Age-Related Variations in Corneal Asphericity and Long-Term Changes.

PURPOSE: Corneal front-surface asphericity is directly related with the optical quality of the eye and with contact lenses fitting. The purpose of this study was to evaluate the corneal asphericity as a function of age, sex, and refractive error measured with autokeratometry and corneal topography and its long-term changes (5- to 10-year period). METHODS: The asphericity and corneal curvature were obtained with the autorefractometer/autokeratometer NIDEK ARK-700A and with the videokeratoscope MODI 2.0 and compared. Corneal asphericity was retrospectively analyzed with NIDEK ARK-700A. The longitudinal study of asphericity was conducted with the same device between 2 appointments within an interval of 5 to 10 years. RESULTS: NIDEK ARK-700A showed agreement of asphericity values with those of MODI 2.0 (P=0.172) for a 7-mm diameter chord. The mean Q value of 1,484 right eyes (58.6% female), with a mean age of 40.2±18.4 years, was -0.24±0.12. No differences were found for Q value between sexes (P=0.424), age groups (P=0.268), and refractive error groups (P=0.107). The longitudinal analysis of corneal asphericity in 190 eyes (62.1% female) over a mean period of 5.9±1.4 years showed no significant differences in the Q value (0.00±0.08, P=0.813) over time. However, 14% showed asphericity changes of ±0.10 or higher while 86% of the subjects showed a change below ±0.10. CONCLUSIONS: The mean Q value observed in this study agrees with the average values of a white population and contributes to slightly reduce the positive spherical aberration of the eye. For the large majority of this population, the asphericity did not show significant changes within a period of 5 to 10 years, but significant changes can be observed in some patients.

Participatory methodologies in research with children: creative and innovative approaches. / Metodologias participativas em pesquisa com crianças: abordagens criativas e inovadoras.

OBJECTIVE: To describe the use of participatory methodologies in research with children. METHODS: Experience report with a qualitative approach, conducted with children between six and eleven years of age, from a municipal school in Pelotas and in the Psychosocial Children and Youth Care Center, in São Lourenço do Sul, both municipalities of the Rio Grande do Sul State. Data collection was based on records made in field and observation diaries, held from April to July 2016. RESULTS: The report pointed out that the Photovoice promoted motivation in the group, in addition to increasing the self-esteem and self-confidence of children. The Five Field Map made it possible to help children express feelings through the game. CONCLUSION: Photovoice and the Five Field Map are seen as tools that enable new methodological approaches in research with children, facilitating the construction of the proposed activities aimed at innovative and creative research processes in health/nursing.

Performance of the phonatory deviation diagram in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. / Desempenho do diagrama de desvio fonatório no monitoramento da qualidade vocal pré e pós exercício vocal em indivíduos com Doença de Parkinson.

PURPOSE: To assess the performance of the phonatory deviation diagram and its measurements in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. METHODS: Retrospective and documentary study. A sample of 30 subjects was used, 50% male, with a mean age of 62.13 ± 9.05 years. The results of the phonatory deviation diagram were analyzed, in the moments before and after vocal exercise with the pushing technique associated with plosive sounds, considering the area, density, shape and location of the diagram in the quadrants. For comparison purposes, the acoustic parameters of jitter, shimmer, glottal to noise excitation ratio and results of the auditory-perceptual analysis, carried out in previous research, were also considered, in the pre- and post-technical moments. RESULTS: Despite the fact that there was no difference in the distribution of samples in the diagram, after performing the vocal technique, a change in the displacement of the diagram towards the area of normality was identified in the visual qualitative analysis, and there was an association between the general degree of vocal deviation in the analysis auditory perception and the area of the diagram. There was an improvement in the shimmer values after the vocal technique. CONCLUSION: The displacement of the phonatory deviation diagram towards the area of normality corroborated the results in relation to the general degree of dysphonia, evaluated by the auditory-perceptual analysis and the shimmer results, after the vocal technique. Thus, the diagram shows good performance in monitoring voice quality of individuals with Parkinson's.

