A associação entre os transtornos de linguagem receptivo e expressivo e os transtornos de aprendizagem / The association between receptive and expressive language disorders and learning disorders

O aprendizado e a linguagem são processos neuronais complexos, os quais possuem íntima ligação entre si. Diante disso, o transtorno de linguagem (TL) também está fortemente correlacionado aos transtornos de aprendizagem (TA), uma associação inicialmente observada no projeto de extensão "Construindo Histórias...", da PUC Minas, e confirmada pela literatura. Foi realizada uma busca de publicações dos últimos 15 anos, nas bases PubMed, LILACS, Up to Date e MedLine, utilizando os descritores Language Development Disorders, Child Languages, Language Development, Learning e Learning Disorders e suas traduções em português. Foram selecionadas 18 publicações e também o foi utilizado o livro Transtornos da aprendizagem. Os TL por definição são mudanças nos padrões normais do aprendizado da linguagem e podem ser classificados em expressivo e receptivo. Como resultado desse quadro, a criança apresenta dificuldades em compreender e de se expressar, o que está diretamente relacionado ao processo de aprendizagem e pode resultar em um TA. O diagnóstico desses transtornos deve ser realizado de maneira individualizada e observando a interação de fatores genéticos, fisiológicos, socioculturais e escolares. Conclui-se que os transtornos de linguagem e de aprendizado não afetam apenas a vida acadêmica, mas também a vida social, comportamental e psicológica e, por isso, é de extrema importância que ocorra um foco maior na detecção precoce desses transtornos, para que, assim, a criança receba um tratamento adequado e, consequentemente, tenha um prognóstico melhor. (AU)

Learning and language are complex neuronal processes, which have an intimate connection with each other. Therefore, language development disorder (LDD) or language impairment is also strongly correlated with learning disorders (LD), an association initially observed in the extension project "Constructing stories" at PUC Minas and confirmed by the literature. A search for publications from the last 15 years was carried out in the following outlets: PubMed, LILACS, Up to Date and MedLine using the descriptors Language Development Disorders, child languages, Language Development, Learning and Learning Disorders and their Portuguese version. Eighteen publications were selected and the book Transtornos da aprendizagem, 2016 was also used. LDD by definition are changes in normal language learning patterns and can be classified as expressive and receptive. Because of this situation, children have difficulties in understanding and expressing themselves, this is directly related to the learning process, which can result in an LD. The diagnosis of these disorders must be done individually and observing the interaction of genetic, physiological, sociocultural and school factors. It is worth noting that language and learning disorders not only affect academic life, but also social, behavioral and psychological life, and therefore it is extremely important that there is a greater focus on the early detection of these disorders, thus, children receive an appropriate treatment and, consequently, have a better prognosis. (AU)

Proteomics in Forensic Sciences: Identification of the Nature of the Last Meal at Autopsy.

A long-term psychiatric 40 years-old male patient was found dead at 9:00 a.m. in the clinic where he lived. Death was caused by traumatic injuries, which the sanitary staff imputed to a fall. Nurses declared that the patient refused having breakfast, whereas at autopsy the stomach contained 350 g of whitish semifluid material. Using both shotgun and gel-based proteomics, we demonstrated that the chyme contained partly digested milk- and bread-derived proteins, eaten during a recent breakfast. The conflict between evidence and assertions of the attending sanitary staff prompted the Legal Authority to undertake detailed investigations to ascertain facts and possible responsibilities. The herein characterization provides insights in the in vivo mechanisms of gastric breakdown of food proteins in a real meal. ß-lactoglobulin was partially resistant to gastric digestion as confirmed by Western blot analysis, in contrast to caseins and wheat gluten proteins, which had been degraded by gastric fluids. In addition to a complex pattern of gastric proteins (e.g., mucin-5AC, pepsin A-3, pepsinogen C, gastric lipase, gastrokine-2, trefoil factors), chyme contained intact proteins and variably sized food-derived polypeptides arising from peptic and nonpeptic proteolytic cleavage as well as heterodimeric disulfide-cross-linked peptides. These findings suggest that the current analytical workflows offer only a partial picture of the real complexity of the human "digestome".

