Para além da heteronormatividade: uma análise dos eunucos representados por Estácio, Marcial e Suetônio (Roma, 80-121 d. C)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Análise dialógica de vinhetas de Maurício de Sousa: o caso do autismo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle

Objective Epidermoid cysts of the cerebellopontine angle (CPA) can be a surgical challenge for the pediatric neurosurgeon. Ideally, total removal must be achieved; however, occasional adhesions of these tumors to vital neurovascular structures and extension far beyond the midline may preclude their total removal. The aims of this article are to present an alternative surgical approach to these lesions and to provide the rationale for this technique. Material and methods A 16-year-old boy was admitted to our pediatric neurosurgery department with a 1-year history of nonspecific headaches. His neurological examination showed right-sided dysmetria and gait ataxia. Magnetic resonance scans showed a space-occupying lesion on the right CPA with low intensity on T-1-weighted images and high intensity on T-2-weighted images. Results Craniotomy for tumor excision via pre- and subtemporal transtentorial approach was performed disclosing a 3.5 x 3 x 2.8-cm(3) well-encapsulated tumor, which was confirmed to be an epidermoid cyst. The postoperative course was uneventful. Conclusions A combined pre- and subtemporal approach utilizes a wide opening of the tentorium and the option of supratentorial retraction of the cerebellum to provide an excellent angle of approach to CPA lesions involving the anterolateral aspect of the brain stem in children.

Incidental mild hyperglycemia in children: two MODY 2 families identified in Brazilian subjects

Maturity-onset diabetes of the young (MODY) is characterized by an autosomal dominant mode of inheritance, early onset of hyperglycemia, and defects of insulin secretion. MODY subtypes described present genetic, metabolic, and clinical differences. MODY 2 is characterized by mild asymptomatic fasting hyperglycemia, and rarely requires pharmacological treatment. Hence, precise diagnosis of MODY is important for determining management and prognosis. We report two heterozygous GCK mutations identified during the investigation of short stature. Case 1: a prepubertal 14-year-old boy was evaluated for constitutional delay of growth and puberty. During follow-up, he showed abnormal fasting glucose (113 mg/dL), increased level of HbA1c (6.6%), and negative beta-cell antibodies. His father and two siblings also had slightly elevated blood glucose levels. The mother had normal glycemia. A GCK heterozygous missense mutation, p.Arg191Trp, was identified in the proband. Eighteen family members were screened for this mutation, and 11 had the mutation in heterozygous state. Case 2: a 4-year-old boy investigated for short stature revealed no other laboratorial alterations than elevated glycemia (118 mg/dL); beta-cell antibodies were negative. His father, a paternal aunt, and the paternal grandmother also had slightly elevated glycemia, whereas his mother had normal glycemia. A GCK heterozygous missense mutation, p.Glu221Lys, was identified in the index patient and in four family members. All affected patients had mild elevated glycemia. Individuals with normal glycemia did not harbor mutations. GCK mutation screening should be considered in patients with chronic mild early-onset hyperglycemia, family history of impaired glycemia, and negative beta-cell antibodies. Arq Bras Endocrinol Metab. 2012;56(8):519-24

Nonlipidized juvenile xanthogranuloma: An unusual variant with a potential diagnostic pitfall

Juvenile xanthogranuloma (JXG) is a histiocytic inflammatory disorder that can present different histologic patterns. Classic JXG consists of sheets of foamy histiocytes and numerous multinucleated Touton giant cells. Nonlipidized JXG (NJXG) is one of the unusual variants of JXG, consisting of a diffuse monomorphic infiltrate of mononuclear histiocytes, suggesting an aggressive or malignant tumor due the high mitotic index. However, NJXG behaves clinically as classic JXG. We present an unusual case of a 6-year-old boy who presented an exophytic ulcerated nodule on the lower lip diagnosed as NJXG. The boy is currently well without recurrence three years after surgical excision. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

A novel DAX1/NR0B1 mutation in a patient with adrenal hypoplasia congenita and hypogonadotropic hypogonadism

