Estudo genético-clínico de mucopolissariodoses no estado do Ceará

As mucopolissacaridoses (MPS) são doenças genéticas raras decorrente da deficiência de enzimas lisossomais envolvidas no catabolismo de glicosaminoglicanos, resultando em um amplo espectro de manifestações clínicas, progressivas e multissistêmicas, exigindo tratamento por uma equipe multidisciplinar. Embora o Nordeste brasileiro seja uma região com grande taxa de consangüinidade e um efeito fundador envolvendo MPS, não há estudos caracterizando os pacientes dessa região. Nosso objetivo foi determinar o perfil epidemiológico, clínico e genético de casos não publicados com MPS provenientes do Ceará, identificando as diferenças entre outros estudos com MPS e possíveis problemas a serem enfrentados para a realização do diagnóstico precoce. O estudo foi seccional, descritivo, com amostra de pacientes com MPS em acompanhamento no Hospital Infantil Albert Sabin e Hospital Geral Cesar Cals no período de 2006-2013. Os dados foram obtidos a partir da avaliação clínica, revisão de prontuários médicos e entrevista com os pacientes e/ou familiares realizadas pelo investigador principal. Cinquenta e três pacientes foram incluídos no estudo (36 do sexo masculino), sendo 6 MPS I, 17 MPS II, 7 MPS III (3 MPSIII-A, 3 MPS III-B, 1 MPS III-C), 7 MPS IV-A, 16 de MPS VI. O óbito ocorreu em 16 casos (3 MPS I, MPS II 6, 1 MPS IIIA , IIIB 1MPS , 1 MPS IV , 4 MPS VI). A amostra foi composta principalmente por crianças. Houve elevada taxa de consangüinidade e recorrência familiar. Os tipos mais comuns foram MPS II e MPS VI. Exceto para macrossomia em MPS II, os dados de nascimento indicam que não houve risco para desenvolvimento de viii complicações perinatais. Os sintomas iniciaram em crianças com menos de 2 anos. As manifestações clínicas foram heterogêneas exceto para atraso no desenvolvimento neurológico em MPS III e manifestações esqueléticas em MPS IV. As principais características clínicas foram macrocefalia, baixa estatura, alterações odontológicas, respiratórias, cardíacas, hepatoesplenomegalia, hérnia umbilical, rigidez articular e anormalidades esqueléticas. A terapia de reposição enzimática foi instituída em 26 casos (4 MPS I, 10 MPS II, 12 MPS VI). Os problemas sócio-econômicos das famílias, o amplo espectro de sintomas e a gravidade da doença foram causas das dificuldades em realizar a avaliação periódica pela equipe multidisciplinar, além de exames complementares de maior custo para determinar as complicações da doença. Este foi o maior estudo transversal sobre MPS no Nordeste do Brasil. Em contraste com a maior incidência de MPS I na maioria das populações ocidentais, houve maior incidência de MPS II e VI. As alterações respiratórias foram um dos principais contribuintes para a mortalidade precoce, exceto nos casos de MPS I, em que a cardiomiopatia foi prevalente. A menor expectativa de vida ocorreu em MPS I. O envolvimento cognitivo foi comum em casos graves e o maior número de órgãos envolvidos representou maior risco de morrer. Para o diagnóstico precoce, deve-se buscar indivíduos afetados em famílias em que há parentes com MPS, além do maior reconhecimento de sinais e sintomas de MPS por profissionais de saúde

Síndrome metabólica e fatores de risco relacionados em crianças e adolescentes com excesso de peso na cidade do Natal