A Síndrome da Exclusão Social: compreensão das origens da violência/ contraviolência no Brasil / The social exclusion syndrome: comprehension of the violence/counter-violence origins in Brazil

A indiferença humana no Brasil desde o início da colonização tem produzido e perpetuado o fenômeno da exclusão social. Um exemplo é a escravidão que durou cerca de 350 anos. Esse fenômeno excludente materializa-se ao produzir uma diversidade de fatores de risco biopsicossociais impactantes desde a gestação e em todos os períodos do ciclo de vida, acumulando e deixando sequelas profundas. Na década de 80 ocorreu interação sinérgica perversa entre o fenômeno da exclusão social e a entrada das drogas no nosso meio. A criança maior, o adolescente e o adulto jovem, muitas vezes socialmente vulneráveis, encontraram nas drogas duas possibilidades: a primeira, usar e abusar de drogas por várias razões, entre elas, baixa autoestima, para aliviar ansiedade e depressão, raiva; devido a uma personalidade extrovertida, impulsividade e inclinação ao comportamento de risco. E a segunda possibilidade, "empoderadora", entrar para o tráfico como meio de subir na vida e também por razões subjetivas. Esses caminhos quase sempre resultam em dependência química, "overdose", hospitalizações, práticas de atos infracionais, prisões, mortes e homicídios. O estudo indica que primariamente ocorreu violência histórica contra esse contingente populacional e que, muitas vezes, essa violência desencadeia um fenômeno também complexo, a contraviolência. A abordagem da violência/contraviolência deve focar, simultaneamente, sua origem (cultura da indiferença) e as consequências (fatores de risco e impactos biopsicossociais).(AU)

The human indifference in Brazil since the beginning of colonization has produced and perpetuated the phenomenon of social exclusion. The example is the slavery, which lasted about 350 years. This exclusive phenomenon has materialized itself as it has produced a diversity of biopsychosocial risk factors, which has impacted the individuals in all their life cycle periods from the gestation, accumulating and leaving their effects. In the 80's there was a perverse synergic interaction between the phenomenon of social exclusion and the entrance of drugs in our environment. The older child, the teenager and the young adult, socially vulnerables, find in drugs two possibilities: first, use and abuse of drugs for many reasons such as low self-esteem, to alleviate depression, anxiety and anger; due to an outgoing personality, impulsivity and more inclined to take risks; second possibility, "empowering", entering the drug trade as a way of getting ahead in life and also for subjective reasons. These pathways often always result in addiction, "overdose", hospitalization, infraction acts practice and also, arrests, deaths and homicides. The study of these cases in our history context shows that we face a primary historical violence against a huge population group that often this violence triggers a complex phenomenon, the counter-violence. The approach of violence/counter-violence should focus, simultaneously, on both the origin (culture of indifference) and the consequences (risk factors and biopsychosocial impacts).(AU)

A síndrome da exclusão social / The syndrome of social exclusion

Quero apresentar-lhe o livro ?A Síndrome da Exclusão Social? fruto do meutrabalho no período de 1978 a 2010 no Departamento de Pediatria da Faculdade de Medicina da Universidade Federal de Minas Gerais (FM-UFMG). O trabalho que originou o livro começou na segunda metade da década de 80. Naquela ocasião criei um ambulatório de Psiquiatria infantil, que funcionou certo período de tempo no ambulatório São Vicente de Paula do complexo do Hospital das Clínicas da FM-UFMG. Percebi, após alguns meses de funcionamento daquele ambulatório, que a maioria das crianças encaminhadas (de aglomerados, vilas, bairros distantes e mesmo do interior de minas) apresentava como queixas principais problemas relacionados à escola. Concluí que problemas escolares não deveriamser abordados em um ambulatório localizado no centro de Belo Horizonte,mas sim próximo do domicílio das pessoas onde melhor integração entre saúde e educação poderia ser mais promissora.

Quiste óseo traumático: presentación inusual en cóndilo mandibular / Traumatic bone cyst: a rare case in the mandibular condyle

Objetivo. Presentar un caso de un quiste óseo traumático localizado en el cóndilo mandibular. Caso clínico. Informamos de un caso de un quiste óseo traumático en el cóndilo mandibular de un paciente masculino de 24 años de edad que presentaba una lesión radiolúcida en la región que causaba expansión y perforación de ambas corticales óseas. Se realizó la exéresis de la lesión mediante un abordaje preauricular y otro submandiular. Conclusiones. Para su confirmación diagnóstica este peusodquiste, raramente encontrado en el cóndilo, requiere de la combinación de los datos de la anamnesis, de los hallazgos clínico-radiográficos y del estudio histopatológico de la pieza obtenida por la exploración quirúrgica.

