Quality of Life in Obstructive Sleep Apnea Patients Who Underwent Maxillomandibular Advancement Surgery.

This study assessed health-related quality of life (HRQOL) and daytime sleepiness in moderate or severe obstructive sleep apnea patients who underwent maxillomandibular advancement (MMA) surgery. We invited patients who had undergone MMA 1 year ago and preoperative patients to answer a self-administered questionnaire to evaluate HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey-SF-36 and Functional Outcomes of Sleep Questionnaire-FOSQ) and daytime sleepiness (Epworth Sleepiness Scale-ESS). Twenty-two patients who underwent MMA and 28 preoperative patients participated in the present study. Patients who underwent MMA reduced their daytime sleepiness [5.0 (3.00-8.00) versus 16.0 (9.00-21.00), P<0.01] and increased their quality of life in the following domains: physical role functioning [100.0 (50.00-100.00) versus 62.5 (0.00-100.00), P<0.05], vitality [65.0 (58.75-90.00) versus 55.0 (21.25-67.50), P<0.0], mental health [78.0 (67.00-88.00) versus 62.0 (45.00-75.00), P<0.01], and social role functioning [88.0 (75.00-100.00) versus 69.0 (41.00-100.00), P<0.05]. Patients also improved their rates of sleep-related quality of life in general productivity [4.00 (3.63-4.00) versus 2.9 (2.03-3.75), P<0.01], social outcome [4.00 (4.00-4.00) versus 3.2 (2.00-4.00), P<0.01], activity level [3.7 (3.56-3.88) versus 2.8 (1.64-3.53), P<0.01], and vigilance [3.9 (3.55-4.00) versus 2.7 (2.03-3.67), P<0.01] when compared with the control group. The results suggest that moderate and severe obstructive sleep apnea patients who undergo MMA have positive impacts on quality of life and daytime sleepiness when compared with preoperative patients.

Contribution of nasal biopsy to leprosy diagnosis.

BACKGROUND: The nasal mucosa plays the main role as the entry and the exit of leprosy bacilli and the nasal involvement may precede the skin lesions by several years. Nasal biopsy has been used in research but its clinical application has not been described. We evaluated the contribution of the nasal biopsy for the diagnosis of leprosy and its correlation to skin biopsy and skin smear in untreated patients. METHODS: We evaluated changes in nasal biopsy in 227 leprosy patients. Patients were clinically classified and skin and nasal biopsies and skin smear were performed. RESULTS: Nasal biopsy showed positivity in 100% of the lepromatous spectrum decreasing toward the tuberculoid (TT) pole. Patients with TT or indeterminate forms did not present any nasal alterations, showing that they are the true paucibacillary forms. Also, the nasal biopsies of two patients were the only exam to show positivity. The bacillary index of the nasal biopsy was strongly correlated to skin biopsy and slit-skin smear. Additionally, the agreement among the exams was good, revealing the reliability of the nasal biopsy in leprosy diagnosis. CONCLUSION: The present study showed a rate of 48% of positivity in nasal biopsy of untreated patients, correlating well with skin biopsy and skin smear. Thus, the method in leprosy diagnosis and clinical form classification has shown great reliability.