Nas últimas décadas, houve grande aumento da prevalência de obesidade, inclusive na faixa etária pediátrica. Com isso, aumentou o número de crianças e adolescentes afetados por síndrome metabólica (SM), diabetes tipo 2 (DM2) e doenças cardiovasculares (DCV), doenças anteriormente consideradas quase exclusivas de adultos. Os objetivos do estudo foram identificar e correlacionar marcadores antropométricos (IMC- índice de massa corpórea, CA- circunferência abdominal, RCQ- razão cintura/quadril, RCArazão cintura altura e PSE- prega subescapular), PAS e PAD- pressão arterial sistólica e diastólica, respectivamente, e laboratoriais (CT- colesterol total, HDL, LDL, TGL- triglicérides, I/G- razão insulina glicose, HOMA- homeostatic model assessment for insulin resistance) de risco para o desenvolvimento de SM e observar a sua prevalência em crianças e adolescentes com excesso de peso. Foi conduzido estudo transversal, em amostra aleatória, de conveniência, onde foram avaliadas 60 crianças e adolescentes com excesso de peso, atendidas no ambulatório de endocrinologia pediátrica do Hospital de Pediatria da Universidade Federal do Rio Grande do Norte (UFRN) com idade mínima e máxima de 7 e 15 anos, de maio de 2009 a abril de 2010. Foram admitidos os indivíduos que apresentavam sobrepeso (IMC P > 85 e < 95) ou obesidade (IMC P > 95) (CDC, 2000) e história familiar positiva para DM2 em parentes de primeiro ou segundo grau ou algum dos sinais de resistência insulínica (acantose, hipertensão arterial, dislipidemia, síndrome de ovários policísticos). 2 O componente individual para SM mais prevalente foi o percentil da CA ≥ 90 (58,3%), seguido de HDL ≤ 40 mg/dl (36,6%). Na regressão linear simples, observaram-se as variações para mais nos parâmetros laboratoriais e de PA para cada unidade de aumento de IMC, CA, RCA, RCQ e PSE, sendo significantes as seguintes correlações: CA com TGL, HOMA IR, I/G, PAS e PAD; RCQ com TGL, HOMA, I/G, LDL e glicemia; RCA com TGL; PSE com TGL, HOMA-IR, I/G e PAS; e IMC com HOMA IR, I/G, PAS e PAD. De acordo com os critérios da IDF (Federação Internacional de Diabetes International Diabetes Federation) 2007, o diagnóstico de SM foi encontrado em seis indivíduos (10%). Do total, oito (13,3%), estavam em situação de sobrepeso e 52 (86,6%), obesos. As evidências de correlação CA e RCQ, medidas de obesidade centrípeta, com vários marcadores como TGL e HOMA, já sabidamente relacionados à SM, chamam atenção para a necessidade de utilização dessas medidas de forma mais rotineira na prática pediátrica, por serem de fácil obtenção, baixo custo e método não invasivo. Os valores de CA, RCQ, RCA e PSE, quando elevados devem justificar maior detalhamento na avaliação laboratorial de possível resistência insulínica. É importante a identificação de crianças e adolescentes que preencham os requisitos para o diagnóstico da SM, pois são indivíduos de maior risco metabólico e devem ser adequadamente acompanhados.

Efeitos da deficiência de vitamina A na função pulmonar de crianças após infecção respiratória viral

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Ação da cafeína sobre o rendimento esportivo de ciclistas em condições de calor e umidade

Objetivo: Verificar a ação da cafeína no tempo de rendimento, a taxa de esforço percebido (RPE), os níveis plasmáticos de glicose, sódio e potássio, a temperatura timpânica (Tt), o peso corporal (PC), freqüência cardíaca (FC) e concentração urinária da cafeína com a ingestão de doses de 5 e 9 mg/kg de cafeína e placebo, em provas ciclísticas sob condições de alto risco térmico. Métodos: Foram estudados 8 ciclistas treinados e aclimatizados em 3 provas de 45 km utilizando o modelo experimental e duplo-cego com randomização intra-sujeitos. Resultados: Não foram observadas diferenças significativas entre as variáveis avaliadas, entretanto o tempo de rendimento e a RPE foram menores com as doses de 5 e 9 mg/kg de cafeína que com a dose placebo. Conclusões: Estes dados indicam que as condições de calor e umidade podem ser suficientes para mascarar o benefício ergogênico da cafeína, entretanto deve-se considerar que a cafeína pode exercer influencia sobre a percepção subjetiva de esforço podendo levar à redução dos sinais de fadiga durante o exercício e conseqüente melhora do desempenho esportivo

Análise das mutações C282Y e H63D no gene da proteína HFE em pacientes com hiperferritinemia