Schwannoma lingual: presentación de un caso / Lingual schwannoma: a case report

El schwannoma o neurilemoma es un tumor benigno originado en las células de Schwann de la vaina nerviosa de nervios periféricos o intracraneales. Generalmente son solitarios. Las localizaciones más frecuentes son extremidades, cabeza y cuello y mediastino. De 25 a 40 por ciento de los casos se ubican en cabeza y cuello y aquí sólo el 1 por ciento son intraorales. En esta última localización, la lengua, es el sitio habitual de presentación, seguido en orden decreciente por paladar, mucosa bucal, labio y encías. Presentamos el caso de un paciente de sexo masculino de 38 años de edad que consulta por una tumoración lingual, la que se biopsia. El diagnóstico es schwannoma lingual. Se completa el tratamiento con resección quirúrgica de la neoformación.

Odanacatib in the treatment of postmenopausal women with low bone mineral density: three-year continued therapy and resolution of effect.

The selective cathepsin K inhibitor odanacatib (ODN) progressively increased bone mineral density (BMD) and decreased bone-resorption markers during 2 years of treatment in postmenopausal women with low BMD. A 1-year extension study further assessed ODN efficacy and safety and the effects of discontinuing therapy. In the base study, postmenopausal women with BMD T-scores between -2.0 and -3.5 at the lumbar spine or femur received placebo or ODN 3, 10, 25, or 50 mg weekly. After 2 years, patients (n = 189) were rerandomized to ODN 50 mg weekly or placebo for an additional year. Endpoints included BMD at the lumbar spine (primary), total hip, and hip subregions; levels of bone turnover markers; and safety assessments. Continued treatment with 50 mg of ODN for 3 years produced significant increases from baseline and from year 2 in BMD at the spine (7.9% and 2.3%) and total hip (5.8% and 2.4%). Urine cross-linked N-telopeptide of type I collagen (NTx) remained suppressed at year 3 (-50.5%), but bone-specific alkaline phosphatase (BSAP) was relatively unchanged from baseline. Treatment discontinuation resulted in bone loss at all sites, but BMD remained at or above baseline. After ODN discontinuation at month 24, bone turnover markers increased transiently above baseline, but this increase largely resolved by month 36. There were similar overall adverse-event rates in both treatment groups. It is concluded that 3 years of ODN treatment resulted in progressive increases in BMD and was generally well tolerated. Bone-resorption markers remained suppressed, whereas bone-formation markers returned to near baseline. ODN effects were reversible: bone resorption increased transiently and BMD decreased following treatment discontinuation.

The cathepsin K inhibitor odanacatib suppresses bone resorption in women with breast cancer and established bone metastases: results of a 4-week, double-blind, randomized, controlled trial.

BACKGROUND: Metastatic bone disease (MBD) is a frequent complication in patients with breast cancer and is associated with significant morbidity. This study assessed the pharmacokinetics, efficacy, and safety of odanacatib, a selective Cat K inhibitor, in reducing markers of bone resorption in women with breast cancer and MBD. PATIENTS AND METHODS: Women with breast cancer and MBD were randomized 2:1 (double-blind) to oral odanacatib 5 mg daily for 4 weeks or intravenous (I.V.) zoledronic acid (ZA) 4 mg given once at study initiation. Plasma samples were collected for pharmacokinetic analysis. Bone resorption was assessed by measuring urinary N-telopeptide of type I collagen corrected for creatinine (uNTx; primary objective, pmol BCE/µmol creatinine). Adverse events (AEs) were monitored throughout the 4-week study and up to 14 days after last dose. RESULTS: A total of 43 patients (mean age, 60 years) received odanacatib (n = 29) or ZA (n = 14); 40 patients completed 4 weeks of treatment. The mean percent change in uNTx values at week 4 was -77% (95% CI, -82 to -71; odanacatib) and -73% (95% CI, -80 to -62; ZA). Mean (standard deviation) plasma concentration of odanacatib was 511.7 (202.9) nM; the range was 63.7-844.8 nM. The most common AEs were nausea, vomiting, headache, and bone pain, which were generally not attributed to study drug. CONCLUSION: Odanacatib suppressed uNTx similarly to ZA after 4 weeks of treatment in women with breast cancer and MBD. Odanacatib was generally safe and well tolerated. These results suggest that Cat K inhibition is a potentially important, novel therapeutic approach for treating MBD.

