Outcomes after Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Patients with Primary Immunodeficiency Diseases.

Allogeneic hematopoietic stem cell transplantation (HCT) can cure primary immunodeficiency diseases (PID). When a HLA-matched donor is not available, a haploidentical family donor may be considered. The use of T cell-replete haploidentical HCT with post-transplantation cyclophosphamide (haplo-PTCy) in children with PID has been reported in few case series. A donor is usually readily available, and haplo-PTCy can be used in urgent cases. We studied the outcomes of 73 patients with PID who underwent haplo-PTCy, including 55 patients who did so as a first transplantation and 18 who did so as a salvage transplantation after graft failure of previous HCT. The median patient age was 1.6 years. Most of the children were male (n = 54) and had active infection at the time of transplantation (n = 50); 10 children had severe organ damage. The diagnosis was severe combined immunodeficiency (SCID) in 34 patients and non-SCID in 39 (Wiskott-Aldrich syndrome; n = 14; chronic granulomatous disease, n = 10; other PID, n = 15). The median duration of follow-up of survivors was 2 years. The cumulative incidence of neutrophil recovery was 88% in the SCID group and 84% in non-SCID group and was 81% for first transplantations and 83% after a salvage graft. At 100 days, the cumulative incidence of acute GVHD grade II-IV and III-IV was 33% and 14%, respectively. The majority of patients reached 200/µL CD4+ and 1000/µL CD3+ cell counts between 3 and 6 months. The estimated 2-year overall survival was 66%; it was 64% for SCID patients and 65% for non-SCID patients and 63% for first HCT and 77% for salvage transplantations. Twenty-five patients died, most of them due to infection early after transplantation (before 100 days). In conclusion, haplo-PTCy is a feasible procedure, can cure two-thirds of children with PID, and can be used as rescue treatment for previous graft failure. © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Impact of CD34 Cell Dose and Conditioning Regimen on Outcomes after Haploidentical Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Relapsed/Refractory Severe Aplastic Anemia.

Severe aplastic anemia (SAA) is a life-threatening disease that can be cured with allogeneic cell transplantation (HCT). Haploidentical donor transplantation with post-transplantation cyclophosphamide (haplo-PTCy) is an option for patients lacking an HLA-matched donor. We analyzed 87 patients who underwent haplo-PTCy between 2010 and 2019. The median patient age was 14 years (range, 1 to 69 years), most were heavily transfused, and all received previous immunosuppression (25% without antithymocyte globulin). Almost two-thirds (63%) received standard fludarabine (Flu)/cyclophosphamide (Cy) 29/total body irradiation (TBI) 200 cGy conditioning, and the remaining patients received an augmented conditioning: Flu/Cy29/TBI 300-400 (16%), Flu/Cy50/TBI 200 (10%), or Flu/Cy50/TBI 400 (10%). All patients received PTCy-based graft-versus-host disease (GVHD) prophylaxis. Most grafts (93%) were bone marrow (BM). The median duration of follow-up was 2 years and 2 months. The median time to neutrophil recovery was 17 days. Primary graft failure occurred in 15% of the patients, and secondary or poor graft function occurred in 5%. The incidences of grade II-IV acute GVHD was 14%, and that of chronic GVHD was 9%. Two-year overall survival and event-free survival (EFS) were 79% and 70%, respectively. EFS was higher for patients who received augmented Flu/Cy/TBI (hazard ratio [HR], .28; P = .02), and those who received higher BM CD34 cell doses (>3.2 × 10E6/kg) (HR, .29; P = .004). The presence of donor-specific antibodies before HSCT was associated with lower EFS (HR, 3.92; P = .01). Graft failure (HR, 7.20; P < .0001) was associated with an elevated risk of death. Cytomegalovirus reactivation was frequent (62%). Haploidentical HCT for SAA is a feasible procedure; outcomes are improved with augmented conditioning regimens and BM grafts with higher CD34 cell doses.

Hematopoietic cell transplantation for Diamond Blackfan anemia: A report from the Pediatric Group of the Brazilian Bone Marrow Transplantation Society.

