Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology.

Neurocritical patients (NCPs) in the intensive care unit (ICU) rapidly progress to respiratory and peripheral muscle dysfunctions, which significantly impact morbidity and death. Early mobilization in NCPs to decrease the incidence of ICU-acquired weakness has been showing rapid growth, although pertinent literature is still scarce. With this review, we summarize and discuss current concepts in early mobilization of critically ill patients within the context of neurologic pathology in NCPs. A narrative synthesis of literature was undertaken trying to answer the following questions: How do the respiratory and musculoskeletal systems in NCPs behave? Which metabolic biomarkers influence physiological responses in NCPs? Which considerations should be taken when prescribing exercises in neurocritically ill patients? The present review detected safety, feasibility, and beneficial response for early mobilization in NCPs, given successes in other critically ill populations and many smaller intervention trials in neurocritical care. However, precautions should be taken to elect the patient for early care, as well as monitoring signs that indicate interruption for intervention, as worse outcomes were associated with very early mobilization in acute stroke trials.

Andean purple maize to produce extruded breakfast cereals: impact on techno-functional properties and sensory acceptance.

BACKGROUND: Andean purple maize (APM) is an ancient crop widely used as a natural coloring in traditional Peruvian cuisine. However, it has been little explored within the food industry. The present study assessed how APM impacts on techno-functional properties and sensory acceptance of breakfast cereals. Extruded samples formulated with 100, 75, 50, and 25% APM, and complemented with yellow corn grits (YCG), were analyzed for their techno-functional and sensory properties. RESULTS: Increases in bulk density, as well as reduction in the expantion and porosity were observated for extrudates containing ≥ 50% APM, accompanied by an increase in purple color intensity. Increase in milk absorption index, reduction in milk solubility index and decrease in cereal hardness with increase in APM were also observed. Despite this, APM extented the cereal bowl-life. High sensory scores of overall liking (6) and color (7) were obtained for extruded formulations containing ≥ 50% APM and low values for extrudates with 25% APM. Aroma, flavor, and texture scores did not present significant differences. CONCLUSION: APM is an ingredient with the potential to be used to produce breakfast cereals since it improves their techno-functional characteristics and sensory acceptance, at the same time, it leads to the production of healthy, nutritious, and sustainable food. © 2022 Society of Chemical Industry.

Spirulina Platensis Supplementation Coupled to Strength Exercise Improves Redox Balance and Reduces Intestinal Contractile Reactivity in Rat Ileum.

The blue alga Spirulina platensis has presented several pharmacological activities, highlighting its actions as an anti-inflammatory and antioxidant. In addition, there are few studies with the influence of strength training on physiological parameters, as intestinal contractility and oxidative cell damage. We evaluated the influence of S. platensis supplementation, strength training, and its association on contractile reactivity of rat ileum, as well as the balance of oxidative stress/antioxidant defenses. Methods: Male Wistar rats were divided into; sedentary (S); S + supplemented with algae at 50 (S50), 150 (S150), and 500 mg/kg (S500); trained (T); and T + supplemented (T50, T150, and T500). Contractile reactivity was analyzed by kymographs; oxidative stress on ileum by the malondialdehyde (MDA) formation; and the antioxidant capacity by 2,2-diphenyl-1-picrylhydrazyl (DPPH) method. S. platensis supplementation reduced the reactivity of rat ileum to carbachol (CCh) and KCl, while training reduced only the CCh efficacy. In addition, association potentiated the reduction on contractile reactivity. Supplementation reduced the oxidative stress and increased oxidation inhibition; training alone did not alter this parameter, however association potentiated this beneficial effect. Therefore, this study demonstrated that both supplementation and its association with strength training promote beneficial effects regarding intestinal contractile reactivity and oxidative stress, providing new insights for intestinal disorders management.

