Trend in mortality due to ill-defined causes in the state of Tocantins and in its capital Palmas, Brazil, 1998-2014. / Tendência da mortalidade por causas mal definidas no estado do Tocantins e na sua capital Palmas, 1998-2014.

OBJECTIVE: to evaluate the time trend of proportional mortality due to ill-defined causes, in Tocantins and Palmas, Brazil, 1998-2014. METHODS: this was a time trend study using data from the Mortality Information System (SIM) and the Death Verification Service (SVO); we evaluated the time trend of this type of this mortality using Joinpoint Regression. RESULTS: between 1998 and 2014, proportional mortality from ill-defined causes fell 88.5% in Tocantins and 88.1% in Palmas; the trend test indicated statistically significant inflection points in 1998-2004 (-4.14; p=0.001) for Tocantins and in 1998-2000 (-7.92; p<0.005) for Palmas; a certain degree of stability was observed with effect from 2004. CONCLUSION: there was a significant decline in proportional mortality due to ill-defined causes in Tocantins; however, it is still necessary to intensify actions aimed at improving the quality of information on mortality in some municipalities.

Gamma-hydroxybutyric acid induces oxidative stress in cerebral cortex of young rats.

GHB is a naturally occurring compound in the central nervous system (CNS) whose tissue concentration are highly increased during drug abuse and in the inherited deficiency of succinic semialdehyde dehydrogenase (SSADH) activity. SSADH deficiency is a neurometabolic-inherited disorder of the degradation pathway of gamma-aminobutyric acid (GABA). It is biochemically characterized by increased concentrations of gamma-hydroxybutyric acid (GHB) in tissues, cerebrospinal fluid (CSF), blood and urine of affected patients. Clinical manifestations are variable, ranging from mild retardation of mental, motor, and language development to more severe neurological symptoms, such as hypotonia, ataxia and seizures, whose underlying mechanisms are practically unknown. In the present study, the in vitro and in vivo effects of GHB was investigated on some parameters of oxidative stress, such as chemiluminescence, thiobarbituric acid-reactive substances (TBA-RS), total radical-trapping antioxidant potential (TRAP), total antioxidant reactivity (TAR), as well as the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) in homogenates from cerebral cortex of 15-day-old Wistar rats. In vitro, GHB significantly increased chemiluminescence and TBA-RS levels, while TRAP and TAR measurements were markedly diminished. In contrast, the activities of the antioxidant enzymes SOD, CAT and GPX were not altered by GHB in vitro. Acute administration of GHB provoked a significant enhance of TBA-RS levels and a decrease of TRAP and TAR measurements. These results indicate that GHB induces oxidative stress by stimulating lipid peroxidation and decreasing the non-enzymatic antioxidant defenses in cerebral cortex of young rats. If these effects also occur in humans, it is possible that they might contribute to the brain damage found in SSADH-deficient patients and possibly in individuals who consume GHB or its prodrug gamma-butyrolactone.

TDAH hackathon: inovação em saúde: app para auxiliar pacientes com transtorno de déficit de atenção e hiperatividade para a adesão ao tratamento / ADHD hackathon: health innovation: app to assist patients with attention deficit disorder and hyperactivity to treatment adherence

Este artigo apresenta o processo de ideação e prototipação de um aplicativo para auxílio de pacientes com TDAH no autogerenciamento de hábitos diários para uma maior adesão ao tratamento e no gerenciamento de tempo, agregando assim muito valor à sociedade. Este processo foi proposto na primeira edição do evento "Experiência HCPA ­ TDAH Hackathon". O método usado foi a pesquisa de campo com pacientes com TDAH e validação de hipóteses. Justifica-se pela necessidade de uma ferramenta confiável, permitindo que os pacientes com TDAH possam centralizar as ações em apenas um aplicativo no celular: seus compromissos, lembretes de medicação e gerenciamento de tempo, entre outras facilidades, sendo o meio mais viável e efetivo para a adesão ao tratamento. (AU)

This article presents the process of ideation and prototyping of an application to helppatients with ADHD in self-management of daily habits to a greater adherence to treatment and time management, thus adding a lot of value to society. This process was proposed in the first edition of the HCPA Experience ­ ADHD Hackathon event. The method used was field research of patients with ADHD and validation of hypotheses. The need for a reliable tool is justified, where ADHD patients will be able to centralize their appointments, medication reminders, time management, among other facilities in just one mobile application, being the most viable and effective means of adhering to treatment. (AU)

Astrocyte stellation in saline media lacking bicarbonate: possible relation to intracellular pH and tyrosine phosphorylation.