We report a case of adrenal hypoplasia congenita (AHC) and hypogonadotropic hypogonadism (HH) due to a novel DAX1 mutation. A 19-month-old boy with hyperpigmentation and failure to thrive came to our service for investigation. Three brothers of the patient had died due to adrenal failure, and a maternal cousin had adrenal insufficiency. Adrenoleukodystrophy was excluded. MRI showed normal pituitary and hypothalamus. Plasma hormone evaluation revealed high ACTH (up to 2,790 pg/mL), and low levels of androstenedione, DHEA-S, 11-deoxycortisol, and cortisol. At 14 years of age the patient was still prepubescent, his weight was 43.6 kg (SDS: -0.87) and his height was 161 cm (SDS: -0.36), with normal body proportions. In the GnRH test, basal and maximum values of LH and FSH were respectively 0.6/2.1 and < 1.0/< 1.0 U/L. Molecular investigation identified a novel mutation that consists of a deletion of codon 372 (AAC; asparagine) in exon 1 of DAX1. This mutation was not found in a study of 200 alleles from normal individuals. Prediction site analysis indicated that this alteration, located in the DAX1 ligand-binding domain, may damage DAX1 protein. We hypothesize that the novel (p.Asp372del) DAX1 mutation might be able to cause a disruption of DAX1 function, and is probably involved in the development of AHC and HH in this patient. Arq Bras Endocrinol Metab. 2012;56(8):496-500

Early diagnosis of Gorlin-Goltz syndrome: case report

The Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is an infrequent multisystemic disease inherited in a dominant autosomal way, which shows a high level of penetrance and variable expressiveness. It is characterized by keratocystic odontogenic tumors (KCOT) in the jaw, multiple basal cell nevi carcinomas and skeletal abnormities. This syndrome may be diagnosed early by a dentist by routine radiographic exams in the first decade of life, since the KCOTs are usually one of the first manifestations of the syndrome. This article paper reports the case of a patient, a 10-year-old boy with NBCCS, emphasizing its clinical and radiographic manifestations. This study highlights the importance of health professionals in the early diagnosis of NBCCS and in a preventive multidisciplinary approach to provide a better prognosis for the patient.

Central giant cell granuloma

Background: Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. Case report: A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42. Discussion: Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissuewhich had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed

The clinical impact of chromosomal rearrangements with breakpoints upstream of the SOX9 gene: two novel de novo balanced translocations associated with acampomelic campomelic dysplasia

Abstract Background The association of balanced rearrangements with breakpoints near SOX9 [SRY (sex determining region Y)-box 9] with skeletal abnormalities has been ascribed to the presumptive altering of SOX9 expression by the direct disruption of regulatory elements, their separation from SOX9 or the effect of juxtaposed sequences. Case presentation We report on two sporadic apparently balanced translocations, t(7;17)(p13;q24) and t(17;20)(q24.3;q11.2), whose carriers have skeletal abnormalities that led to the diagnosis of acampomelic campomelic dysplasia (ACD; MIM 114290). No pathogenic chromosomal imbalances were detected by a-CGH. The chromosome 17 breakpoints were mapped, respectively, 917–855 kb and 601–585 kb upstream of the SOX9 gene. A distal cluster of balanced rearrangements breakpoints on chromosome 17 associated with SOX9-related skeletal disorders has been mapped to a segment 932–789 kb upstream of SOX9. In this cluster, the breakpoint of the herein described t(17;20) is the most telomeric to SOX9, thus allowing the redefining of the telomeric boundary of the distal breakpoint cluster region related to skeletal disorders to 601–585 kb upstream of SOX9. Although both patients have skeletal abnormalities, the t(7;17) carrier presents with relatively mild clinical features, whereas the t(17;20) was detected in a boy with severe broncheomalacia, depending on mechanical ventilation. Balanced and unbalanced rearrangements associated with disorders of sex determination led to the mapping of a regulatory region of SOX9 function on testicular differentiation to a 517–595 kb interval upstream of SOX9, in addition to TESCO (Testis-specific enhancer of SOX9 core). As the carrier of t(17;20) has an XY sex-chromosome constitution and normal male development for his age, the segment of chromosome 17 distal to the translocation breakpoint should contain the regulatory elements for normal testis development. Conclusions These two novel translocations illustrate the clinical variability in carriers of balanced translocations with breakpoints near SOX9. The translocation t(17;20) breakpoint provides further evidence for an additional testis-specific SOX9 enhancer 517 to 595 kb upstream of the SOX9 gene.