OBJECTIVES: The aim of this study was to analyze the outcomes of children with Diamond-Blackfan anemia (DBA) treated in Brazil with hematopoietic cell transplantation (HCT). METHODS: We performed a retrospective analysis of 44 pediatrics patients transplanted between 1990 and 2018. The median age of patients was 5 years, and 57% were male. Twenty-five received their first HCT from an HLA-matched sibling donor (MSD), 12 from a HLA matched unrelated bone marrow donor (MUD 10/10, n = 12) and 7 other HLA mismatched donors (MMD). RESULTS: After a median follow-up of 4 years, estimate 5-year overall survival (OS) for the entire cohort was 70%, 80% for MSD group, 73% for MUD, and 29% for MMD. Thirty-eight out of the 44 evaluable patients engrafted successfully. Primary and secondary graft failure was observed in five and three patients, respectively. Rates of grade II-IV and III-IV acute graft-versus-host disease (aGVHD) were 25% and 18%, respectively. Nine patients developed chronic GVHD (cGVHD). CONCLUSION: Overall survival rates observed after HLA matched donors transplant for DBA were comparable to those reported from higher-income countries and international registries.

The Use of a High Flow PICC Catheter for Stem Cell and Lymphocyte Apheresis: The Initial Experience of a Pediatric Oncology Center in Brazil.

BACKGROUND: Autologous hematopoietic stem cell transplant (HSCT), characterized by high intensity chemotherapy followed by the infusion of HSC previously collected from the peripheral blood, is a procedure used in the treatment of several malignancies. In pediatrics, the apheresis procedure represents a challenge, due to the need for insertion of a rigid central venous catheter (CVC) in small children. The CVC is usually used for stem cell collection and then removed. Later, the patient will need a new device for cell infusion. AIM: We propose the use of one single catheter for both apheresis and infusion. METHODS: We present five children between 1 and 13 years of age who underwent apheresis using a high flow PICC catheter surgically inserted. RESULTS: All patients utilized a PICC line double lumen 5Fr (PowerPICC™ 5Fr DL BARD/USA) placed in the brachiocephalic vein tunneled on the chest, inserted under 24 h prior to apheresis to assure the devices were pervious. Three of the patients were diagnosed with solid tumor and one with acute lymphoblastic leukemia (ALL) awaiting Car-T Cell therapy. The four children who underwent autologous HSCT used the same catheter for cell infusion and remained with the catheter following discharge. The child who was submitted for Car-T Cell still awaits infusion and the catheter was removed. CONCLUSIONS: High flow PICC is a viable alternative for apheresis to maintain an adequate flow of 5 ml/s and can be used as a single catheter throughout the HSCT process, reducing the risks from anesthesia and the catheter insertion procedure. TYPE OF STUDY: Clinical Research.

Heterotopic ovarian allotransplantation in a caprine model: Effects of implant site on morphological parameters.

This study aimed to investigate a new implantation site (intra-auricular subcutaneous - IA) compared to intramuscular (IM) in the cervical portion (cervical splenius muscle) of the neck for ovarian transplantation in goats. Morphological aspects of the implant, follicular activation and morphology, and type I and III collagen deposits of the transplanted tissue were evaluated. Four fragments of the ovarian cortex were allotransplanted at the IA and IM sites in all goat recipients and recovered 7 (IA-7; IM-7) or 15 (IA-15; IM-15) days later and submitted to histological analysis. Two fragments/animal were separated for the fresh control (FC) group. There was a higher percentage of normal and developing primordial follicles at the IA-7 site (P < 0.05) compared to the other treatments, with similar values to the fresh control. Type I and III collagen fibers differed between the groups (P < 0.05), showing a considerable decrease in type I collagen fibers at the IA-7 site compared to the FC. However, the IM-7 and IA-15 sites showed higher values of type I collagen fibers, showing similarity to the FC. Therefore, we conclude that the IA site in goats is an effective site for ovarian tissue transplantation, as it is easily accessible, low invasive and has presented satisfactory rates of morphology and follicular activation.

Trunk, Mass Grasp, Knee, and Hip Muscle Performance in CrossFit Participants: Reference Values According to Participants' Sex and Limb Dominance.