Fractura de cóndilo mandibular: alternativas de tratamiento / Mandibular condyle fractures: treatment alternatives

Las fracturas mandibulares se presentan de manera frecuente en pacientes con trauma facial. Pueden ser la única manifestación traumática de o bien combinarse con otros trazos fracturarios del macizo facial. Las fracturas de cóndilo mandibular constituyen entre el 25 y el 35 por ciento de las lesiones del maxilar inferior y son provocadas en la gran mayoría de los casos por un mecanismos traumático indirecto. Los abordajes terapéuticos pordrían resumirse en dos grupos, los denominados tratamientos conservadores cerrados y los tratamientos abiertos, quirúrgicos, con fijación interna estable en alguna de sus formas. El objetivo de este trabajo es exponer las distintas alternativas de tratamiento y evaluar la eficacia de los mismos a corto y mediano plazo. Se realiza, además, una extensa revisión bibliográfica, comparando la evidencia encontrada con la experiencia acumulada en nuestro servicio.

Fractura mandibular como complicación de la exodoncia del tercer molar inferior / Mandibular fracture as a complication of lower third molar extraction

La exodoncia de los terceros molares retenidos es uno de los procedimientos más frecuentes en cirugía bucal y puede estar asociada con diferentes complicaciones, tales como alveolitis, infecciones secundarias, hemorragias y alteraciones nerviosas. La fractura de ángulo mandibular asociada con la extracción del tercer molar retenido es una complicación infrecuente que puede darse durante el acto quirúrgico, o bien en el postoperatorio inmediato. Presentaremos una serie de casos en los que la consecuencia del acto quirúrgico fue la fractura mandibular, estableciendo parámetros para el diagnóstico y tratamiento inicial de la complicación, así como para su resolución final.

Tratamiento de la sialolitiasis: informe de 22 casos / Treatment of sialolithiasis: report of 22 cases

La sialolitiasis es una patología obstructiva de las glándulas salivales caracterizada por la formación de cálculos en el interior del parénquima o del sistema ductal glandular. El presente estudio retrospectivo fue orientado a evaluar nuestros resultados en el tratamiento de esta afección. Se incluyeron 22 pacientes (12 mujeres, 10 hombres) tratados en nuestro hospital durante un periodo de 5 años. La edad promedio fue de 48,6 años. La glándula submaxilar se afectó en un 86,36 por ciento de los casos, mientras que la parótida lo hizo en un 13,64 por ciento. La sialolitiasis submaxilar se trató con submaxilectomía en 10 casos y con whartectomía para extraer el lito en 7. La sialolitiasis parotídea se trató con remoción intraoral del cálculo en un casoy con parotidectomía parcial en el otro. Se reigstró la expulsión espontánea del sialolito en 3 casos. Sólo se observaron complicaciones posteriores a subaxilectomía: hubo 2 casos de whartonitis, una parestesia transitoria del nervio lingual y una infección de la herida quirúrgica. En conclusión, el tratamiento de la sialolitiasis debe realizarse en función de la localización y tamaño de los cálculos presentes

Evaluation of the safety, pharmacokinetics and treatment effects of an alpha(nu)beta(3) integrin inhibitor on bone turnover and disease activity in men with hormone-refractory prostate cancer and bone metastases.