Hereditary Hemochromatosis (HH) is a genetic disease caused by high iron absorption and deposition in several organs. This accumulation results in clinical disturbances such as cirrhosis, arthritis, cardiopathies, diabetes, sexual disorders and skin darkening. The H63D and C282Y mutations are well defined in the hemochromatosis etiology. The aim of this paper was that of identifying the H63D and C282Y genetical mutations in the hemochromatosis gene and the frequency assessment of these mutations in the HFE protein gene in patients with hyperferritin which are sent to the DNA Center laboratory in Natal, state of Rio Grande do Norte. This paper also evaluates the HH H63D and C282Y gene mutations genotype correlation with the serum ferritin concentration, glucose, alanine aminotransferasis, aspartato aminotransferasis, gama glutamil transferasis and with the clinical complications and also the interrelation with life habits including alcoholism and iron overload. The biochemical dosages and molecule analyses are done respectively by the enzymatic method and PCR with enzymatic restriction. Out of the 183 patients investigated, 51,4% showed no mutation and 48,6% showed some type of mutation: 5,0% were C282Y heterozygous mutation; 1,1%, C282Y homozygous mutation; 31%, H63D heterozygous mutation; 8,7%, H63D homozygous mutation; and 3,3%, heterozygous for the mutation in both genes. As to gender, we observed a greater percentage of cases with molecular alteration in men in relation to women in the two evaluated mutations. The individuals with negative results showed clinical and lab signs which indicate hemochromatosis that other genes could be involved in the iron metabolism. Due to the high prevalence of hemochromatosis and taking into account that hemochromatosis is considered a public health matter, its gravity being preventable and the loss treatment toxicity, the early genetic diagnosis is indicated, especially in patients with high ferritin, and this way it avoids serious clinical manifestations and increases patients' life expectation. Our findings show the importance of doing such genetic studies in individuals suspected of hereditary hemochromatosis due to the high incidence of such a hereditary disease in our region

Avaliação da presença de osteopatia decorremte do diabetes tipo 1 em criança e adolecentes do Rio Grande do Norte

Diabetes Mellitus (DM) and osteoposes are chronic diseases with great socioeconomic consequences, mainly due to the late complications and consequent disabilities. The potential effects of DM on bone metabolism remain a very conroversial issue, and disagreement exists with regard to the clinical implications of diabetic osteopenia and the mechanism of its ocurrence. The issue is further complicated by the contribuicion of the especific factors, such as duration of disease an dthe degree of metabolic control. The objective of this study is to identify the osteopathy in children and adolescents with DM 1 assisted in the hospital of pediatrics, UFRN, through biochemical markers of bone and mineral metabolism and the extent of bone mineral density. The study was composed by 74 diabetics type 1 patients (DM1) of both gender and aged 6 to 20 yars. Normoglicêmic group was composed by 97 healthy subjects of both genders, which showed the same age range of DM1, in addition to same socioeconomic class. These individuals qere students from the networks of public education in the city of Natal-RN, randomly invited to paticipate in our study. Both groups DM1 and NG were divided intofour subgroups, according to the classification of tanner , T1, T2, T3, T4 for achieving a benchmark. Diabetic individuals showed up with a poor glycemic control. the group DN1 T4 showed an incresead value for total protein, albumin, urea and microalbumiuria are predictors of grumelura injury in DM1 patients . The total alkaline phosphatase activitywas kept on high levels for both groups because they are in a stature development age. For osteocalcin there were decreased levels for groups Dm1 T1, T2, and T3 when compared to their NG (s), suggesting that this decrease could be associated with reduction in the number and/or differentiation os osteoblasts thereby contributing to reducing bone formation. There were no changes in the activity of TRAP. The serum concentrations of total and ionized calcium, phosphorus and magnesium were included within the RV. It was observed that the BMD (Z- SCORE ) has always been within the RV for both groups, despite to DM1 T4. Taking all together, our results support the hypothesis that children and adolescents with type 1 DM present the risk in the long run to suffer a reduction in the bone mass, associated to poor glicemic control and disease duration. It could limit the bone growth and increase the probality of development of osteopenia, as well as other complications surch as retinopathy and renal failure