Background: CrossFit is characterized by a diverse range of exercises recruiting different muscles and requiring different muscle functions. A characterization of muscular performance parameters in this population is needed. Purpose: To determine reference values for various aspects of muscular performance of muscles of the trunk, thigh, hip, and mass grasp in CrossFit participants. Also, this investigation aimed to compare the strength measures between male and female CrossFit participants, as well as between dominant and non-dominant limbs. Design: Descriptive, Cross-sectional. Setting: Laboratory. Methods: Isometric strength of trunk extensors (TE) and mass grasp was measured with handheld and Jamar dynamometer respectively. An isokinetic dynamometer was used to assess the muscle performance of the knee flexors (KF) and extensors (KE) (at 60º/s and 300º/s), and hip flexors (HF), extensors (HE), and abductors (HA) (60º/s and 240º/s ). Reference values for torque, work, power, fatigue, flexor:extensor ratio for the knee (hamstring:quadriceps - H:Q) and hip (HF:HE) joints were calculated. The torque and work values were normalized by the body mass. Mixed multivariate and univariate analyses of variance and independent t-tests were used for statistical analyses to compare between sexes and limbs. Results: Participants included 111 individuals (58 males and 53 females) with at least one year of experience in CrossFit. Normative data are provided for the outcome variables. Males had greater values of muscular performance parameters than females in most variables (p<0.05). Also, the dominant limb had greater mass grasp strength (p<0.002), greater KE power at 60º/s (p=0.015), lower H:Q ratio at 60º/s (p=0.021) and 300º/s (p=0.008), and lower KE fatigue (p=0.002). Conclusion: This study provides reference values for the trunk extensors, mass grasp, knee, and hip muscle performance in male and female CrossFit practitioners. Their muscle performance profile was characterized by few inter-limb asymmetries, and males demonstrated greater muscular performance outcomes than females, even after normalization by body mass. These reference values can be used for comparisons in research and clinical settings. Level of Evidence: 3b.

Immune reconstitution after allogenic stem cell transplantation: An observational study in pediatric patients.

INTRODUCTION: The immune reconstitution (IR) after the allogenic hematopoietic stem cell transplantation (allo-HSCT) is a progressive process intrinsically correlated to the therapeutic success. It is essential to understand the interfering factors in IR to prevent the HSCT-related mortality. METHODS: We retrospectively evaluated the clinical outcomes, absolute lymphocyte counts (ALCs) and lymphocyte subtypes at different time-points of 111 pediatric patients with allogeneic HSCT for malignant and non-malignant diseases from 2013 to 2018. RESULTS: The ALCs gradually increased on D+30, D+100, and D+180 (medians 634/µL, 1022/µL and 1541/µL, respectively). On D+100, the CD3+CD8+ achieved the highest recovery rate (68%), followed by the CD16+CD56+ (47%), CD3+CD4+ (39%) and CD19+ (8%). The adequate ALC recovery was associated with age < 8 years, bone marrow grafts, myeloablative conditioning, non-use of serotherapy and non-haploidentical donors. The ALC and CD3+CD8+ on D+100 counts were higher in patients with the cytomegalovirus infection. The CD3+CD4+ recovery was associated with an age < 8 years, a non-malignant disease and a lower incidence of acute graft-versus-host disease ≥ grade 2. Furthermore, the ALC recovery on D+100 resulted in a higher overall survival, regardless of the disease type (HR 3.65, 1.05 - 12.71, p = 0.04). CONCLUSION: Several factors influenced the IR after the allo-HSCT. The ALC ≥ 500/µL on D+100 was a simple IR predictor of survival, easily available to resource-limited centers.

Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia.

This study investigated whether blood-based biomarkers were related to functional test performance and respiratory muscle strength in older adults with COPD and sarcopenia. The participants included in this cross-sectional study were from both sexes and sixty years or older. Based on clinical assessment, participants were categorized in COPD (n = 43) and non-COPD (NCOPD) (n = 43) groups. They were also assessed for body composition and muscular mass by dual-energy X-ray absorptiometry, using the relative skeletal muscle index for the diagnosis of sarcopenia. A series of functional tests, including short physical performance battery (SPPB), 6-minute walking test (6MWT), maximal inspiratory and expiratory pressures (MIP and MEP), were carried out. Plasma levels of myokines (Irisin and BDNF), and soluble TNF receptors (sTNFR1 and sTNFR2) were determined by ELISA. In the multivariate analysis, 6MWD was associated with age, COPD-related sarcopenia and BDNF (R2 = 0.29; f2 = 0.41). SPPB score was associated with COPD-related sarcopenia and sTNFR1 (R2 = 0.25; f2 = 0.33). MIP value was associated with sex, COPD-related sarcopenia, sTNFR2 and Irisin (R2 = 0.24; f2 = 0.31). Finally, MEP value was associated with sex COPD-related sarcopenia (R2 = 0.18; f2 = 0.22). Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia.