Primary cultures of astrocytes exhibit a polygonal morphology, but on treatment with agents that increase cAMP they change to stellate cells. We found that astrocyte stellation also occurred on replacing the culture medium with saline buffered with HEPES. However, stellation did not occur when the medium was replaced with saline buffered with bicarbonate/CO(2) provided Ca(2+) was present. Since exposure of astrocytes to media lacking bicarbonate results in a decrease in intracellular pH (pH(i)) we sought evidence for an association between pH(i) and morphology. Astrocytic pH(i) was monitored for 60 min after transferring the cells to HEPES or bicarbonate-buffered saline. HEPES-induced stellation was associated with transient acidification which coincided with the morphological changes. Acidification was not observed in cells transferred to bicarbonate-saline. However when cytoplasmic acidification of cells in bicarbonate-saline was induced pharmacologically, rapid stellation occurred. Stellation induced by cAMP is reversed by activation of the RhoA pathway with lysophosphatidic acid (LPA). Here we found that LPA inhibited HEPES-induced stellation, but only with Ca(2+) present. Inhibition of stellation by LPA+Ca(2+) was associated with transient acidification followed by modest alkanization. A close association of tyrosine phosphorylation with stellation and pH(i) was observed. Thus incubation of astrocytes in HEPES-saline with orthovanadate to inhibit dephosphorylation abolished stellation and acidification; conversely incubation of cells in bicarbonate-saline with genistein to inhibit tyrosine kinases caused stellation and major acidification. Acidification may be one of several factors resulting in stellation, but it is not a necessary factor since stellation without acidification was observed in bicarbonate-saline lacking Ca(2+).

Tendência da mortalidade por causas mal definidas no estado do Tocantins e na sua capital Palmas, 1998-2014 / Tendencia de mortalidad por causas mal definidas en el estado de Tocantins y en su capital Palmas, Brasil, 1998-2014 / Trend in mortality due to ill-defined causes in the state of Tocantins and in its capital Palmas, Brazil, 1998-2014

Objetivo: avaliar a tendência temporal da mortalidade proporcional por causas mal definidas no Tocantins e em Palmas, Brasil, em 1998-2014. Métodos: estudo de tendência temporal, utilizando dados do Sistema de Informações sobre Mortalidade (SIM) e do Serviço de Verificação de Óbitos (SVO); a tendência temporal dessa mortalidade foi avaliada mediante emprego da Regressão Joinpoint. Resultados: de 1998 a 2014, a mortalidade proporcional por causas mal definidas foi reduzida em 88,5% no Tocantins e 88,1% em Palmas; o teste de tendência indicou pontos de inflexão estatisticamente significante em 1998-2004 (-4,14; p=0,001) para Tocantins e em 1998-2000 (-7,92; p<0,005) para Palmas; a partir de 2004, observou-se certa estabilidade. Conclusão: a redução da mortalidade proporcional por causas mal definidas no Tocantins e em Palmas foi bastante expressiva; todavia, ainda se faz necessária a intensificação de ações voltadas para melhoria da qualidade da informação sobre mortalidade em alguns municípios.

Objetivo: evaluar la tendencia temporal de la mortalidad proporcional por causas mal definidas en Tocantins y Palmas, Brasil, en 1998-2014. Métodos: Estudio de tendencia temporal, utilizando datos del Sistema de Información sobre Mortalidad (SIM) y Servicio de Verificación de Óbitos (SVO); la tendencia temporal de dicha mortalidad fue evaluada mediante empleo de la Regresión Joinpoint. Resultados: de 1998 a 2014, la mortalidad proporcional por causas mal definidas bajó 88,5% en Tocantins y 88,1% en Palmas; la prueba de tendencia indicó puntos de inflexión en 1998-2004 (-4,14; p=0,001) para Tocantins y en 1998-2000 (-7,92; p<0,005) para Palmas; a partir de 2004, se observó cierta estabilidad. Conclusión: la reducción de la mortalidad proporcional por causas mal definidas en Tocantins y Palmas fue bastante expresiva; sin embargo, aún se hace necesaria la intensificación de acciones dirigidas a mejorar la calidad de la información sobre mortalidad en algunos municipios.

Objective: to evaluate the time trend of proportional mortality due to ill-defined causes, in Tocantins and Palmas, Brazil, 1998-2014. Methods: this was a time trend study using data from the Mortality Information System (SIM) and the Death Verification Service (SVO); we evaluated the time trend of this type of this mortality using Joinpoint Regression. Results: between 1998 and 2014, proportional mortality from ill-defined causes fell 88.5% in Tocantins and 88.1% in Palmas; the trend test indicated statistically significant inflection points in 1998-2004 (-4.14; p=0.001) for Tocantins and in 1998-2000 (-7.92; p<0.005) for Palmas; a certain degree of stability was observed with effect from 2004. Conclusion: there was a significant decline in proportional mortality due to ill-defined causes in Tocantins; however, it is still necessary to intensify actions aimed at improving the quality of information on mortality in some municipalities.