Memória e cultura: os Fulni-ô afirmando identidade étnica

Ce travail s agit du processus d´affirmation de l´identité Fulni-ô et de la mobilisation ethnique du groupe qui sont organisées et maintenues en bénéfice de leurs droits; ceux-ci consistent en la reconnaissance comme indiens devant la société et leurs droits sur le territoire. Le groupe est situé dans la municipalité d´Águas Belas, localisé entre l´ agreste et le sertão de l´état du Pernambuco. Ce sont, en moyenne, 3.676 indiens qui présentent comme signes d´identification ethnique: le Yathê, langue spécifique du groupe qui continue à être utilisée au quotidien; l´Ouricuri, terme qui désigne le rituel qui a lieu pendant le printemps et pendant des périodes spécifiques de l´année; le Toré, danse commune aux indiens du Nordeste. La mémoire et la matière culturelle sont les signes de mobilisation ethnique sélectionnés par les Fulni-ô pour favoriser l´affirmation de leur identité et la protection de leurs droits. Cet aspect sera traité tout au long de ce travail. La mobilisation ethnique est permanente, les Fulni-ô ne cessent d´utiliser des moyens qui peuvent les aider à vivifier leur identité et à protéger l´intégrité de leur territoire. Au travers de la mémoire ou grâce à l´utilisation de signes et de symboles ethniques (comme la langue, le rituel religieux et le Toré) ils consolident l´idée qu´ils sont indiens en même temps qu´ils établissent et défendent leurs frontières ethniques et physiques

Desenvolvimento, pobreza e meio ambiente no seridó potiguar: um estudo centrado nas micro-regiões do seridó oriental e ocidental

This research work intends to carry out a study focused on the dynamic between development, poverty reduction and conservation of natural resources. To consider this relationship to the region chosen was the micro-region of Eastern and Western Seridó in the state of Rio Grande do Norte. In recent years, several studies (Araújo, 2011; BASTOS, 2009) have pointed out that after a period of economic crisis in its tripodproductive, formed by the activities of farming, cotton farming, mining and faced in the eighties, this region of the State of Rio Grande do Norte, has not only shown signs of economic recovery but also improve their social indicators. On the other hand, studies of desertification as the view of the state of RN (produced in cooperation between the Government of RN and research institutions) and the Sustainable Development Plan of Seridó (ADES, 2000), indicate that there is an ongoing French process of degradation of natural resources that is capable of compromising the ability of sustaining such a system. To verify this reality and likely finding this relationship, this work is adopted for this study, the analysis of evolution of secondary data from official bodies such as the IBGE on HDI, per capita income and other social indicators between 2000 and 2009. Here is another time of the survey analysis of qualitative data collected from interviews with institutions of academic intervention in nature, researchers at the Federal University of Rio Grande do Norte (UFRN) State agencies that address the issue of the Middle Environment in Seridó: Institute for Sustainable Development of the NB (IDEMA) and the Brazilian Institute of Environment and the Amazon (IBAMA) and institutions of direct intervention in the region, as the Agency's Sustainable Development Seridó (adhesive) and the Joint Semi-Arid (ASA). After crossing data from quantitative and qualitative, it was found that the dynamics of the region's economic Seridó Potiguar partially answers the improvement of social indicators of poverty. Contribution by the State in this shared stock transfer income. Regarding the influence of productive restructuring in the region on issues of environment, it is noted that the ceramic tile industry, responsible for the absorption percentage of the population with limited ingress into the urban economy, given the low education, accounts for the increase of susceptibility to the ongoing process of desertification in North Seridó Rio Grande. We conclude finally that the guarantee of increased income, freedom and conservation of natural resources ensures primarily by changing the beliefs and values, especially on the part of the business sector, which use natural resources so predatory, aimed at maintaining their rates of return on investment. And concomitantly, the synchronization between technological change, through the use of new energy sources, and institutional change.

Constituição, consolidação e ocaso do capital político: uma compreensão sociológica da "Era Tasso" no Ceará

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Avaliação multidimensional de pessoas idosas atendidas por equipes de saúde da família em Natal-RN: uma análise demográfica e epidemiológica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A Eficácia dos direitos fundamentais nos contratos civis e de consumo: uma teoria contratual baseada na colisão dos direitos ou bens constitucionalmente protegidos