Immediate Effects of Whole-Body Vibration Associated with Squatting Exercises on Hemodynamic Parameters in Sarcopenic Older People: A Randomized Controlled Trial.

Whole-body vibration (WBV) exercises have recently been introduced as a nonpharmacological therapeutic strategy for sarcopenic older people. The present study aimed to evaluate the effect of WBV exercise on hemodynamic parameters in sarcopenic older people. Forty older people, divided into groups of nonsarcopenic (NSG = 20) and sarcopenic (SG = 20), participated in the study and were cross randomized into two interventions of eight sets of 40 s each, these being squatting with WBV and squatting without WBV. Heart rate (HR), peak heart rate (peak HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), mean arterial pressure (MAP), and subjective perception of effort (SPE), were assessed at baseline, during, and after a single WBV session. The HR, peak HR, and DP variables were similar at baseline between groups. WBV exercise increased all the hemodynamic parameters both during and immediately after the intervention, in both groups (SG and NSG). The MAP values were similar at baseline between groups; however, in the NSG there was a significant increase during and immediately after the squatting with WBV intervention (p < 0.05). The HR behavior, in both groups, showed that there was an increase in HR after the first set of exercises with vibration and this increase was maintained until the final set. The absence of adverse effects of WBV exercise on the cardiovascular system and fatigue suggests this exercise modality is adequate and safe for sarcopenic older people.

Newborn Screening for the Detection of the TP53 R337H Variant and Surveillance for Early Diagnosis of Pediatric Adrenocortical Tumors: Lessons Learned and Way Forward.

The incidence of pediatric adrenocortical tumors (ACT) is high in southern Brazil due to the founder TP53 R337H variant. Neonatal screening/surveillance (NSS) for this variant resulted in early ACT detection and improved outcomes. The medical records of children with ACT who did not participate in newborn screening (non-NSS) were reviewed (2012-2018). We compared known prognostic factors between the NSS and non-NSS cohorts and estimated surveillance and treatment costs. Of the 16 non-NSS children with ACT carrying the R337H variant, the disease stages I, II, III, and IV were observed in five, five, one, and five children, respectively. The tumor weight ranged from 22 to 608 g. The 11 NSS children with ACT all had disease stage I and were alive. The median tumor weight, age of diagnosis, and interval between symptoms and diagnosis were 21 g, 1.9 years, and two weeks, respectively, for the NSS cohort and 210 g, 5.2 years, and 15 weeks, respectively, for the non-NSS cohort. The estimated surveillance/screening cost per year of life saved is US$623/patient. NSS is critical for improving the outcome of pediatric ACT in this region. Hence, we strongly advocate for the inclusion of R337H in the state-mandated universal screening and surveillance.

Effect of the smoking using Brazilian reforestation woods on volatile organic compounds, lipid oxidation, microbiological and hedonic quality of bacons during shelf life.

The aim of this study was to investigate the effect of using different reforestation woods (Acacia mearnsii and Eucalyptus citriodora) on the formation of volatile organic compounds and to evaluate the changes in the lipid fraction (peroxide value and thiobarbituric acid reactive substances), microbiological counts and overall liking in bacons stored for 60 days at 5 ± 1 °C. Smoking with Eucalyptus citriodora wood increased the total phenolic content and, consequently, reduced the concentration of hexanal, TBARS, and PV values. Although smoking with different reforestation woods did not impact negatively on the liking of products, no changes on antimicrobial activity was observed in the developed products. Thus, the use of Eucalyptus citriodora wood may be an alternative for smoking meat products as it reduced lipid oxidation and improved the volatile compounds profile, and provided higher antioxidant activity. The information generated herein can be used as a platform for companies to test the viability of producing meat products smoked with reforestation woods.

