Sub-zero Temperatures.

(R)-3-Hydroxybutyrate dehydrogenase (HBDH) catalyzes the NADH-dependent reduction of 3-oxocarboxylates to (R)-3-hydroxycarboxylates. The active sites of a pair of cold- and warm-adapted HBDHs are identical except for a single residue, yet kinetics evaluated at -5, 0, and 5 °C show a much higher steady-state rate constant (kcat) for the cold-adapted than for the warm-adapted HBDH. Intriguingly, single-turnover rate constants (kSTO) are strikingly similar between the two orthologues. Psychrophilic HBDH primary deuterium kinetic isotope effects on kcat (Dkcat) and kSTO (DkSTO) decrease at lower temperatures, suggesting more efficient hydride transfer relative to other steps as the temperature decreases. However, mesophilic HBDH Dkcat and DkSTO are generally temperature-independent. The DkSTO data allowed calculation of intrinsic primary deuterium kinetic isotope effects. Intrinsic isotope effects of 4.2 and 3.9 for cold- and warm-adapted HBDH, respectively, at 5 °C, supported by quantum mechanics/molecular mechanics calculations, point to a late transition state for both orthologues. Conversely, intrinsic isotope effects of 5.7 and 3.1 for cold- and warm-adapted HBDH, respectively, at -5 °C indicate the transition state becomes nearly symmetric for the psychrophilic enzyme, but more asymmetric for the mesophilic enzyme. His-to-Asn and Asn-to-His mutations in the psychrophilic and mesophilic HBDH active sites, respectively, swap the single active-site position where these orthologues diverge. At 5 °C, the His-to-Asn mutation in psychrophilic HBDH decreases Dkcat to 3.1, suggesting a decrease in transition-state symmetry, while the His-to-Asn mutation in mesophilic HBDH increases Dkcat to 4.4, indicating an increase in transition-state symmetry. Hence, temperature adaptation and a single divergent active-site residue may influence transition-state geometry in HBDHs.

Dissecting the Mechanism of (R)-3-Hydroxybutyrate Dehydrogenase by Kinetic Isotope Effects, Protein Crystallography, and Computational Chemistry.

The enzyme (R)-3-hydroxybutyrate dehydrogenase (HBDH) catalyzes the enantioselective reduction of 3-oxocarboxylates to (R)-3-hydroxycarboxylates, the monomeric precursors of biodegradable polyesters. Despite its application in asymmetric reduction, which prompted several engineering attempts of this enzyme, the order of chemical events in the active site, their contributions to limit the reaction rate, and interactions between the enzyme and non-native 3-oxocarboxylates have not been explored. Here, a combination of kinetic isotope effects, protein crystallography, and quantum mechanics/molecular mechanics (QM/MM) calculations were employed to dissect the HBDH mechanism. Initial velocity patterns and primary deuterium kinetic isotope effects establish a steady-state ordered kinetic mechanism for acetoacetate reduction by a psychrophilic and a mesophilic HBDH, where hydride transfer is not rate limiting. Primary deuterium kinetic isotope effects on the reduction of 3-oxovalerate indicate that hydride transfer becomes more rate limiting with this non-native substrate. Solvent and multiple deuterium kinetic isotope effects suggest hydride and proton transfers occur in the same transition state. Crystal structures were solved for both enzymes complexed to NAD+:acetoacetate and NAD+:3-oxovalerate, illustrating the structural basis for the stereochemistry of the 3-hydroxycarboxylate products. QM/MM calculations using the crystal structures as a starting point predicted a higher activation energy for 3-oxovalerate reduction catalyzed by the mesophilic HBDH, in agreement with the higher reaction rate observed experimentally for the psychrophilic orthologue. Both transition states show concerted, albeit not synchronous, proton and hydride transfers to 3-oxovalerate. Setting the MM partial charges to zero results in identical reaction activation energies with both orthologues, suggesting the difference in activation energy between the reactions catalyzed by cold- and warm-adapted HBDHs arises from differential electrostatic stabilization of the transition state. Mutagenesis and phylogenetic analysis reveal the catalytic importance of His150 and Asn145 in the respective orthologues.

Linear Eyring Plots Conceal a Change in the Rate-Limiting Step in an Enzyme Reaction.