Eruption sequestrum - case report and histopathological findings

Eruption sequestrum is an uncommon disturbance in eruption and consists of small fragments of calcified tissue overlying the crowns of erupting permanent molar teeth, especially at the time of eruption of the mandibular first molars. This paper reports a case of unilateral eruption sequestrum in a 7-year-old Brazilian boy and describes its histopathological findings. A white small fragment, 0.5 cm in diameter, with hard consistency, irregular shape and located on the occlusal surface of the erupting mandibular left first molar was excised. Microscopic examination revealed large trabeculae with empty lacunae and a minimal amount of existing spongy bone consisting of acute inflammatory cells (neutrophils). Signs of necrosis were found on the periphery. The histological analysis was consistent with non-vital bone and the diagnosis of eruption sequestrum was established. Clinical and radiographic follow-up visits scheduled at short intervals and then every 6 months revealed normal postoperative conditions.

Quando se inicia o processo de alfabetização?

Embora a aprendizagem informal da língua escrita na fase pré-escolarjá fosse observada desde o século XIX, muitos anos se passaram até que fosse reconhecida. Com as pesquisas lideradas por Vygotsky, Luria, Ferreiro e os estudos sobre letramento, foi possível recuperar a gênese da alfabetização e considerar suas implicações para o ensino. Assim, importa perguntar: Como compreender as primeiras escritas? Como o reconhecimento delas pode afetar as concepções sobre a língua escrita? Que condições favorecem a construção da escrita? Que implicações as aprendizagens pré-escolares trazem para as práticas pedagógicas e para as políticas de alfabetização? Com o objetivo de aprofundar o entendimento destas questões, o artigo vale - se de um estudo de caso sobre a produção textual de um menino de quatro anos, configurando-se como mais um a iniciativa para subsidiar os debates sobre a articulação entre ensino e aprendizagem.

Low-level laser therapy in pediatric Bell's palsy: case report in a three-year-old child

Objectives: The objective of this study was to apply low-level laser therapy (LLLT) to accelerate the recovery process of a child patient with Bell's palsy (BP). Design: This was a prospective study. Subject: The subject was a three-year-old boy with a sudden onset of facial asymmetry due to an unknown cause. Materials and methods: The low-level laser source used was a gallium aluminum arsenide semiconductor diode laser device (660nm and 780 nm). No steroids or other medications were given to the child. The laser beam with a 0.04-cm2 spot area, and an aperture with approximately 1-mm diameter, was applied in a continuous emission mode in direct contact with the facial area. The duration of a laser session was between 15 and 30 minutes, depending on the chosen points and the area being treated. Light was applied 10 seconds per point on a maximum number of 80 points, when the entire affected (right) side of the face was irradiated, based on the small laser beam spot size. According to the acupuncture literature, this treatment could also be carried out using 10-20 Chinese acupuncture points, located unilaterally on the face. In this case study, more points were used because the entire affected side of the face (a large area) was irradiated instead of using acupuncture points. Outcome measures: The House-Brackmann grading system was used to monitor the evolution of facial nerve motor function. Photographs were taken after every session, always using the same camera and the same magnitude. The three-year-old boy recovered completely from BP after 11 sessions of LLLT. There were 4 sessions a week for the first 2 weeks, and the total treatment time was 3 weeks. Results: The result of this study was the improvement of facial movement and facial symmetry, with complete reestablishment to normality. Conclusions: LLLT may be an alternative to speed up facial normality in pediatric BP.