Postexercise Hypotension Is Volume-Dependent in Hypertensives: Autonomic and Forearm Blood Responses.

de Freitas Brito, A, Brasileiro Santos, MdS, Coutinho de Oliveira, CV, and da Cruz Santos, A. Postexercise hypotension is volume-dependent in hypertensives: autonomic and forearm blood responses. J Strength Cond Res 33(1): 234-241, 2019-The purpose of this study was to evaluate the effect of 2 sessions of resistance exercise (RE) with different volumes on postexercise hypotension (PEH), forearm blood flow (FBF), and cardiac autonomic balance (LF/HF) in hypertensive elderly woman. The study was conducted with 16 hypertensive elderly (25.7 ± 3 kg·m², 55.5 ± 3 years) subjected to 3 experimental sessions, i.e., a control session, exercise with a set (S1), and exercise with 3 sets (S3). For each session, the subjects were evaluated before and after intervention. In the preintervention period, blood pressure (BP), FBF, and LF/HF were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same period. Both S1 and S3 comprised a set of ten repetitions of 10 exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (postintervention) in the supine position. Postexercise hypotension (systolic/diastolic) was greater in S3 than in S1 (-26 ± 4/-14 ± 5 mm Hg vs. -18 ± 5/-8 ± 5 mm Hg, p ≤ 0.05). Similarly, FBF and cardiac LF/HF increased in both sessions, being more evident in S3 than in S1 (4.98 ± 0.32 vs. 4.36 ± 0.27 ml·min·100 ml, p ≤ 0.05; and LF/HF = 1.69 ± 0.225 vs. 1.37 ± 0.13 p ≤ 0.05, respectively). We conclude that a single RE session with 3 series were able to promote higher PEH in hypertensive women, and this phenomenon was accompanied by increased FBF and increased cardiac autonomic activity.

Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors.

INTRODUCTION: Tocantins State in north Brazil remains endemic for leprosy, with high detection rates and occurrence of disabilities at diagnosis. We analyzed trends and identified factors associated with the occurrence of disability at diagnosis. METHODS: We analyzed data from the Notifiable Diseases Information System (SINAN). We included new leprosy cases resident in Tocantins, diagnosed between 2001 and 2012. RESULTS: During the study period, there were 14,532 new leprosy cases residing in Tocantins. Of these, 12,328 (84.9%) were assessed for degree of disability at diagnosis: 9,166 (74.4%) with Grade 0; 2,498 (20.3%) with Grade 1; and 664 (5.4%) with Grade 2 disability. The proportion of disability Grade 2 remained stable over time. Factors associated with Grade 2 at diagnosis included: male gender (RR = 2.24; CI: 1.89 - 2.65), age ≥ 45 years (RR = 5.31; CI: 3.21 - 8, 29), illiteracy (RR = 6.70; CI: 3.75 - 11.95), diagnosis made through mass campaigns (RR = 2.40; CI: 1.50 - 3.85), and residency in rural areas (RR = 1.28; CI: 1.06 - 1.5). Grade 2 disabilities at diagnosis were also more common in the presence of ≥ 5 five skin lesions (RR = 4.42, CI: 3.74 - 5.21), leprosy reactions (RR = 2.78; CI: 2.31 - 3.33), multibacillary disease (RR = 7.43; CI: 6.11 - 9.04), and lepromatous clinical form (RR = 16.53, CI: 12.10 - 20.60). CONCLUSIONS: The leprosy control programme should focus on socio-economically disadvantaged and difficult-to-reach population groups. Leprosy mass campaigns and other collective examinations, to be integrated with other disease control programmes, may be an effective means to reduce disability degree at diagnosis.

High-Intensity Resistance Exercise Promotes Postexercise Hypotension Greater than Moderate Intensity and Affects Cardiac Autonomic Responses in Women Who Are Hypertensive.