5-Oxoproline reduces non-enzymatic antioxidant defenses in vitro in rat brain.

5-Oxoproline (pyroglutamic acid) accumulates in glutathione synthetase deficiency, an inborn metabolic defect of the gamma-glutamyl cycle. This disorder is clinically characterized by hemolytic anemia, metabolic acidosis and severe neurological disorders. Considering that the mechanisms of brain damage in this disease are poorly known, in the present study we investigated whether oxidative stress is elicited by 5-oxoproline. The in vitro effect of (0.5-3.0 mM) 5-oxoproline was studied on various parameters of oxidative stress, such as total radical-trapping antioxidant potential, total antioxidant reactivity, chemiluminescence, thiobarbituric acid-reactive substances, sulfhydryl content, carbonyl content, and 2',7'-dichlorofluorescein fluorescence, as well as on the activities of the antioxidant enzymes catalase, superoxide dismutase and glutathione peroxidase in cerebral cortex and cerebellum of 14-day-old rats. Total radical-trapping antioxidant potential and total antioxidant reactivity were significantly reduced in both cerebral structures. Carbonyl content and 2',7'-dichlorofluorescein fluorescence were significantly enhanced, while sulfhydryl content was significantly diminished. In contrast, chemiluminescence and thiobarbituric acid-reactive substances were not affected by 5-oxoproline. The activities of catalase, superoxide dismutase and glutathione peroxidase were also not altered by 5-oxoproline. These results indicate that 5-oxoproline causes protein oxidation and reactive species production and decrease the non-enzymatic antioxidant defenses in rat brain, but does not cause lipid peroxidation. Taken together, it may be presumed that 5-oxoproline elicits oxidative stress that may represent a pathophysiological mechanism in the disorder in which this metabolite accumulates.

Citrulline and ammonia accumulating in citrullinemia reduces antioxidant capacity of rat brain in vitro.

Citrullinemia is an inborn error of the urea cycle caused by deficient argininosuccinate synthetase, which leads to accumulation of L-citrulline and ammonia in tissues and body fluids. The main symptoms include convulsions, tremor, seizures, coma, and brain edema. The pathophysiology of the neurological signs of citrullinemia remains unclear. In this context, we investigated the in vitro effects of L-citrulline and ammonia in cerebral cortex from 30-day-old rats on oxidative stress parameters, namely thiobarbituric acid-reactive substances (TBA-RS), chemiluminescence, mitochondrial membrane protein thiol content, intracellular content of hydrogen peroxide, total radical-trapping antioxidant potential (TRAP), total antioxidant reactivity (TAR) as well as on the activities of the antioxidant enzymes (catalase, superoxide dismutase, and glutathione peroxidase). L-Citrulline significantly diminished TRAP (26%) and TAR (37%), while ammonia decreased TAR (30%). Ammonia increased SOD activity (65%) and L-citrulline did not affect the activities of any antioxidant enzymes. We also observed that L-citrulline and ammonia did not alter lipid peroxidation parameters, levels of hydrogen peroxide, and mitochondrial membrane protein thiol content. Taken together, these results may indicate that L-citrulline and ammonia decreased the antioxidant capacity of the brain, which may reflect a possible involvement of oxidative stress in the neuropathology of citrullinemia.

Culpa e castigo / Mourning and punishment

Visando contribuir para a compreensão da psique feminina e a prevenção da saúde mental e física da mulher, a autora apresenta um estudo sobre uma paciente atendidaem Psicoterapia Psicanalítica, cujo mundo mental estava cindido, sob a égide da crueldade do superego. Idealizava a si mesma, a figura masculina, a relação homem-mulher. Casada, vivia buscando a realização da fantasia edípica. Frustrada, buscou amantes. Nessa situação, o ato da concepção tornou-se uma possibilidade de vingança e punição, ao permitir-se ficar grávida e infligir-se abortos. Sob o tormento da culpa moral, estava incapacitada para elaborar e reparar. Assim, impossibilitada de utilizar o conhecimento básico que possuía sobre concepção e contracepção, corria perigos de toda ordem.

This study intends to contribute to a better comprehension of the female psyche and prevention of woman’s physical disease, and mental health. For this purpose, the author presents a case of a patient under psychoanalytical psychotherapy, whose mental world was sundered under the aegis of the super-ego’s cruelty. She idealized herself, the male figure, and the relation man-woman. As a married woman, she kept searching for the fulfillment of her Oedipal fantasy. Once frustrated, she searched for lovers. In this situation, the act of conception became a possibility of revenge and punishment, as she allowed herself to be pregnant and inflict herself abortions. Under the torment of moral guilt, she was unable to work-through and make reparations. This way, she kept taking all sorts of risks, incapable of using her basic knowledge of conception and contraception.