Desarrollo de videojuegos en 2D usando Simple DirectMedia

[ES]Los Indie games, o videojuegos independientes, son aplicaciones creadas por individuos o pequeños grupos sin apoyo financiero de distribuidores. A menudo se centran en la innovación, y se basan en la distribución digital. En los últimos años han visto un gran aumento principalmente debido a; nuevos métodos de distribución en línea (Steam Greenlight1, Xbox Live2, Playstation Store3, Android Market, Apple Store), nuevas formas de financiación como Kickstarter4 y potentes herramientas gratuitas para el desarrollo. Este proyecto se puede considerar como uno de los primeros pasos en el desarrollo de videojuegos independientes o Indie. Usando SDL como base se pretende diseñar y desarrollar dos prototipos de videojuego, el primero será un clon del conocido Tetris, aprovechando la poca complejidad de las mecánicas del juego para tener un primer contacto con las herramientas. El segundo, de mayor complejidad, se centrará en desarrollar las principales características de un juego tipo plataformas en 2D, del estilo Super Mario, Sonic o los anteriormente mencionados Super Meat Boy y Braid. La Simple DirectMedia Layer (SDL) es un conjunto de bibliotecas desarrolladas en el lenguaje de programación C, que proporcionan funciones básicas para realizar operaciones de dibujo en dos dimensiones, gestión de efectos de sonido y música, además de carga y gestión de imágenes. Fueron desarrolladas inicialmente por Sam Lantinga en 1998, en este proyecto se ha usado la versión 1.2.15 y se espera que este año se termine la versión 2.0, el uno de Junio de este año ha alcanzado el estado Release Candidate.

External drivers of biogeochemical cycles in a tropical montane forest in Ecuador

Successful conservation of tropical montane forest, one of the most threatened ecosystems on earth, requires detailed knowledge of its biogeochemistry. Of particular interest is the response of the biogeochemical element cycles to external influences such as element deposition or climate change. Therefore the overall objective of my study was to contribute to improved understanding of role and functioning of the Andean tropical montane forest. In detail, my objectives were to determine (1) the role of long-range transported aerosols and their transport mechanisms, and (2) the role of short-term extreme climatic events for the element budget of Andean tropical forest. In a whole-catchment approach including three 8-13 ha microcatchments under tropical montane forest on the east-exposed slope of the eastern cordillera in the south Ecuadorian Andes at 1850-2200 m above sea level I monitored at least in weekly resolution the concentrations and fluxes of Ca, Mg, Na, K, NO3-N, NH4-N, DON, P, S, TOC, Mn, and Al in bulk deposition, throughfall, litter leachate, soil solution at the 0.15 and 0.3 m depths, and runoff between May 1998 and April 2003. I also used meteorological data from my study area collected by cooperating researchers and the Brazilian meteorological service (INPE), as well as remote sensing products of the North American and European space agencies NASA and ESA. My results show that (1) there was a strong interannual variation in deposition of Ca [4.4-29 kg ha-1 a-1], Mg [1.6-12], and K [9.8-30]) between 1998 and 2003. High deposition changed the Ca and Mg budgets of the catchments from loss to retention, suggesting that the additionally available Ca and Mg was used by the ecosystem. Increased base metal deposition was related to dust outbursts of the Sahara and an Amazonian precipitation pattern with trans-regional dry spells allowing for dust transport to the Andes. The increased base metal deposition coincided with a strong La Niña event in 1999/2000. There were also significantly elevated H+, N, and Mn depositions during the annual biomass burning period in the Amazon basin. Elevated H+ deposition during the biomass burning period caused elevated base metal loss from the canopy and the organic horizon and deteriorated already low base metal supply of the vegetation. Nitrogen was only retained during biomass burning but not during non-fire conditions when deposition was much smaller. Therefore biomass burning-related aerosol emissions in Amazonia seem large enough to substantially increase element deposition at the western rim of Amazonia. Particularly the related increase of acid deposition impoverishes already base-metal scarce ecosystems. As biomass burning is most intense during El Niño situations, a shortened ENSO cycle because of global warming likely enhances the acid deposition at my study forest. (2) Storm events causing near-surface water flow through C- and nutrient-rich topsoil during rainstorms were the major export pathway for C, N, Al, and Mn (contributing >50% to the total export of these elements). Near-surface flow also accounted for one third of total base metal export. This demonstrates that storm-event related near-surface flow markedly affects the cycling of many nutrients in steep tropical montane forests. Changes in the rainfall regime possibly associated with global climate change will therefore also change element export from the study forest. Element budgets of Andean tropical montane rain forest proved to be markedly affected by long-range transport of Saharan dust, biomass burning-related aerosols, or strong rainfalls during storm events. Thus, increased acid and nutrient deposition and the global climate change probably drive the tropical montane forest to another state with unknown consequences for its functions and biological diversity.