The purpose of this study was to evaluate the effect of high-intensity resistance exercise (RE) sessions on blood pressure (BP), heart rate (HR), cardiac autonomic modulation, and forearm blood flow (FBF). Sixteen trained hypertensive women (n = 16, 56 ± 3 years) completed the following 3 experimental sessions: control (CS), RE at 50% (EX50%), and RE at 80% (EX80%) of 1 repetition maximum (1RM). Both EX50% and EX80% comprised a set of 10 repetitions of 10 exercises, with an interval of 90 seconds between exercises. Measurements were taken preintervention and postintervention (at 10, 30, 50, 70, and 90 minutes of recovery). Reductions in systolic/diastolic BP after exercise were greater in EX80% (largest declines, -29 ± 4/-14 ± 5 mm Hg) than EX50% (largest declines, -18 ± 6/-8 ± 5 mm Hg, p ≤ 0.05). Heart rate and cardiac sympathovagal balance (LF/HF) increased more in relation to pre-exercise values in EX80% than EX50% (largest increases 96 ± 3 vs. 90 ± 4 b·min, LF/HF = 1.77 ± 0.25 vs. 1.40 ± 0.20, respectively, p ≤ 0.05). Increases in FBF and hyperemia was also higher in EX80% than EX50% compared with pre-exercise (4.97 ± 0.28 vs. 4.36 ± 0.27 ml·min·100 ml and 5.90 ± 0.20 vs. 5.38 ± 0.25 ml·min·100 ml; p ≤ 0.05, respectively). These results suggest that RE of higher intensity promoted greater postexercise hypotension accompanied by greater increases in FBF, vasodilator response, HR, and cardiac sympathovagal balance.

Anabolic-androgenic steroid use among Brazilian bodybuilders.

This cross-sectional, quantitative, exploratory study investigated the prevalence and profile of anabolic-androgenic steroids (AAS) users amongst a convenience sample of 510 bodybuilders from 52 gyms, in João Pessoa, Brazil, with a structured questionnaire containing selected questions about socioeconomic and training variables on the use of AAS. Data were analyzed using frequency and chi-square tests. AAS prevalence use was 20.6%; mostly young men (98.1%), of a low education level (46.7%), who trained for more than 4 years (49.5%). The use of AAS was related to the use of dietary supplements. About 81% of consumed AAS consisted of Deca-Durabolin, Winstrol, and Sustanon. Study's limitations are noted.

The Microemulsion with Solubilization of the Ethanolic Extract of the Leaves of Melão-de-São-Caetano (Momordica charantia) and Antibacterial Action.

Extracts obtained from plants have significantly contributed to the creation of new drugs due to their medicinal properties, which are provided by the presence of bioactive components. This has led to a growing interest from the pharmaceutical industry in using this type of extract for the creation of increasingly advanced medications. The main components sought are antibacterial agents from sustainable and renewable sources, whether of animal or vegetable origin or derived from other natural components. Tissues become a source of microbial proliferation, especially when in contact with the human body, which can cause serious diseases. In line with this, the goal of this research was to create an antibacterial Melon-de-São-Caetano (Momordica charantia) leaf microemulsion for application on material surfaces. This microemulsified system is an effective alternative for solubilizing functional agents, and being thermodynamically stable, it is efficient for long-term use. For this study, an extract of Momordica charantia leaves (EMC) was obtained, and microemulsions with different EMC concentrations (P1, P2, and P3) were produced. The extract and microemulsions were investigated using Fourier Transform Infrared (FTIR) spectroscopy, particle size, zeta potential, thermal stress, pH, electrical conductivity, Transmission Electron Microscopy (TEM), and antibacterial analysis (Staphylococcus aureus). In summary, the proposed objective was met, and EMC, SME, and the P2 and P3 microemulsions showed positive results against S. aureus, with the P3 microemulsified system being the most effective with a 12.5 mm inhibition halo. Therefore, the product developed in this research has the potential for application on surfaces, providing antibacterial action.

Supplementation With Spirulina platensis Improves Tracheal Reactivity in Wistar Rats by Modulating Inflammation and Oxidative Stress.