The temperature dependence of psychrophilic and mesophilic ( R)-3-hydroxybutyrate dehydrogenase steady-state rates yields nonlinear and linear Eyring plots, respectively. Solvent viscosity effects and multiple- and single-turnover pre-steady-state kinetics demonstrate that while product release is rate-limiting at high temperatures for the psychrophilic enzyme, either interconversion between enzyme-substrate and enzyme-product complexes or a step prior to it limits the rate at low temperatures. Unexpectedly, a similar change in the rate-limiting step is observed with the mesophilic enzyme, where a step prior to chemistry becomes rate-limiting at low temperatures. This observation may have implications for past and future interpretations of temperature-rate profiles.

Acciones metodológicas para el mejoramiento ortográfico de los técnicos medios de la salud / Methodological actions for the spelling improvement of health technicians

Fundamento: es necesario fortalecer el componente ortográfico como expresión de dominio de la lengua materna y de la cultura de los técnicos medios de la salud, con la actuación conjunta de los docentes que imparten las distintas asignaturas. Objetivo: elaborar acciones metodológicas para el mejoramiento ortográfico de los técnicos medios de la salud. Métodos: se realizó una investigación de desarrollo en la Facultad de Tecnología de la Salud durante el curso 2014-2015. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo y el enfoque sistémico; empíricos: análisis documental, prueba pedagógica a la muestra de estudiantes y la encuesta en forma de cuestionario a docentes; y matemáticos estadísticos para los valores absolutos y relativos. Resultados: en el análisis documental del programa y las orientaciones metodológicas se detectó que la ortografía es tratada someramente, la prueba pedagógica mostró resultados significativos de prevalencia de errores ortográficos entre los estudiantes; y en el cuestionario aplicado a los docentes, a pesar de considerar estar bien preparados para el tratamiento de la ortografía, no lo demostraron en sus argumentos, por lo que se elaboraron acciones metodológicas para su capacitación. Conclusiones: las acciones son variadas, factibles de ser aplicadas por los docentes, independientemente de su especialidad, y fueron aprobadas por criterios de especialistas por su adecuado tratamiento metodológico, su pertinencia para la solución de la problemática, utilidad, factibilidad y novedad, y entre los aspectos a destacar se refieren al logro de una propuesta de uso común en todas las asignaturas, previa preparación de los docentes.

Background: it is necessary to strengthen the spelling component as an expression of good language command in the mother tongue and culture of health technicians, with the joint action of all teachers who teach different subjects. Objective: to develop methodological actions for the spelling improvement of health technicians. Methods: a development research work was carried out at the Health Technology Faculty during 2014-2015 academic year. Theoretical methods were used: analysis-synthesis and inductive-deductive and the systemic approach; empirical ones: documentary analysis, pedagogical test sample of students and the survey questionnaire to teachers; mathematical and statistical for absolute and relative values. Results: in the documentary analysis of the program and methodological guidelines was detected that spelling is treated briefly, pedagogical test showed significant prevailing misspelling results among students; and the questionnaire applied to teachers, although considered to be well prepared for the methodological treatment of spelling, they did not show their arguments, so methodological actions for training were developed. Conclusions: actions are varied, feasible to be implemented by teachers, regardless of specialty, and were approved by the criteria of specialists for proper methodological approach, its relevance to the solution of the problem, its utility, feasibility and novelty, and among notable aspects related to the achievement of a proposal for common use in all subjects, prior preparation of teachers.

Acciones metodológicas para el mejoramiento ortográfico de los técnicos medios de la salud / Methodological actions for the spelling improvement of health technicians

Fundamento: es necesario fortalecer el componente ortográfico como expresión de dominio de la lengua materna y de la cultura de los técnicos medios de la salud, con la actuaciónconjunta de los docentes que imparten las distintas asignaturas. Objetivo: elaborar acciones metodológicas para el mejoramiento ortográfico de los técnicos medios de la salud. Métodos: se realizó una investigación de desarrollo en la Facultad de Tecnología de la Salud durante el curso 2014-2015. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo y el enfoque sistémico; empíricos: análisis documental, prueba pedagógica a la muestra de estudiantes y la encuesta en forma de cuestionario a docentes; y matemáticos estadísticos para los valores absolutos y relativos.Resultados: en el análisis documental del programa y las orientaciones metodológicas se detectó que la ortografía es tratada someramente, la prueba pedagógica mostró resultadossignificativos de prevalencia de errores ortográficos entre los estudiantes; y en el cuestionario aplicado a los docentes, a pesar de considerar estar bien preparados para el tratamiento de laortografía, no lo demostraron en sus argumentos, por lo que se elaboraron acciones metodológicas para su capacitación. Conclusiones: las acciones son variadas, factibles de ser aplicadas por los docentes, independientemente de su especialidad, y fueron aprobadas por criterios de especialistas por su adecuado tratamiento metodológico, su pertinencia para la solución de la problemática, utilidad, factibilidad y novedad, y entre los aspectos a destacar se refieren al logro de unapropuesta de uso común en todas las asignaturas, previa preparación de los docentes(AU)