Allogeneic Hematopoietic Stem Cell Transplantation for Children and Adolescents with Acute Myeloid Leukemia in Brazil: A Multicentric Retrospective Study.

The survival rates of children with high-risk acute myeloid leukemia (AML) treated with hematopoietic stem cell transplant (HSCT) range from 60% to 70% in high-income countries. The corresponding rate for Brazilian children with AML who undergo HSCT is unknown. We conducted a retrospective analysis of 114 children with AML who underwent HSCT between 2008 and 2012 at institutions participating in the Brazilian Pediatric Bone Marrow Transplant Working Group. At transplant, 38% of the children were in first complete remission (CR1), 37% were in CR2, and 25% were in CR3+ or had persistent disease. The donors included 49 matched-related, 59 matched-unrelated, and six haploidentical donors. The most frequent source of cells was bone marrow (69%), followed by the umbilical cord (19%) and peripheral blood (12%). The 4-year overall survival was 47% (95% confidence interval [CI] 30%-57%), and the 4-year progression-free survival was 40% (95% CI 30%-49%). Relapse occurred in 49 patients, at a median of 122 days after HSCT. There were 65 deaths: 40 related to AML, 19 to infection, and six to graft versus host disease. In conclusion, our study suggests that HSCT outcomes for children with AML in CR1 or CR2 are acceptable and that this should be considered in the overall treatment planning for children with AML in Brazil. Therapeutic standardization through the adoption of multicentric protocols and appropriate supportive care treatment will have a significant impact on the results of HSCT for AML in Brazil and possibly in other countries with limited resources.

Immune reconstitution after allogenic stem cell transplantation: An observational study in pediatric patients

Abstract Introduction The immune reconstitution (IR) after the allogenic hematopoietic stem cell transplantation (allo-HSCT) is a progressive process intrinsically correlated to the therapeutic success. It is essential to understand the interfering factors in IR to prevent the HSCT-related mortality. Methods We retrospectively evaluated the clinical outcomes, absolute lymphocyte counts (ALCs) and lymphocyte subtypes at different time-points of 111 pediatric patients with allogeneic HSCT for malignant and non-malignant diseases from 2013 to 2018. Results The ALCs gradually increased on D+30, D+100, and D+180 (medians 634/μL, 1022/μL and 1541/μL, respectively). On D+100, the CD3+CD8+ achieved the highest recovery rate (68%), followed by the CD16+CD56+ (47%), CD3+CD4+ (39%) and CD19+ (8%). The adequate ALC recovery was associated with age < 8 years, bone marrow grafts, myeloablative conditioning, non-use of serotherapy and non-haploidentical donors. The ALC and CD3+CD8+ on D+100 counts were higher in patients with the cytomegalovirus infection. The CD3+CD4+ recovery was associated with an age < 8 years, a non-malignant disease and a lower incidence of acute graft-versus-host disease ≥ grade 2. Furthermore, the ALC recovery on D+100 resulted in a higher overall survival, regardless of the disease type (HR 3.65, 1.05 - 12.71, p= 0.04). Conclusion Several factors influenced the IR after the allo-HSCT. The ALC ≥ 500/μL on D+100 was a simple IR predictor of survival, easily available to resource-limited centers.

Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial.

OBJECTIVE: to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl cellulose in the treatment of chronic venous ulcer patients. METHOD: randomized controlled clinical trial with 12-week follow-up. The sample consisted of 18 volunteers and 28 venous ulcers. In the trial group, 2% papain gel was used and, in the control group, 2% carboxymethyl cellulose gel. RESULTS: the trial group showed a significant reduction in the lesion area, especially between the fifth and twelfth week of treatment, with two healed ulcers and a considerable increase in the amount of epithelial tissue in the wound bed. CONCLUSION: 2% papain gel demonstrated greater effectiveness in the reduction of the lesion area, but was similar to 2% carboxymethyl cellulose gel regarding the reduction in the amount of exudate and devitalized tissue. Multicenter research is suggested to evidence the effectiveness of 2% papain gel in the healing of venous ulcers. UTN number: U1111-1157-2998.