Spirulina platensis has shown effectiveness in the treatment of allergic rhinitis in rats, but its action in tracheal reactivity or on markers of relaxation and antioxidant profile has not yet been possible to determine. In this paper, the animals were divided into the groups healthy (SG) and supplemented with S. platensis at doses of 50 (SG50), 150 (SG150), and 500 mg/kg (SG500). We also evaluated nitrite levels, lipid peroxidation, and antioxidant activity through biochemical analysis. For contractile reactivity, only SG500 (pEC50 = 5.2 ± 0.06 showed reduction in carbachol contractile potency. Indomethacin caused a higher contractile response to carbachol in SG150 and SG500. For relaxation, curves for SG150 (pEC50 = 5.0 ± 0.05) and SG500 (pEC50 = 7:3 ± 0:02) were shifted to the left, more so in SG500. We observed an increase in nitrite in the trachea only with supplementation of 500 mg/kg (54.0 ± 8.0 µM), also when compared to SG50 (37.0 ± 10.0 µM) and SG150 (38.0 ± 7.0 µM). We observed a decrease in lipid peroxidation in the plasma and an increase in oxidation inhibition for the trachea and lung in SG150 and SG500, suggesting enhanced antioxidant activity. S. platensis (150/500 mg/kg) decreased the contractile response and increased relaxation by increasing antioxidant activity and nitrite levels and modulating the inflammatory response.

Active intervals between sets of resistance exercises potentiate the magnitude of postexercise hypotension in elderly hypertensive women.

Active and passive intervals (AI, PI) between exercise series promote different hemodynamic responses; however, the impact of these intervals on the blood pressure response has not yet been investigated. The objective of this study was to compare the impact of AIs and PIs during resistance exercises with the magnitude of postexercise hypotension (PEH). Elderly hypertensive women (n = 21, 61.2 ± 2 years of age) completed 4 sessions for upper or lower limbs with AI or PI (3 sets, 15 repetitions, 60% load of 15 repetition maximum (RM), and an interval of 90 seconds between sets). Blood pressure was measured 10 minutes before and at 10, 20, 30, 40, and 50 minutes after the exercise sessions. The heart rate at the end of each AI was always significantly higher than that after the PI, but the perceived exertion as measured by the Perceived Exertion Scale (OMNI-RPE) was similar to that of PI exercise protocols. In the lower limb exercises, AI resulted in significantly and consistently higher PEH than in exercises with PI for both systolic (from 20 minutes postexercise) and diastolic (from 10 minutes postexercise) pressures. The upper limb exercises promoted much more discrete PEH in relation to the lower limb exercises, given that the AI promoted significantly higher PEH relative to the PI protocols, but only for systolic PEH and only from 30 minutes postexercise. This is the first time that AIs between sets in a session of resistance exercises have been shown to be a highly effective methodological strategy to increase PEH in elderly hypertensive women.

Food consumption of branched chain amino acids and insulin resistance: A systematic review of observational studies in humans.

This review systematically investigated observational studies in humans that evaluated the dietary intake of branched-chain amino acids (BCAA) and its association with insulin resistance. A search implemented through the electronic databases of PubMed, Scopus, and Web of Science. The evaluation of insulin resistance or the risk of developing insulin resistance in humans were the variables of interest in the search for articles. After using the selection criteria, three studies included in this review. The Food Frequency Questionnaire (FFQ) was the instrument used to evaluate the diet in all of the selected studies. Overall, 1940 studies identified and three thoroughly reviewed. We found only one study with positive effects of BCAA on insulin resistance; the other two reviewed studies did not demonstrate positive effects of the dietary intake of BCAA, individually or the sum of three amino acids on variables of interest. In this sense, the associations between BCAA and insulin resistance are inconsistent, potentially due to other longitudinal outcomes.

Spirulina platensis prevents oxidative stress and inflammation promoted by strength training in rats: dose-response relation study.