Judicialização da saúde e contribuições da teoria de justiça de Norman Daniels / Judicialization of health and contributions of the Norman Daniels’ theory of justice

A temática da judicialização da saúde gera discussão em várias áreas de conhecimento, com contribuições, em especial, de juristas, médicos e gestores públicos. Pela diversidade dos atores envolvidos, a gama de temas tratados é farta. Algumas teses destacam os argumentos positivos da judicialização da saúde, outras defendem a necessidade de se estabelecerem critérios ou limitações à atuação judicial. Outros estudos, ainda, ressaltam preocupações com as possíveis consequências negativas desse processo. No intuito de fundamentar uma análise sobre o tema, este artigo pretende realizar uma revisão bibliográfica e adota o instrumental teórico de Norman Daniels, que propõe uma reflexão sobre as necessidades de saúde e o modo como podemos atendê-las, a importância moral da saúde e a desigualdade de saúde considerada como injusta. Conclusivamente, verifica-se que algumas das teses defendidas no debate nacional não se sustentam perante os dados apresentados. A partir do pensamento de Daniels sobre a Teoria de Justiça voltada às questões de saúde, extrai-se do debate brasileiro que não há muitos conflitos quanto à importância moral especial do tema; além disso, há um silêncio quanto ao segundo aspecto da teoria, que se refere à reflexão sobre quando uma desigualdade de saúde pode ser considerada injusta. Propõe-se conclusivamente que a teoria de Daniels acrescente dois importantes pontos ao debate nacional. O primeiro relaciona-se à necessidade de situar os problemas de saúde dentro de uma reflexão maior sobre políticas públicas. E o segundo, quanto à necessidade de que a fixação de limites para o atendimento de demandas de saúde, encaixa-se em uma política pública que vise a melhor atender às necessidades da população, não sendo uma simples avaliação de custo-benefício.

The judicialization of health generates debate in various areas of knowledge, with particular contributions from legal experts, doctors, and policymakers. Because of the diversity of those involved, several topics are considered. Some studies highlight positive arguments for the judicializationof health, whereas others defend the need for establishing criteria for or limitations to judicial action. Furthermore, others still report concerns over the possible negative consequences of this process. In order to offer an analysis on this topic, this study provides a review of the literature and adopts the theoretical instrument by Norman Daniels, who proposes a reflection on the needs for health and the ways in which these needs can be met, the moral importance of health and the inequalities in health to be an injustice. In conclusion, it can be affirmed that some of these studiesdefended in the Brazilian national debate cannot be sustained in light of the data presented herein. Throughout Norman Daniels’ thoughts on the Theory of Justice in terms of questions of health,it can be deduced that, in the Brazilian debate, there are few conflicts over the moral importance of the topic; in addition, not much is known about the second aspect of the theory, which isthe reflection when inequality in health can be considered unjust. It is therefore proposed that Daniels’ theory adds two important points to the national debate. The first involves the need to place health problems within a greater reflection in public policy. The second, which involves the need to establish limits to meeting health demands, fits into a public policy that seeks to bettermeet the needs of the population, which is not a simple cost-benefit assessment.

Judicialização da saúde: analisando a audiência pública no Supremo Tribunal Federal / Legalization of health: analyzing public hearing in the Brazilian Supreme Federal Court

A audiência pública sobre judicialização da saúde, convocada em 2009 pelo Supremo Tribunal Federal, objetivou possibilitar o debate dos diversos setores envolvidos na busca por soluções judiciais. Este texto analisa a audiência à luz do referencial teórico de Nancy Fraser. Notam-se a ausência de falas sobre necessidades e a concentração da discussão em três focos: dispensação de medicamentos, alocação de recursos e função e interligação entre os três poderes. Para Fraser, o discurso político sobre necessidades abrange três momentos: (i) estabelecimento ou negação do status político de uma necessidade; (ii) interpretação da necessidade e poder de defini-la; e (iii) satisfação da necessidade. Conclusivamente, percebe-se a importância de que o debate sobre necessidades na área de saúde, incluindo o aspecto da judicialização, não se restrinja aos aspectos jurídicos, administrativos ou terapêuticos elencados por Fraser, mas busque avançar na definição e na satisfação das necessidades identificadas pelos diversos setores sociais...