The apparent virtuosity that if could wait of the globalization and the neoliberalism has given signals of deterioration in the contractual relations, especially in contracts of mass consumption, generating innumerable offensive situations to the basic rights and the goods constitutionally protected of the contractors. In the world of today, still that it does not reveal any desire, the individual practically is compelled to contract, for force of necessities and customs completely imposed, mainly in face of the essentiality of the services or agreed to goods. Ahead of as much and unexpected changes in the civil liames and of consumption, dictated for the globalization, it comes to surface the reflection if the private law e, more specifically, the civil law, meet prepared adequately to deal with these new parameters of the economy. The present dissertation has the intention to investigate if the globalization and the consequent neoliberalism, in this beginning of third millennium, will imply to revive of the principles and the basics paradigms of the contracts that consolidated and had kept, for more than two centuries, the liberal State. One notices that the study of this phenomenon it gains importance to the measure where if it aggravates the decline of the social State (Welfare State), with the embrittlement and the loss of the autonomy of the state authority, over all in countries of delayed modernity, as it is the case of Brazil, that presents deep deficiencies to give or to promote, with a minimum of quality and efficiency, essential considered public services to the collective and that if they find consecrated in the Federal Constitution, as basic rights or as goods constitutionally protecting, the example of the health, the education, the housing, the security, the providence, the insurance, the protection the maternity, the infancy and of aged and deficient. To the end, the incidence of constant basic rights of the man in the Constitution is concluded that, in the process of interpretation of the right contractual conflicts that have as object rights or goods constitutionally proteges, in the universe of the globalized perhaps economy and of the neoliberalismo, it consists in one of the few ways - unless the only one - that still they remain to over all deal with more adequately the contractual relations, exactly that if considers the presence of clauses generalities in the scope of the legislation infraconstitutional civil and of consumption, front the private detainers of social-economic power. To be able that it matters necessarily in disequilibrium between the parts, whose realignment depends on the effect and the graduation that if it intends to confer to the basic right in game in the private relation. The Constitution, when allowing the entailing of the basic rights in the privates relations, would be assuming contours of a statute basic of all the collective, giving protection to the man against the power, if public or independently private

Representações sociais, relações de gênero e programas de assistência e educação à saúde da mulher no climatério em Natal/RN

Climacteric is the name of the period of the human life that it is going from the 40 years old, approximately, until the 65 years old. Though, for besides a biological phase of the woman's life, the climacteric is an object of the social world that is rendered to different apprehensions and readings on the symbolic plan. In this study, it was looked for to know the social representations, that health' professionals acting in the programs of the climacteric and the users of those same services, build in respect of that purpose. Besides, it tried to be seen that the social hegemonic representation that guides the actions and the agents' attitudes in the practices of attendance and education for the woman's health in the climacteric in the extent of the investigated institutions. The data were collected through interviews, questionnaire, focal discussion group and direct observation. The observation field was constituted by the three institutions that develop the attendance and education for the woman's health in the climacteric phase, in the city of Natal. A gender perspective was also been adopted, sought to evidence as the cognitive structures that assure the masculine power reproduction, pronounce to the social representations to build a sense to the investigated purpose. It was verified that the social representations of the climacteric are built mainly around the semantic fields old age and disease. For the health professionals, the meaning of the simbol old age carries the marks of the indentified system of the middle class employed, but also, of the feminine habitus that guides them to have an ethical and aesthetic apprehension of their own body. The climacteric, in that way, is seen as a difficult phase , a painful event that scares . For the women attended by those professionals, the sign old age means feeling emphasis from the biological climacteric aspects, in other words, the sensations and signs that forbid the body to accomplish certain linked basic life functions. Along the whole course of this thesis, it was verified that the climacteric is a complex phenomenon that needs to be faced as such. While cultural phenomenon, it is urgent to look for means to help to combat the centrality of the professional representations that face the climacteric as old age and disease, particularly in the field of health

Participação de mulheres na história da Escola Mista no Pará - 1870/1901

This study aims to problematize the history of mixed schools in Pará, from 1870 to 1901, highlighting women participation that helped to build them. The analytical focus of the research fell on the changes and the continuities of the mixed school in Pará. The object of analysis is the Paraense mixed schools, formed by women. The study also brings out arguments that the mixed school was set up in variable forms, concepts, times and spaces, in an overlapping with the inclusion of women in educational universe, either through education, professionalization or teaching in schools of girls and boys. The documentary sources privileged by the study are: the educational law, the newspapers, the government reports and the journals of education, which were examined in a confrontation between what was said and done. The evidential method helped the documentary reading revealed that, in small lines, the linkages built in the search for clues and signs of Paraense mixed schools was assembled with the participation of women, from the perception that historical knowledge is indirect, conjectural. Evidences indicated that the school for both sexes, legally established in the Province of Grão-Pará in 1870, gave the signals of the junction of girls and boys in school, at a time when the presence of women in education was suggested. Mutations related to the educational organization, with the introduction of mixed school in the following decade had a closer relationship with restrictive settings and more effective integration of women in that school. The inaccuracies of the Republican mixed school have revealed, through winding paths, that signal of contradictions between the modern discourse and conservative practices regarding this school, in communion with the expansion of the mixed school throughout the state, including in groups schools, observing the presence of effective women teachers in the regency of such schools and an expansion of students in relation to the equity between the sexes

