Swallowing evaluation in patients who underwent Partial CO2 LASER Epiglottectomy for Sleep Apnea treatment.

OBJECTIVE: To evaluate swallowing in patients who underwent CO2 LASER Partial Epiglottectomy (CO2-LPE) for Obstructive Sleep Apnea Syndrome and to assess the risk of aspiration with this technique. MATERIAL & METHODS: Chart review of adult patients who underwent CO2-LPE between 2016 and 2020, in a secondary care hospital. Patients underwent surgery for OSAS, in accordance to Drug Induced Sleep Endoscopy findings and an objective swallowing evaluation was done at least 6 months after surgery. Eating Assessment Tool (EAT-10) questionnaire was applied and Volume-Viscosity Swallow Test (V-VST) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Dysphagia was classified according to Dysphagia Outcome Severity Scale (DOSS). RESULTS: Eight patients were included in the study. The mean time between surgery and the swallowing evaluation was 50 (±13,2) months. Only 3 patients presented ≥ 3 points on EAT-10 questionnaire. Two patients presented signs of decreased efficacy of swallowing (piecemeal deglutition) but none had a decrease in safety, according to V-VST. Although 50% of the patients presented some pharyngeal residue on FEES, it was classified as trace to mild in most of the cases. No evidence of penetration or aspiration was identified (DOSS ≥ 6 in all patients). CONCLUSION: The CO2-LPE is a potential treatment for OSAS patients with epiglottic collapse and no evidence of swallowing safety compromise was found.

Unilateral vocal fold paralysis as a port complication.

Unilateral vocal fold paralysis (UVFP) is a frequent finding in otorhinolaryngology practice, but its occurrence as a port complication was very rarely described in English Literature. The authors report a 55-year-old woman with a pancreatic adenocarcinoma who presented a left vocal fold paralysis that occurred concurrently with a venous thrombosis of the left subclavian vein, where a totally implantable venous-access had been previously placed. Although the patient's oncologic disease, that could mislead to a neoplastic cause of the UVFP, the authors came across with an unusual etiology and to their best knowledge, it is the first case of irreversible UVFP associated with onsite thrombosis of the vessel where a port was implanted. The objective of this article is to present and discuss this rare case of UVFP secondary to a port complication and to review the main mechanisms of iatrogenic vocal fold paralysis related to these devices.

One Year of COVID-19 in Pregnancy: A National Wide Collaborative Study.

INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.

Introdução: Apesar do risco da COVID-19 na gravidez poder ser acrescido, são necessários estudos em larga escala para o melhor conhecimento do impacto desta infeção nesta população. O objetivo deste estudo é descrever as complicações obstétricas e a taxa de transmissão vertical em grávidas com infeção a SARS-CoV-2. Material e Métodos: Os casos conhecidos de infeção por SARS-CoV-2 na gravidez foram registados nos hospitais portugueses por obstetras. Foram recolhidos dados epidemiológicos, da gravidez e do parto. Resultados: Registaram-se 630 casos positivos em 23 maternidades portuguesas, a maioria no termo (87,9%) e assintomática (62,9%). A comorbilidade materna mais frequente foi a obesidade. A taxa de parto pré-termo e de leves para a idade gestacional foi de 12,1% e 9,9%, respectivamente. No terceiro trimestre, 2,9% das grávidas necessitaram de suporte respiratório. Verificou-se uma taxa de 1,5% de morte fetal, incluindo dois casos de transmissão vertical. Houve cinco casos de degradação respiratória no pós-parto, mas sem mortes maternas registadas. A taxa de cesarianas foi mais elevada na primeira do que na segunda vaga (68,5% vs 31,5%). A positividade do RT-PCR SARS-CoV-2 entre os recém-nascidos foi de 1,3%. Conclusão: A infeção pelo SARS-Cov-2 na gravidez pode acarretar riscos aumentados para as grávidas e fetos. Recomenda-se uma vigilância individualizada nestes casos e a profilaxia desta população com a vacinação.

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature.

Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devem ser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature / Manejo conservador da espondilodiscite após colpopexia sacral laparoscópica: Relato de caso e revisão da literatura

Abstract Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication.We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of imageguided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

Resumo A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devemser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.

Fatores de risco cardiovasculares e qualidade de vida em universitários / Cardiovascular risk factors and quality of life in university students

Objetivo: avaliar a associação dos fatores de risco para as doenças cardiovasculares e qualidade de vida em universitários que trabalham. Método: trata-se de um estudo quantitativo, transversal e analítico, com 40 discentes. Analisaram-se os dados no SPSS 21. Resultados: 55% da amostra possuem qualidade de sono ruim e que 15% distúrbio do sono. Quanto ao nível de atividade física, 65% dos que trabalham foram classificados com sedentários. Com relação aos domínios de "dor", foi observada uma diferença estatisticamente significativa (p = 0,01) apontando que os universitários que trabalham apresentam mais dor. Conclusão: mesmo em uma população de adultos jovens, observou-se o estado de vulnerabilidade para o desenvolvimento de DCV, sendo preocupantes, entre os universitários que trabalham, o nível da qualidade de sono e o sedentarismo observados, que podem comprometer a saúde e a qualidade de vida dessa população.(AU)

The prognostic role of RANK SNP rs34945627 in breast cancer patients with bone metastases.

Receptor activator of NF-kB (RANK) pathway regulates bone remodeling and is involved in breast cancer (BC) progression. Genetic polymorphisms affecting RANK-ligand (RANKL) and osteoprotegerin (OPG) have been previously associated with BC risk and bone metastasis (BM)-free survival, respectively. In this study we conducted a retrospective analysis of the association of five missense RANK SNPs with clinical characteristics and outcomes in BC patients with BM. SNP rs34945627 had an allelic frequency of 12.5% in BC patients, compared to 1.2% in the control group (P = 0.005). SNP rs34945627 was not associated with any clinicopathological characteristics, but patients presenting SNP rs34945627 had decreased disease-free survival (DFS) (log-rank P = 0.039, adjusted HR 2.29, 95% CI 1.04-5.08, P = 0.041), and overall survival (OS) (log-rank P = 0.019, adjusted HR 4.32, 95% CI 1.55-12.04, P = 0.005). No differences were observed regarding bone disease-free survival (log-rank P = 0.190, adjusted HR 1.68, 95% CI 0.78-3.66, P = 0.187), time to first skeletal-related event (log-rank P = 0.753, adjusted HR 1.28, 95% CI 1.42-3.84; P = 0.665), or time to bone progression (log-rank P = 0.618, adjusted HR 0.511, 95% CI 0.17-1.51; P = 0.233). Our analysis shows that RANK SNP rs34945627 has a high allelic frequency in patients with BC and BM, and is associated with decreased DFS and OS.

Impacto de um programa de competências em alunos do 2º ciclo de escolaridade / Impact of a skill development intervention in 5th and 6th grade students / Impacto de un programa intervención em alunos del segundo ciclo

O objetivo do presente estudo consistiuem avaliar um programa de intervenção junto a alunos do 2º ciclo de escolaridade nas seguintes dimensões: tomada de decisão, conhecimentos sobre sexualidade, competências sociais, assertividade e autoconceito. Metodologia: Participaram 145 alunos, distribuídos pelos grupos controle e experimental. Os instrumentos utilizados foram: TCU Decision-Making; Questionário de Conhecimentos sobre Sexualidade; Assertion Self-Statement Test- Revised; Questionário de Competências Sociais; Piers-Harris Children's Self-Concept Scale. Os resultados revelaram diferenças no pós-teste entre os grupos ao nível da sexualidade. Verificaram-se diferenças do pré-teste para o pós-teste no grupo experimental nos níveis da sexualidade, da assertividade e das competências sociais. No grupo experimental encontraram-se associações positivas entre tomada de decisão, competências sociais e assertividade, bem como entre sexualidade, competências sociais e autoconceito, no pós-teste. Os preditores da assertividade no pós-teste foram tomada de decisão, sexualidade e competências sociais. Como conclusão, os resultados enfatizam a importância de intervenção junto a adolescentes, particularmente na tomada de decisão, na sexualidade e nas competências sociais.