La Audiencia Pública convocada sobre la judicialización de la salud en 2009 por el Supremo Tribunal Federal dirigida a facilitar la discusión de los diversos sectores implicados en la búsqueda de soluciones judiciales. Este texto pretende analizar esta audiencia a la luz del marco teórico de Nancy Fraser. Se observa la falta de discursos sobre las necesidades y la concentración de la discusión sobre tres enfoques: dispensación de medicamentos, de asignación de recursos y función y de interconexión entre los tres poderes. Para Nancy Fraser, el discurso político sobre las necesidades abarca tres fases: ( i ) la creación o la negación de la condición política de la necesidad; ( ii ) la interpretación de la necesidad y el poder de definirla y; ( iii ) el cumplimiento de la necesidad. En conclusión, se da cuenta de que la importancia del debate sobre las necesidades de atención de la salud, incluido el aspecto de la legalización, no se limita a los aspectos jurídicos, administrativos o terapéuticos enumerados por Fraser, pero tratan de avanzar en la definición y el cumplimiento de las necesidades identificadas por los diferentes sectores sociales...

Lesiones endoperiodontales y mortalidad dentaria / Endoperiodontal lesions and dental mortality

Introducción: la caries dental afecta la integridad de los dientes, pudiendo provocar lesiones endodónticas irreversibles que le confieren un carácter incurable a los mismos. El periodonto está anatómicamente interrelacionado con la pulpa dental. Las lesiones resultantes de la interacción entre la enfermedad pulpar y periodontal son conocidas como lesiones endoperiodontales. Objetivo: evaluar el comportamiento de las lesiones endoperiodontales en el área de salud de la Facultad de Estomatología de enero de 1998 a diciembre de 2002. Material y Métodos: para ello se realizó un estudio descriptivo, retrospectivo y transversal con las historias clínicas de pacientes atendidos con este diagnóstico en la Facultad de Estomatología de La Habana, en el período comprendido entre enero de 1998 y diciembre del 2002. La muestra quedó constituida por 124 historias clínicas pertenecientes a pacientes con dientes afectados por estas lesiones.Resultados: el 15,6 por ciento de los pacientes presentaron lesión endoperiodontal, 60,5 por ciento tuvieron la causa endodóntica como origen de las lesiones. El 42 por ciento de los dientes afectados tuvo que ser extraído debido a causas periodontales. Conclusiones: dentro de las causas que favorecieron el origen del objeto de estudio, el endodóntico ocupó el lugar cimero. Las terapéuticas más realizadas fueron la endodóntica y combinadas ocupando el primero y segundo lugares respectivamente. El porcentaje de lesiones endoperiodontales fue bajo, aunque la mortalidad dentaria por este tipo de afecciones fue alta y estuvo fundamentalmente relacionada con la causa periodontal, y con el grupo de 35 a 59 años de edad(AU)

Introduction: dental caries affects the integrity of the teeth and can cause irreversible endodontic lesions that confer an incurable character to them. The periodontium is anatomically interconnected with the dental pulp. Injuries resulting from the interaction between the pulp and periodontal disease are known as Endoperiodontal injuries.Objective: to evaluate the behavior of Endoperiodontal injuries in the policlinic belongs to The Havana Dentistry Faculty from January 1998 to December 2002.Material and Methods: descriptive, retrospective and cross-sectional study was performed using the medical records of patients seen with this diagnosis in the Faculty of Dentistry of Havana, in the period between January 1998 and December 2002. The sample was composed of 124 medical records belonging to patients with teeth affected by these injuries. Results: 15.6 pr ciento of patients had Endoperiodontal injury, 60.5 por ciento of patients had the cause and origin of endodontic lesions. 42 por ciento of the affected teeth had to be extracted due to periodontal reasons. Conclusions: among the causes that favored the origin of the object of study, endodontic occupied the top place. Therapeutic most performed were combined endodontic and occupying the first and second place respectively. The percentage of endoperiodontales lesions was low, although the tooth mortality such conditions was high and was mainly related to periodontal cause, and the group of 35 to 59 years old(AU)

[The judicialization of health in the Federal District of Brazil]. / A judicialização da saúde no Distrito Federal, Brasil.

This paper seeks to analyze the Judiciary's approach with respect to demands for the judicialization of the right to health by means of a case study of civil lawsuits for access to health care in Brazil's Federal District. Judicialization of the right to health signifies the judicialization of various of the health services provided. This is a descriptive and exploratory case study that covers the Federal District and uses mixed techniques to gather and analyze data. This study analyzed 385 lawsuits (87% of the total number of cases of judicialization of health for the period from 2005 to 2010 that reached the Appellate court). The results indicate that the most judicialized service is access to intensive care unit, followed by drugs and health care. Almost all lawsuits are filed by public defenders, with medical prescriptions and recommendations from the public health service. The results of this study challenge some dominant themes in the national debate, particularly the claim that judicialization is a phenomenon of the elites and that the services judicialized are drugs. The study does not seek to make generalizations, but highlights the fact that the phenomenon of judicialization of health has different aspects encompassed under the same concept.