The purpose of this study was to evaluate the effects of Spirulina Platensis supplementation on selected blood markers of oxidative stress, muscle damage, inflammation, and performance in trained rats. Rats (250 g - 300 g) were submitted to a strength training program (eight weeks), divided into four groups: control (GT) (trained without supplementation), trained with daily-supplementation of 50 mg/kg (GT50), 150 mg/kg (GT150) and 500 mg/kg (GT500). Training consisted of a jump protocol in PVC-cylinder containing water, with increasing load over experimental weeks. We evaluated the markers of oxidative stress (malondialdehyde - MDA and antioxidant capacity) and inflammation (C-reactive protein) at the end of the training. Among groups submitted to strength training, concentration of C-reactive protein decreased after 8 weeks of intervention in the trained group and GT500. Strength training enhanced plasma MDA concentration of malondialdehyde with supplementation of S. platensis in GT150 and GT500. In plasma analysis, strength training enhanced the percentage of oxidation inhibition, with spirulina supplementation in rates of 150 and 500 mg/kg. Spirulina supplementation for 8 weeks (in a dose-effect manner) improved antioxidant capacity as well as attenuated exercise-induced increases in ROS and inflammation. As a practical application, the use as high doses did not cause a reduction in positive physiological adaptations to exercise training. Additional studies are necessary to test the application of Spirulina Platensis in other contexts, as collective sports (basketball, football, soccer).

Supplementation with Spirulina platensis Modulates Aortic Vascular Reactivity through Nitric Oxide and Antioxidant Activity.

The possible mechanism is involved in the effects of Spirulina platensis on vascular reactivity. Animals were divided into sedentary group (SG) and sedentary groups supplemented with S. platensis at doses of 50 (SG50), 150 (SG150), and 500 mg/kg (SG500). To evaluate reactivity, cumulative concentration-response curves were constructed for phenylephrine and acetylcholine. To evaluate the involvement of the nitric oxide (NO) pathway, aorta tissue was preincubated with L-NAME and a new curve was then obtained for phenylephrine. Biochemical analyses were performed to evaluate nitrite levels, lipid peroxidation, and antioxidant activity. To contractile reactivity, only SG500 (pD2 = 5.6 ± 0.04 vs. 6.1 ± 0.06, 6.2 ± 0.02, and 6.2 ± 0.04) showed reduction in phenylephrine contractile potency. L-NAME caused a higher contractile response to phenylephrine in SG150 and SG500. To relaxation, curves for SG150 (pD2 = 7.0 ± 0.08 vs. 6.4 ± 0.06) and SG500 (pD2 = 7.3 ± 0.02 vs. 6.4 ± 0.06) were shifted to the left, more so in SG500. Nitrite was increased in SG150 and SG500. Lipid peroxidation was reduced, and oxidation inhibition was increased in all supplemented groups, indicating enhanced antioxidant activity. Chronic supplementation with S. platensis (150/500 mg/kg) caused a decrease in contractile response and increase in relaxation and nitrite levels, indicating greater NO production, due to decreased oxidative stress and increased antioxidant activity.

Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality.

OBJECTIVE: To characterize approach methods for intradomiciliary contacts (IdC) of leprosy cases resident in Northern Brazil, during 2001-2012. METHOD: A cross-sectional and descriptive study in the state of Rondônia. Included IdC of leprosy cases diagnosed/reported in SINAN-Ministry of Health (MS), 2001-2012. A semi-structured instrument was applied to the IdCs, with six interventions: complete dermatological examination; complete neurological examination; BCG vaccination; instructions for return to the health unit; BCG guidance; and guidance to mobilize other contacts.Results: From a total of 459 IdCs included, failure to perform the dermatological examination was reported by 191 people (41.6%) and the neurological examination, by 252 (54.9%); 138 (30.1%) did not have BCG indicated and 122 (26.6%) did not receive guidelines; 257 (56.0%) were not advised to return for a new evaluation/follow-up and 186 (40.5%) were not asked to mobilize other contacts. CONCLUSION: Despite the favorable indicators of IdC examination coverage in the state, the evaluation process presents patterns that indicate operational quality failures.

Aortic Response to Strength Training and Spirulina platensis Dependent on Nitric Oxide and Antioxidants.