In this study we evaluate an intervention program in the following dimensions: Decision Making, Knowledge on Sexuality, Social Skills, Assertiveness and Self-Concept with students in 5th and 6th grade. Methodology: 145 students participated in the study divided by control and experimental group. The instruments used were: Decision-Making TCU, Knowledge on Sexuality Questionnaire; Assertion Self-Statement Test-Revised;Social Skills Questionnaire, and Piers-Harris Children's Self- Concept Scale. The results indicate differences at post-test between the groups on knowledge regarding sexuality. There were also differences from pre-test to post-test in the experimental group on knowledge on sexuality, assertiveness and social skills. Positive associations among decision making, social skills and assertiveness were found as well as among knowledge on sexuality, social skills and self-concept, in the experimental group, in the pos-test. Finally, the predictors of assertiveness regarding health behaviors, in the pos-test were: decision making, knowledge regarding sexuality and social skills. The results emphasize the importance of intervention for adolescents in terms of health promotion particularly in decision making, sexuality and social skills.

El objetivo del presente estudio fue evaluar un programa de intervención con alumnos del 2º ciclo de escolaridad en las siguientes dimensiones: Toma de Decisión, Conocimientos sobre Sexualidad, Habilidades Sociales, Asertividad y Autoconcepto. Metodología: Participaron 145 alumnos, distribuidos en grupo control y experimental. Los instrumentos utilizados fueron: TCU Decision-Making; Cuestionario de Conocimientos sobre Sexualidad; AssertionSelf-Statement Test-Revised; Cuestionario de Habilidades Sociais; Piers-Harris Children'sSelf-Concept Scale. Los resultados mostraron diferencias en el post-test entre los grupos en cuanto a la sexualidad. Se verificaron diferencias del pre-test para el post-teste en el grupo experimental, cuanto a sexualidad, asertividad y habilidades sociales. Se encontraron asociaciones positivas entre toma de decisión, habilidades sociales y asertividad, así como entre sexualidad,habilidades sociales yautoconcepto, en el post-test en el grupo experimental. Los predictores de la asertividad en el post-test fueron toma de decisión, sexualidad y habilidades sociales. Los resultados destacan la importancia de la intervención con adolescentes particularmente en la toma de decisiones, sexualidad y habilidades sociales.

Fatores de risco para sibilância recorrente em lactentes / Risk factors for recurrent wheezing in infants

Introdução: a sibilância é um dos sintomas respiratórios mais comuns na infância. Independentemente da causa, é motivo de procura por atendimento médico em serviços de urgência, sobretudo se há recorrência dos episódios. Muito frequente na infância, a sibilância de repetição tem seus primeiros episódios no primeiro ano de vida. Objetivo: verificar os fatores de risco para sibilância recorrente em lactentes no primeiro ano de vida. Método: pesquisa de campo do tipo exploratória, transversal com abordagem quantitativa, onde foi aplicado um questionário padronizado do Estudo Internacional de Sibilância em Lactentes, traduzido e validado no Brasil, constituído por questões objetivas. Foram questionadas 40 mães cadastradas em duas Unidades de Saúde da Família. Resultados: os fatores de risco encontrados: tabagismo durante a gestação, histórico familiar de asma, rinite e dermatite alérgica, presença de pelo menos um animal doméstico em domicílio na época do nascimento e idade do primeiro resfriado menor ou igual a três meses de vida. Não foram encontradas relações significativas entre sibilância e gênero masculino, amamentação exclusiva equantidade de resfriados no primeiro ano de vida. Conclusão: mesmo utilizando um instrumento de pesquisa padronizado, é notória a discrepância nos resultados encontrados.