Impressões auditivas da voz do professor na percepção de alunos, professores e leigos / Auditory impressions of the teacher's voice in the perception of students, teachers and naive people

RESUMO Objetivo Comparar as impressões auditivas de estudantes, professores e leigos para a voz, na docência do ensino fundamental. Métodos Estudo transversal formado por três grupos: 104 alunos; 40 professores e 40 não professores. O objeto de estudo foi um banco de 14 vozes, composto pela voz de uma atriz. Os participantes assinalaram as vozes preferidas para uma professora do ensino fundamental, indicando se eram agradáveis, motivadoras e capazes de despertar atenção. Resultados As vozes preferidas foram de qualidade vocal neutra (95,1%), pitch grave (75%) e velocidade lenta (67,9%), consideradas agradáveis, motivadoras e capazes de despertar atenção. As vozes menos escolhidas foram soprosa moderada (98,4%) e intensa (97,3%), rugosa leve (94,6%), moderada (94,0%) e intensa (94,6%), com articulação de fala imprecisa (94,0%), todas com psicodinâmica vocal negativa. A voz grave foi, proporcionalmente, a mais escolhida pelos professores (95%). As vozes de velocidade lenta, intensidade forte e soprosa leve foram mais assinaladas pelos leigos (90%, 52,5% e 37,5%) e os alunos indicaram menos as vozes rugosas leves e moderadas (1,9%). Conclusão Vozes de qualidade vocal neutra, de pitch grave e com velocidade de fala lenta são as preferidas para uma professora do ensino fundamental, consideradas agradáveis, motivadoras e capazes de despertar a atenção. Vozes com articulação de fala imprecisa, rugosas e soprosas moderadas e intensas não são bem aceitas e a psicodinâmica é negativa. Professores valorizam mais o pitch grave; leigos, a velocidade de fala lenta, soprosidade leve e intensidade forte e os alunos são os que mais avaliam negativamente as vozes rugosas.

ABSTRACT Purpose Compare the auditory perceptions of students, teachers and naive people regarding the voice, in elementary school teaching. Methods It is a cross-sectional study composed by three groups of 104 students, 40 teachers and 40 non-teachers. The object of the research was a 14-voice bank, composed by the voice of an actress. The participants pointed out which voices they would choose for an elementary school teacher, indicating if the voices were pleasant, motivating and able to arouse attention. Results The preferred voices were of neutral vocal quality (95.1%), bass pitch (75%) and slow speed (67.9%), considered pleasant, motivating and able to arouse attention. The less chosen voices were the moderate breathy (98.4%), intense breathy (97.3%), mild rough (94.6%), moderate rough (94.0%), intense rough (94.6%) and with imprecise speech articulation (94.0%), all of them with negative vocal psychodynamic. Proportionally, the bass voice was the most chosen by teachers (95%). The slow speed, strong intensity and mild breathy voices were more marked by naive people (90%, 52.5%, 37.5%) and the students reported less the mild rough (1.9%) and moderate rough (1.9%) ones. Conclusion Voices of neutral vocal quality, of bass pitch and with slow speech speed are the preferred ones for a teacher of elementary school, considered pleasant, motivating and able to arouse attention. The voices with imprecise speech articulation, moderate and intense rough and breathy are not well accepted and the psychodynamic is negative. Teachers appreciate more the bass pitch; naive people, the slow speech speed, mild breathy and strong intensity; and students evaluate negatively the rough voices.

The use of the URICA-VOICE questionnaire to identify the stages of adherence to voice treatment.

PURPOSE: To adapt the URICA questionnaire to assess the motivational stages of patients undergoing voice treatment, and to determine the association between these stages with age, type of dysphonia, level of education, profession, and number of voice therapy sessions. METHODS: A cross-sectional study design was employed, using a convenience sample composed of 66 dysphonic patients--women and eight men--aged from 18 to 68 years, who were enrolled in outpatient care at two federal universities. As an exploratory tool, the URICA questionnaire was adapted to the area of voice, based on specific situations related to vocal behaviors. This questionnaire was named URICA-VOICE. It was administered individually and subjected to analyses. RESULTS: Most patients, 38 (57.6%), were in the contemplation stage, 20 (30.3%) were in the pre-contemplation, and only eight (12.1%) in the action stage, which is ideal to voice therapy. There was no association between adherence stages and the variables age, type of dysphonia, level of education, and number of voice therapy sessions. The variable profession was associated with the action stage of the URICA-VOICE. CONCLUSION: The URICA-VOICE showed that most dysphonic patients undergoing treatment are still in the contemplation stage, which may limit therapy outcomes. There was no relationship between the other variables and the adherence stages of the URICA-VOICE questionnaire.

