RESUMEN
OBJECTIVES: To analyze clinical, vocal, and videolaryngoscopic parameters, as well as the treatments of patients with sulcus vocalis. METHODS: This is an observational study. The medical records of patients diagnosed with sulcus vocalis (type II or III) were selected and demographic data, vocal symptoms, videolaryngostroboscopies, vocal analyses (perceptual and acoustic), and maximum phonation time (MPT) were collected. The vocal parameters of patients who underwent microsurgery to treat the sulcus were compared before and after surgery. RESULTS: Exactly 109 patients were diagnosed with sulcus; however, only 60 completed the inclusion criteria (39 women and 21 men), with a mean age of 45 years. Hoarseness and vocal fatigue were reported in 100% and 88% of cases, respectively. Laryngoscopy indicated a type II sulcus (90%), type III sulcus (10%), and an association of the sulcus with other benign lesions (23%), especially polyps. Perceptual evaluations indicated mild to moderate dysphonia, roughness and breathiness of the voice, mean MPT of 10 seconds, and high values of jitter, pitch perturbation coefficient, and soft phonation index (SPI). Twenty-two patients (14 women and 8 men) underwent sulcus microsurgery. The surgery promoted a decrease in the GRBAS scores, an increase in the MPT, and a decrease in the SPI; however, other acoustic parameters remained unchanged. CONCLUSIONS: Patients with sulcus vocalis had mild to moderate dysphonia, in addition to voice roughness and breathiness and elevated fundamental frequency. Surgical treatment improved vocal parameters but maintained some degree of dysphonia, indicating incomplete restoration of vocal qualities.
RESUMEN
The impact of serum concentrations of vancomycin is a controversial topic. RESULTS: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624-0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. DISCUSSION: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. CONCLUSION: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used.