INTRODUCTION: wheezing is one of the most common respiratory symptoms in childhood. Regardless of the cause, it is a reason to seek medical care in emergency rooms, especially if there is recurrence of episodes. Very common in childhood, recurrent wheezing has its first episodes in the first year of life. We sought to examine the risk factors for recurrent wheezing in infants in the first year of life. METHODS: this is a cross-sectional quantitative study in which a standardized questionnaire of the International Study of Wheezing in Infants, translated and validated in Brazil, consisting of objective questions, applied 40 mothers were enrolled in two Family Health units. RESULTS: the risk factors found were: smoking during pregnancy, family history of asthma, rhinitis and allergic dermatitis, the presence of at least one pet in the home at the time of birth and age at first cold less than or equal to three months of life. No significant relationships were found between males and wheezing, exclusive breastfeeding or numbers of colds in the first year of life. CONCLUSION: our findings are different from those reported in the literature.

Relationship between flexibility and physical, chemical, and geometric characteristics of rotary nickel-titanium instruments.

OBJECTIVE: The purpose of this study was to assess the influence of both the metallurgic and the geometric characteristics of nickel-titanium endodontic instruments on their flexibility. STUDY DESIGN: ProTaper Universal (PTU), K3, and EndoSequence (ES) instruments were evaluated. Their chemical composition and phase constitution were characterized by conventional analytical techniques. Instrument diameter and cross-sectional area were evaluated by image analysis. Flexibility was evaluated in bending tests according to the ISO 3630-1. RESULTS: K3 presented the highest average bending moment (M(B)), followed by PTU and ES. A linear relationship was found between M(B) and the instrument's diameter and cross-sectional area at 3 mm from the tip. Alloy chemical compositions were similar among the files, but transformation temperatures were lower for K3 instruments, which presented only austenite as a constituent phase. CONCLUSION: Nickel-titanium instruments from different manufacturers have unequal behavior related to their flexibility properties. Manufacturing processes changed the phase constitution and transformation temperatures of the instruments investigated and may also have influenced their flexibility.

Influence of simulated clinical use on the torsional behavior of nickel-titanium rotary endodontic instruments.

OBJECTIVE: The aim of this study was to assess the influence of cyclic deformation up to one half and three quarters of the fatigue life of NiTi rotary endodontic instruments on their behavior in torsion. STUDY DESIGN: Thirty sets of 0.04 and 0.06 ProFile instruments in sizes #20, #25, and #30 were randomly divided into 3 groups: 1 contained 10 sets of new files, torsion tested to failure, while the other 2 groups, with 10 sets each, were first submitted to fatigue tests of up to one half and three fourths of their fatigue life, respectively, in geometrical conditions similar to those of the clinical practice and then torsion tested for rupture. RESULTS: Statistical analysis of the values obtained for the torque to failure and maximum angular deflection, using the Student t test at the 95% confidence level, showed that the cyclic deformation of instruments of up to one half and three fourths of their fatigue life gives rise to a significant reduction in these parameters. CONCLUSIONS: The simulated clinical use of ProFile instruments for shaping curved canals adversely affects their torsional properties.

Fatigue resistance of engine-driven rotary nickel-titanium endodontic instruments.

A comparative study of the fatigue resistance of engine-driven nickel-titanium endodontic instruments was performed, aiming to access the influence of the cutting flute design and of the size of the files that reach the working length in curved canal shaping. Geometrical conditions similar to those found in practice were used. Series 29 #5 ProFile, together with #6 and #8 Quantec instruments, were tested in artificial canals with a 45-degree angle of curvature and 5-mm radius of curvature. It was observed that the size of the instrument, which determines the maximum strain amplitude during cyclic deformation, is the most important factor controlling fatigue resistance. The effect of heat sterilization on the fatigue resistance of the instruments was also examined. The results obtained indicate that the application of five sterilization procedures in dry heat increases the average number of cycles to failure of unused instruments by approximately 70%.

Pode-se ler o teste de Mantoux com apenas 24 horas? / Can be to possible to read the tuberculin test of Mantoux with only 24 hours?

Foi realizada a medicao seriada do Teste Tuberculinico deMantoux em 22 pacientes com tuberculose-doenca. Verificou-se que em todos os casos, o teste ja demonstrava positividade entre 20-24 horas apos a aplicacao .