AIM: This study aimed to evaluate the safety, pharmacokinetics and treatment effects of an alpha(nu)beta(3) integrin inhibitor on bone turnover and disease activity in men with hormone-refractory prostate cancer (HRPC) and bone metastases. METHODS: A total of 21 patients with bone metastases and HRPC were randomized to receive MK-0429 200 mg b.i.d. or 1600 mg b.i.d. for 4 weeks. Toxicity, pharmacokinetics and markers of bone turnover and tumor activity were examined. RESULTS: Nausea was the most common adverse event: one (200-mg group) and 11 (1600-mg group) patients. At 4 weeks, mean AUC(0-12 h) was 210 mmol*h (200-mg group) and 673 mmol*h (1600-mg group); mean C(max) values were 42 mmol/L (200-mg group) and 154 mmol/L (1600-mg group). Urinary cross-linked N-telopeptides of type I collagen to creatinine ratio (uNTx), a bone turnover biomarker, showed a change from baseline of -43.4 percent (200-mg group) and -34.1 percent (1600-mg group). There was an increase in serum prostate specific antigen (PSA), a marker for disease activity, of 54.1 percent (200-mg group) and 44.5 percent (1600-mg group). CONCLUSION: MK-0429 was generally well tolerated, with the most common side-effect being nausea. There was some evidence of an early reduction of bone turnover, indicating a potential for clinical use in the treatment of MBD although serum PSA was unexpectedly increased during the study.

Tumor mixto benigno en paladar blando: revisión de la literatura y reporte de un caso / Benign mixed tumor in the soft palate: review of the literature and report of a case

Los tumores de glándulas salivales son relativamente infrecuentes y representan aproximadamente entre el 3% y el 10% de las neoplasias de la región de cabeza y cuello. El tumor mixto benigno (TMB) o adenoma pleomórfico (AP) es el tumor benigno más común de las glándulas salivales. Entre el 34% y el 86% de los casos se presentan en la glándula parótida. El paladar duro resulta la localización más frecuente para tumores de glándulas salivales menores intraorales. Las lesiones que involucran el paladar blando son infrecuentes. En este trabajo se realiza la presentación de un caso clínico de tumor mixto benigno en paladar blando acompañado de una minuciosa revisión bibliográfica.

Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial.

CONTEXT: The optimal duration of treatment of women with postmenopausal osteoporosis is uncertain. OBJECTIVE: To compare the effects of discontinuing alendronate treatment after 5 years vs continuing for 10 years. DESIGN AND SETTING: Randomized, double-blind trial conducted at 10 US clinical centers that participated in the Fracture Intervention Trial (FIT). PARTICIPANTS: One thousand ninety-nine postmenopausal women who had been randomized to alendronate in FIT, with a mean of 5 years of prior alendronate treatment. INTERVENTION: Randomization to alendronate, 5 mg/d (n = 329) or 10 mg/d (n = 333), or placebo (n = 437) for 5 years (1998-2003). MAIN OUTCOME MEASURES: The primary outcome measure was total hip bone mineral density (BMD); secondary measures were BMD at other sites and biochemical markers of bone remodeling. An exploratory outcome measure was fracture incidence. RESULTS: Compared with continuing alendronate, switching to placebo for 5 years resulted in declines in BMD at the total hip (-2.4%; 95% confidence interval [CI], -2.9% to -1.8%; P<.001) and spine (-3.7%; 95% CI, -4.5% to -3.0%; P<.001), but mean levels remained at or above pretreatment levels 10 years earlier. Similarly, those discontinuing alendronate had increased serum markers of bone turnover compared with continuing alendronate: 55.6% (P<.001) for C-telopeptide of type 1 collagen, 59.5% (P < .001) for serum n = propeptide of type 1 collagen, and 28.1% (P<.001) for bone-specific alkaline phosphatase, but after 5 years without therapy, bone marker levels remained somewhat below pretreatment levels 10 years earlier. After 5 years, the cumulative risk of nonvertebral fractures (RR, 1.00; 95% CI, 0.76-1.32) was not significantly different between those continuing (19%) and discontinuing (18.9%) alendronate. Among those who continued, there was a significantly lower risk of clinically recognized vertebral fractures (5.3% for placebo and 2.4% for alendronate; RR, 0.45; 95% CI, 0.24-0.85) but no significant reduction in morphometric vertebral fractures (11.3% for placebo and 9.8% for alendronate; RR, 0.86; 95% CI, 0.60-1.22). A small sample of 18 transilial bone biopsies did not show any qualitative abnormalities, with bone turnover (double labeling) seen in all specimens. CONCLUSIONS: Women who discontinued alendronate after 5 years showed a moderate decline in BMD and a gradual rise in biochemical markers but no higher fracture risk other than for clinical vertebral fractures compared with those who continued alendronate. These results suggest that for many women, discontinuation of alendronate for up to 5 years does not appear to significantly increase fracture risk. However, women at very high risk of clinical vertebral fractures may benefit by continuing beyond 5 years. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT 00398931.