Impactos da voz do professor na sala de aula: revisão da literatura / Impact of the teacher's voice in the classroom: a literature review / Impactos de la voz del maestro en el aula: una revision de la literatura

Objetivo: Realizar uma revisão da literatura referente aos impactos da voz do professor no contexto da sala de aula Método: foi realizado levantamento na literatura publicada nos idiomas inglês, espanhol ou português, utilizando-se as bases de dados MEDLINE, IBECS, LILACS e Web of Science, dos últimos 15 anos. Foram utilizados os seguintes descritores e palavras-chaves: distúrbios da voz, disfonia, voz disfônica, qualidade da voz, testes de linguagem, compreensão, percepção da fala e cognição. Resultados: sete estudos foram selecionados de acordo com o tema de investigação em uma busca realizada nos últimos 15 anos. Foram encontrados sete estudos transversais e uma revisão de literatura, categorizados pelas autoras, da seguinte forma: disfonia e compreensão da linguagem; disfonia e compreensão da linguagem em ambiente ruidoso; percepção da voz disfônica; qualidade vocal e velocidade de fala. Conclusão: Os estudos evidenciam que a disfonia do professor interfere na compreensão da mensagem transmitida pelo professor para os alunos, principalmente em ambientes ruidosos. A voz disfônica do professor é avaliada negativamente pelos alunos e a velocidade de fala mais lenta se apresenta como um fator importante para o processamento da linguagem, no contexto da sala de aula.

Objective: To realize a review of the literature about the impact of teacher's dysphonia on student learning. Methods: It was conducted a survey over the last 15 years in national and international literature, published in English, Portuguese or Spanish, using the MEDLINE, IBECS, LILACS and Web of Science. The following keywords and descriptors were used: voice disorders, dysphonia, dysphonic voice, voice quality, language tests, comprehension, speech perception and cognition. Results: Eight articles have included the proposed criteria in the last 15 years. It was found seven cross-sectional studies and a literature review, which were categorized by the authors as follow: dysphonia and language comprehension, dysphonia and language comprehension in noisy environments; perception of dysphonic voice, vocal quality and speech rate. Conclusions: Studies show that teacher's dysphonia interferes in the understanding of the message in the classroom, especially in noisy environments. The students evaluate the dysphonic voice negatively. The speech rate also presented as an important factor for language processing.

Objetivo: revisar la literatura sobre los impactos de la voz del maestro en el aula. Métodos: Se realizó el estudio de la literatura publicada en inglés, español o portugués, usando las bases de datos MEDLINE, IBECS, LILACS y Web of Science, de los últimos 15 años. Se utilizaron los siguientes descriptores e palabras clave: trastornos de la voz, la voz disfonía, disfonía, calidad de voz, pruebas de lenguaje, comprensión, percepción del habla y cognición. Resultados: Se seleccionaron ocho estudios de acuerdo con el tema de la investigación registrados en los últimos 15 anõs. Se encontraron siete estúdios transversales y una revisión de la literatura, categorizados por los autores, de la siguiente manera: disfonía y comprensión del lenguaje, disfonia y comprensión del lenguaje en ambiente ruidoso, percepción de la voz de disfonia, calidad vocal y velocidad de la voz. Conclusión: Los estudios demuestran que la disfonía del maestro interfiere con la comprensión del mensaje transmistido por el para los estudiantes, especialmente en ambientes ruidosos. La disfonia del professor es evaluada negativamente por los estudiantes y la velocidad del habla, más lenta, se presenta como un factor importante para el procesamiento del lenguaje en el contexto del aula.

Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial / Efetividade do gel de papaína no tratamento de úlceras venosas: ensaio clínico randomizado / Efectividad del gel de papaína en el tratamiento de úlceras venosas: ensayo clínico aleatorio

to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl cellulose in the treatment of chronic venous ulcer patients.

avaliar a efetividade do gel de papaína a 2% comparado ao gel de carboximetilcelulose a 2% no tratamento de pacientes com úlceras venosas crônicas.

evaluar la efectividad del gel de papaína a 2% comparado con el gel de carboximetilcelulosa a 2% en el tratamiento de pacientes con úlceras venosas crónicas.

Wound care research groups registered in Brazil: a transversal study

Aim: to describe the main characteristics of Brazilian nursing and health groups registered in the Research Group Directory in Brazil involved in the study of wound care. Method: This is a documentary study which adopts a transversal approach, performed between March 3rd and April 10th 2012, with information collected from research groups that study wound care. Results: Of the 61 selected groups, 42.6% are located in the Southeast region of Brazil; only 44.26% of the groups have nursing staff involved. The majority of the group leaders are medical doctors; 78.7% of the groups have developed up to seven lines of research. Of these, 31.8% of the lines of research focus on histopathology and wound healing. Conclusion: Nursing staff develop many lines of research in the area of assistance and quality of life, but there is a significant paucity of research based on an interdisciplinary context.

Escala URICA-VOZ para identificação de estágios de adesão ao tratamento de voz / The use of the URICA-VOICE questionnaire to identify the stages of adherence to voice treatment

OBJETIVOS: Adaptar a escala URICA à avaliação dos estágios de mudança para a adesão de pacientes em tratamentos de voz; e verificar a relação destes com a idade do paciente, o tipo de disfonia, a escolaridade, a profissão e o número de sessões de fonoterapia. MÉTODOS: Estudo transversal, com amostra de conveniência, composta por 66 pacientes com disfonia, sendo 58 mulheres e oito homens, com idade entre 18 e 65 anos, atendidos em dois ambulatórios de instituições de ensino de Fonoaudiologia. Como instrumento exploratório, procedeu-se à adaptação brasileira da escala URICA para a área de voz, tendo como base situações específicas relacionadas ao comportamento vocal, denominada URICA-VOZ. O instrumento foi aplicado individualmente e as variáveis foram relacionadas. RESULTADOS: A maioria dos pacientes, 38 (57,6%), concentrou-se no estágio de contemplação, 20 (30,3%) no de pré-contemplação e apenas oito (12,1%) no de ação, ideal para a terapia fonoaudiológica. Não houve associação entre os estágios de adesão com as variáveis idade, tipo de disfonia, escolaridade e número de sessões de fonoterapia. A variável profissão apresentou associação com o estágio de ação URICA-VOZ. CONCLUSÃO: O uso da escala URICA-VOZ revelou que a maioria dos pacientes com disfonia em tratamento ainda se encontra no estágio de contemplação, o que pode restringir os resultados da terapia. Não houve relação entre as demais variáveis estudadas e os estágios de adesão do protocolo URICA-VOZ.

PURPOSE: To adapt the URICA questionnaire to assess the motivational stages of patients undergoing voice treatment, and to determine the association between these stages with age, type of dysphonia, level of education, profession, and number of voice therapy sessions. METHODS: A cross-sectional study design was employed, using a convenience sample composed of 66 dysphonic patients - 58 women and eight men - aged from 18 to 68 years, who were enrolled in outpatient care at two federal universities. As an exploratory tool, the URICA questionnaire was adapted to the area of voice, based on specific situations related to vocal behaviors. This questionnaire was named URICA-VOICE. It was administered individually and subjected to analyses. RESULTS: Most patients, 38 (57.6%), were in the contemplation stage, 20 (30.3%) were in the pre-contemplation, and only eight (12.1%) in the action stage, which is ideal to voice therapy. There was no association between adherence stages and the variables age, type of dysphonia, level of education, and number of voice therapy sessions. The variable profession was associated with the action stage of the URICA-VOICE. CONCLUSION: The URICA-VOICE showed that most dysphonic patients undergoing treatment are still in the contemplation stage, which may limit therapy outcomes. There was no relationship between the other variables and the adherence stages of the URICA-VOICE questionnaire.