Obstáculos superados pelos matemáticos no passado e vivenciados pelos alunos na atualidade : a polêmica multiplicação de números inteiros

In Mathematics literature some records highlight the difficulties encountered in the teaching-learning process of integers. In the past, and for a long time, many mathematicians have experienced and overcome such difficulties, which become epistemological obstacles imposed on the students and teachers nowadays. The present work comprises the results of a research conducted in the city of Natal, Brazil, in the first half of 2010, at a state school and at a federal university. It involved a total of 45 students: 20 middle high, 9 high school and 16 university students. The central aim of this study was to identify, on the one hand, which approach used for the justification of the multiplication between integers is better understood by the students and, on the other hand, the elements present in the justifications which contribute to surmount the epistemological obstacles in the processes of teaching and learning of integers. To that end, we tried to detect to which extent the epistemological obstacles faced by the students in the learning of integers get closer to the difficulties experienced by mathematicians throughout human history. Given the nature of our object of study, we have based the theoretical foundation of our research on works related to the daily life of Mathematics teaching, as well as on theorists who analyze the process of knowledge building. We conceived two research tools with the purpose of apprehending the following information about our subjects: school life; the diagnosis on the knowledge of integers and their operations, particularly the multiplication of two negative integers; the understanding of four different justifications, as elaborated by mathematicians, for the rule of signs in multiplication. Regarding the types of approach used to explain the rule of signs arithmetic, geometric, algebraic and axiomatic , we have identified in the fieldwork that, when multiplying two negative numbers, the students could better understand the arithmetic approach. Our findings indicate that the approach of the rule of signs which is considered by the majority of students to be the easiest one can be used to help understand the notion of unification of the number line, an obstacle widely known nowadays in the process of teaching-learning

A formação de professores surdos de Libras: a centralidade de ambientes bilíngues em sua formação

The study object of this thesis intertwines the history of deaf education in the last 30 years in three schools for the deaf in the cities of Campina Grande, Gado Bravo and Aroeiras, Paraiba, the life stories of six deaf teachers of brasilian sign language (Libras) that have formed and works in these educational institutions for the deaf and our own journey, as a teacher and researcher. The study was conducted on the theoretical-methodological principles of (auto)biographical research in education and socio-historical studies on the social formation of the human. The corpus used for analysis was consisted of six narrative interviews conducted in sign language and transcribed into portuguese, documents and personal files and institutional. The analysis allowed us to define three hinge moments of this story: the creation of the first school for the deaf, within the framework of oralism (1980 - 1991), the passage into the Total Communication (1991 - 1995) and, finally, the introduction of Bilingualism (1995 to today). The analyzes show that the trajectories of teacher formation of the research participants reflect the history of the three schools which have costituted bilingual social spaces of paramount importance to the subjects and the deaf community as a group of linguistic and cultural minority. The evolution of this trajectory has allowed to demarcate between the two generations of research participants. The generation of heirs of oralism, which had delayed access to the Libras and lived an education referenced in oralism, whose reminiscences of childhood and adolescence are strongly marked by suffering for the lack of communication, which hinders their social and professional career until today. And the generation of the sons of bilingualism, the youngest in age, who had childhood access to Libras and education within the framework of bilingualism, whose reminiscences are not marked by suffering and have a positive vision of the future. With respect to your teacher formation, three figures stand out as a teacher. The teacher's improvised, closer to the first generation of teachers who were called to teach without proper training. The figure of the teacher craftsman, which corresponds to the image that most of them have of yourself now, understanding that their knowledge are based on the exchange between peers. And finally the figure of the real teacher, which stands on the horizon of expectations as future graduates in Letters |Libras. The narratives allowed to realize that the evolution between these figures is based on the contributions of the other: hearing teachers of EDAC and the Federal University of Campina Grande and deaf teachers of the two generations who learn from each other. The analyzes and reflections allowed to defend the thesis of the centrality of bilingual environments for the establishment of the deaf person as a citizen with full rights, based on the voice of the deaf, muted by the history of education, conducted by listeners