Repetência e evasão escolar em classe socioeconomica desfavorecida: exemplos de indicadores de exclusão social / School failure and evasion of children of low social economic status: exemples of exclusion social indicators

Objetivo: Conhecer aspectos biopsicossociais de familiares e crianças com repetência escolar de classe socioecondmica desfavorecida e possíveis associações entre repetência, evasão e agravantes biopsicossociais. Método: O estudo foi desenvolvido em dois momentos. No primeiro, em 1990, foram escolhidas aleatoriamente 39 crianças das 465 que cursavam a 1 série, na qual aconteciam os mais altos índices de repetência. Foi utilizada metodologia descritiva Estudo de Caso. O roteiro da entrevista permitiu conhecer a história pregressa e o perfil bicpsicossocial das crianças. No segundo momento, em 1993, obteve-se o nível de escolaridade das 39 crianças. Posteriormente, em 2003, foram obtidas informações de duas crianças da amostra. Resultados: Constatou-se que a maioria das crianças foi exposta a muitos fatores de risco em idade precoce. À entrada para a escola, a maioria apresentava-se com vários problemas simultâneos de saúde, crescimento e desenvolvimento. Verificaram-se, também, múltiplos problemas nos familiares, entre os quais prejuízos na escolaridade, na qualificação profissional, na saúde física e/ou psíquica, renda, moradia. Identificaram-se muitos fatores de risco (circunstanciais, outros eram de natureza crônica) e outros foram incorporados à vida das crianças como os próprios impactos físicos e/ou psíquicos e o fracasso escolar. Todos contribuíram potencialmente para a perpetuação da repetência e do fracasso escolar. Conclusão: O trabalho aponta para a necessidade de se implantarem politicas públicas, alcançando as crianças precocemente, de forma a prevenir impactos em seu crescimento e desenvolvimento; aponta para a necessidade de interlocução intersetorial entre a saúde e educação, para a necessidade de parcerias com a comunidade e a valorização da atenção primária como estratégias da abordagem do fracasso escolar. Enfatiza que repetência e evasão escolar são alguns dos inúmeros sintomas da exclusão social. Assim, é uma tentativa de contribuir para a...

Objective: To know biopsychosocial aspects of children of low socioeconomic class and their families and possible with school failure and evasion. Methodology: The study was developed in two moments. In 1990, 39 out of 465 first grade children were randomly selected; this group had the highest indices of failure. Case-oriented approach was used. Personal interviews revealed the history and the psychological profile of the children. In 1993, the school level of the 39 children was obtained. In 2003 informations about two children of sample were obtained. Results: Most of the children had been submitted to many factors of risk before entering, school; On admission, most of them had health, growth, and development problems, The families faced many problems: low school levels, poor professional qualification, physical and/or psychological diseases, low income, poor housing conditions. Many eventual and chronic problems were detected. Some of those drawbacks had been incorporated by the children affecting school performance leading to failure and perpetuation of the phenomenon. Conclusion: There is na urgent need of implementing public politicies, to reach children precociously avoiding negative impacts in growth and development. School failure and evasion are, certainly, a consequence of the pre-school environment.

Problemas de ensino/aprendizagem: contribuiçöes para uma abordagem interdisciplinar / Teaching/learning problems: contribuitions to an interdisciplinary approach

O presente artigo pretende, através do relato de caso de um aluno de escola pública de Belo Horizonte, percorrer a prática e o referencial teórico existente em algumas áreas do conhecimento teórico da dificuldade de aprendizagem e do fracasso escolar, em especial nas áreas da saúde e educaçäo. Considera que essa tentativa de explicaçäo do fenômeno e a intervençäo de forma isolada, entre outros fatores, näo têm contribuído para a superaçäo dos índices de evasäo e repetência nas escolas. Coloca a necessidade de, através de açäo conjunta, principalmente em nível primário (centro de saúde, escola), compreender o aluno como um todo, como um sujeito de diversidades e compreender também os processos de ensino aprendizagem por que passam estes sujeitos.