A judicializacao da saude no Distrito Federal, Brasil / The judicialization of health in the Federal District of Brazil

Este artigo discute as tendências do Poder Judiciário frente às demandas sobre judicialização do direito à saúde, por meio de um estudo de demandas judiciais cíveis por acesso à assistência em saúde no Distrito Federal. Por judicialização do direito à saúde, entende-se a judicialização de variadas prestações de saúde. Trata-se de um estudo exploratório, descritivo, longitudinal, com uso de técnicas mistas de levantamento e análise dos dados coletados no DF. Foram analisadas 385 ações, o que corresponde a 87% do total de casos de judicialização da saúde do período entre 2005 e 2010 que alcançaram a 2ª Vara. Os resultados indicam que o principal bem judicializado é o acesso à UTI, seguido por medicamentos e assistência médica. A quase totalidade dos processos é apresentado por defensor público, com receitas e indicações médicas oriundas do serviço público de saúde. Em cerca de 8% dos casos, há comprovante de renda no processo com predominância dos valores em torno de R$ 500,00. Os resultados da pesquisa desafiam algumas teses dominantes no debate nacional, em particular a alegação de que é um fenômeno das elites e que o bem judicializado são os medicamentos. Os dados não têm pretensões generalizantes, mas aponta que o fenômeno da judicialização da saúde tem diferentes aspectos englobados pelo mesmo conceito.

This paper seeks to analyze the Judiciary's approach with respect to demands for the judicialization of the right to health by means of a case study of civil lawsuits for access to health care in Brazil's Federal District. Judicialization of the right to health signifies the judicialization of various of the health services provided. This is a descriptive and exploratory case study that covers the Federal District and uses mixed techniques to gather and analyze data. This study analyzed 385 lawsuits (87% of the total number of cases of judicialization of health for the period from 2005 to 2010 that reached the Appellate court). The results indicate that the most judicialized service is access to intensive care unit, followed by drugs and health care. Almost all lawsuits are filed by public defenders, with medical prescriptions and recommendations from the public health service. The results of this study challenge some dominant themes in the national debate, particularly the claim that judicialization is a phenomenon of the elites and that the services judicialized are drugs. The study does not seek to make generalizations, but highlights the fact that the phenomenon of judicialization of health has different aspects encompassed under the same concept.

Psicologia do desenvolvimento e estudo da cognição no adulto / Developmental psychology and aging cognition study

Quando se pensa, ou fala, nas alterações cognitivas ao longo da vida adulta, a idéia mais freqüente é a afirmação do declínio gradual das capacidades. Pretendemos com este trabalho rever e questionar alguns dos pressupostos que sustentam tal afirmação, assim como analisar algumas questões metodológicas envolvidas. Defendemos uma interpretação que transcenda os meros 'dados objectivos' e, simultaneamente, esperamos destacar as hipóteses que, à luz das investigações actuais, consideramos mais fidedignas e promissoras em termos de avaliação futura(AU)

Non-epileptic myclonus and mitochondrial encephalomyopathy

Foram examinados dois irmäos portadores de uma síndrome miclónica progressiva comn discretos sintomas cerebelares. O exame neurológico mostrava sinais cerebelares moderados e papilas pálidas; mioclonais assíncronas, arrítmicas e assimétricas, um déficit artrestésico e ausência de fraqueza muscular. A atividade de base do EEG era moderadamente lenta e sem atividade irritativa. A TC era normal em ambos os casos. A estimulaçäo fótica intemitente aumentava a freqüência dos abalos mioclônicos que se tornavam bilaterais e sincronos, progredindo para uma crise tônico-clônica generalizada. Potenciais evocados e RMN em um caso foram normais . Drogas anticonvulsivantes foram ineficazes no controle das mioclonias. O diagníostico de encefalomiopatia mitocondrial foi realizado através do achado em espécimes musculares de membranas basais espessadas, com degeneraçäo miofibrilar e um número elevado de mitocondrias distribuídos perifericamente e com uma matriz densa, granular e com alguns vacúolos. Os achados clínicos e eletrográficos sugerem uma origem subcortical para esta síndrome mioclônica