Studies have shown that supplementation with Spirulina platensis improves vascular reactivity. However, it is unclear whether in association with strength training this effect can be enhanced. Thus, this study aimed to determine the effects of strength training and S. platensis on the reactivity of the aorta from Wistar rat and the possible mechanisms involved. The animals were supplemented with S. platensis and divided into sedentary (SG, SG50, SG150, and SG500) and trained groups (TG, TG50, TG150, and TG500). Nitrite, malondialdehyde (MDA) and antioxidant activity were determined by biochemical assays. To evaluate vascular response, cumulative concentration-response curves to phenylephrine (PHE) and acetylcholine (ACh) were constructed. L-NAME was used to assess the participation of nitric oxide (NO). It was observed that the PHE contractile potency was reduced in TG50, TG150, and TG500 groups compared to SG50, SG150, and SG500 groups, respectively. However, the presence of L-NAME increased the contractile response in all groups. Strength training potentiated the increase in relaxing activity induced by S. platensis, where the pCE50 values of ACh increased in TG150 and TG500. These responses were accompanied by increased nitrite production, MDA reduction and increased antioxidant activity in the aorta of both TG150 and TG500 groups. Thus, the present study demonstrated that combined with strength training, S. platensis potentiates vascular improvement through the participation of NO and reduction of oxidative stress.

Violence in schools and the voice of teachers. / Situações de violência na escola e a voz do professor.

PURPOSE: To correlate self-reporting of voice disorders with habits that impact voice production and situations of violence experienced by teachers. METHODS: The study involved 41 elementary-school teachers of rural and urban areas. Two instruments were used for data collection: The Vocal Production Condition - Teacher (CPV-P) questionnaire and the Screening Index for Voice Disorders - ITDV. The chi-square test was used to verify association among variables with a significance level of 5%. RESULTS: The sample consisted of 8 men and 33 women aged 25-66 years with a median of 39 years. Regarding vocal habits, 33 people (80.5%) mentioned the screaming as usual practice, 40 people (97.5%) declared they talk a lot. As for voice care, 31 people (73.1%) reported drinking water while using their voice. As for the ITDV total score, 30 teachers (73.1%) were above the score threshold set for predisposition to vocal disorders. Statistical analysis revealed a significant association between female participants and complaint of graffiti writings as a type of violence. No significant correlation between the ITDV results with gender and the ITDV with forms of violence evaluated in the study was indicated. CONCLUSION: Self-reporting of voice disorders showed no significant relationship with acts of violence. However, analysis of the context of violence in schools and vocal problems are issues worthy of attention, particularly the observed naturalization of gender inssues, which is seldom problematized.

Estudo de série de casos sobre voz e transexualidade: características acústicas de homens e mulheres trans brasileiras / Case series study on voice and transsexuality: acoustic characteristics of Brazilian trans men and women / Estudio de serie de casos sobre voz y transexualidad: características acústicas de hombres y mujeres trans brasileños

Objetivo: Descrever as características acústicas na voz de homens e mulheres trans. Método: Participaram desta pesquisa seis pessoas trans, dois homens e quatro mulheres trans, com idade superior a 18 anos. Foram utilizados o software SoundForge 10.0®, o Advanced Multi- Dimensional Voice Programm (MDVP-Adv) para extração das medidas da análise acústica computadorizada e o programa Analysis Synthesis Laboratory (Computerized Speech Lab - Kay Pentax®) para análise do filtro vocal. Resultados: Os valores dos formantes se mostraram menores quando comparados à literatura nacional e internacional. As medidas de f0 apresentaram valores abaixo do esperado ao gênero feminino e aumentados ao gênero masculino. Quanto às medidas de frequência fundamental máxima (fhi) e mínima (flo), os resultados apresentaram uma grande variabilidade, sugerindo instabilidade fonatória. Os resultados de jitter e shimmer e os parâmetros relacionados ao ruído, como o Índice de turbulência vocal (VTI) e Índice de fonação suave (SPI) mostraram-se incongruentes quando relacionados aos parâmetros de normalidade. A medida de ruído/harmônico NHR se mostrou maior que os valores de normalidade, sugerindo presença de ruído ou rouquidão durante a emissão. As medidas de tremor vocal (Fatr e Ftri) apresentaram distribuição anormal quando comparadas à literatura. Não foi possível observar relação nas análises das características acústicas entre os valores de referência e as pessoas participantes desta pesquisa. Conclusão: As medidas acústicas de vozes de homens e mulheres trans apresentam análises diferentes quando comparados à literatura, evidenciando fragilidade dos programas de análise vocal acústica que não contemplam a heterogeneidade cultural e as variadas identidades de gênero.

Objective: To describe the acoustic characteristics in the voice of trans men and women. Method: Six trans subjects, two men and four trans women, aged over 18 years participated in this study. The SoundForge 10.0® software was used to edit and select the vowel /a/, the Advanced Multi-Dimensional Voice Program (MDVP-Adv) for extraction of measurements from computerized acoustic analysis, and the Analysis Synthesis Laboratory program (Computerized Speech Lab - Kay Pentax®) for analysis of the vocal filter. Results: Formant values were lower when compared to national and international literature. The measures of f0 presented values below that expected for the female gender and increased to the male gender. Regarding the measures of the highest fundamental frequency (fhi) and the lowest (flo), the results showed great variability, suggesting phonatory instability. The results of jitter and shimmer and noise-related parameters, such as Voice Turbulence Index (VTI) and Soft Phonation Index (SPI), were incongruent when related to normality parameters. The noise / harmonic NHR measurement showed to be higher than the normal values, suggesting the presence of noise or hoarseness during the emission. Measurements of vocal tremor (Fatr and Ftri), presented an abnormal distribution when compared to the literature. It was not possible to observe relations in the analysis of the acoustic characteristics between the reference values and the people participating in this research. Conclusion: The acoustic measures of voices of trans people present different analysis when compared to the literature, evidencing the fragility of acoustic vocal analysis programs that do not contemplate the cultural heterogeneity and the varied gender identities.

Objetivo: describir las características acústicas en la voz de hombres y mujeres trans. Metodos: Seis personas trans, dos hombres y cuatro mujeres trans, mayores de 18 años participaron en esta investigación. El software SoundForge 10.0®, Programa de voz multidimensional avanzado (MDVP-Adv) se utilizaron para extraer las mediciones del análisis acústico computarizado y el programa del Laboratorio de síntesis de análisis (Laboratorio de habla computarizada - Kay Pentax®) para analizar el filtro vocal. Resultados: Los valores de los formantes demostraron ser más bajos en comparación con la literatura nacional e internacional. Las mediciones de f0 mostraron valores inferiores al esperado para el género femenino y aumentaron para el género masculino. En cuanto a las medidas de frecuencia fundamental máxima (fhi) y mínima (flo), los resultados mostraron una gran variabilidad, lo que sugiere inestabilidad fonatoria. Los resultados de jitter y shimmer y los parámetros relacionados con el ruido, como el índice de turbulencia vocal (VTI) y el índice de fonación suave (SPI) fueron incongruentes cuando se relacionaron con los parámetros de normalidad. La medida de ruido / armónicos NHR fue más alta que los valores normales, lo que sugiere la presencia de ruido o ronquera durante la emisión. Las mediciones del temblor vocal (Fatr y Ftri) mostraron una distribución anormal en comparación con la literatura. No fue posible observar una relación en el análisis de las características acústicas entre los valores de referencia y las personas que participan en esta investigación. Conclusión: Las medidas acústicas de las voces de las personas trans presentan diferentes análisis en comparación con la literatura, mostrando la fragilidad de los programas de análisis acústico vocal que no contemplan la heterogeneidad cultural y las diferentes identidades de género.

Temporal trends of leprosy in a Brazilian state capital in Northeast Brazil: epidemiology and analysis by joinpoints, 2001 to 2012. / Tendência temporal da hanseníase em uma capital do Nordeste do Brasil: epidemiologia e análise por pontos de inflexão, 2001 a 2012.

The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.