OBJETIVO: Verificar o desempenho do diagrama de desvio fonatório e de suas medidas no monitoramento da qualidade da voz, pré e pós exercício vocal, em indivíduos com Doença de Parkinson. MÉTODO: Estudo retrospectivo e documental. Utilizou-se uma amostra de 30 sujeitos, sendo 50% do sexo masculino, com média de idade de 62,13 ± 9,05 anos. Foram analisados os resultados do diagrama de desvio fonatório, nos momentos pré e pós exercício vocal com a técnica de empuxo associada aos sons plosivos, considerando-se a área, densidade, forma e localização do diagrama nos quadrantes. Para fins de comparação, os parâmetros acústicos de jitter, shimmer, glottal to noise excitation ratio e resultados da análise perceptivo-auditiva, realizada em pesquisa anterior, também foram considerados, nos momentos pré e pós-técnica. RESULTADOS: A despeito de não ocorrer diferença na distribuição das amostras no diagrama, após realização da técnica vocal, foi identificada, na análise qualitativa visual, mudança no deslocamento do diagrama em direção à área de normalidade e houve associação entre o grau geral do desvio vocal da análise perceptivoauditiva e a área do diagrama. Houve melhora nos valores de shimmer, após a técnica vocal. CONCLUSÃO: O deslocamento do diagrama de desvio fonatório em direção à área de normalidade corroborou os resultados em relação ao grau geral de disfonia avaliado pela análise perceptivoauditiva e os resultados de shimmer, após a técnica vocal empregada. Desse modo, o diagrama de desvio fonatório apresentou bom desempenho no monitoramento da qualidade vocal de indivíduos com Parkinson.

Lamellar body count and stable microbubble test on tracheal aspirates from infants for the diagnosis of respiratory distress syndrome.

OBJECTIVES: To evaluate the performance of lamellar body count in tracheal aspirates from intubated preterm babies to predict respiratory distress syndrome. DESIGN: Case-control study. SETTING: Three neonatal intensive care units. PATIENTS: Seventy-two patients not older than 3 days were included in the study, 38 preterm infants with respiratory distress syndrome, 16 preterms without respiratory distress syndrome, and 18 term infants. All required mechanical ventilation. INTERVENTIONS: Lamellar body count was performed in an automated cell counter. Tracheal samples were diluted in dithiothreitol without centrifugation and kept frozen at -20°C until use. Samples were placed in a dithiothreitol-containing test tube at a ratio of one part tracheal aspirate to six parts dithiothreitol solution, vortexed for 10 secs, and aspirated by the cell counter. Lamellar body count was performed using the platelet channel. All results were multiplied by seven. The stable microbubble test was done for comparison. MEASUREMENTS: Lamellar body count and stable microbubble test. MAIN RESULTS: Lamellar body count was significantly lower in the respiratory distress syndrome group compared with the non respiratory distress syndrome preterm group and also with the term group. The median and interquartile range obtained for lamellar body count were 38,500/µL (14,000-112,000) for the respiratory distress syndrome group, 822,500/µL (442,000-962,500) for the non respiratory distress syndrome preterm group, and 633,000/µL (322,000-1,608,000) for the term group (p < .001). The sensitivity and specificity of lamellar body count and stable microbubble test for the diagnosis of respiratory distress syndrome were calculated, taking into consideration the respiratory distress syndrome and the non respiratory distress syndrome preterm groups. Considering a cutoff point of 200,000 lamellar bodies/µL, lamellar body count sensitivity was 92.1% (95% confidence interval 78.6-98.3) and lamellar body count specificity was 93.8% (95% confidence interval 69.8-99.8). The area under the curve was 0.94 (95% confidence interval 0.84-1.00). CONCLUSIONS: Lamellar body count and stable microbubble test can be rapidly and easily performed on tracheal aspirates and they seem to have very good performance for diagnosing respiratory distress syndrome in intubated patients.

Leaf anatomy and its contribution to the systematics of Aechmea subgenus Macrochordion (de Vriese) Baker (Bromeliaceae).

The leaf anatomy of the species Aechmea subgenus Macrochordion was analyzed to obtain valuable data on their taxonomic delimitation and to identify anatomical adaptations to their respective habitats and habits. All leaves of these species are hypostomatic, and present: peltate trichomes on both surfaces; stomata sunk in epidermal depressions; small epidermal cells with thick walls and inclusions of silica bodies; a mechanical hypodermis; an aquiferous parenchyma; chlorenchyma with fibrous clusters and air channels; and vascular bundles surrounded by a parenchymatic sheath and a cap of fibers. The results are evaluated within an adaptive and taxonomic context. Variations in hypodermic thickening, amount of water parenchyma, position of the air channels and shape of the cells filling the air channels are useful for delimiting groups of species, strengthening the relationships suggested by their external morphology.

Asthma and pregnancy in the 2020 decade: still a matter of concern.

Asthma is a fairly common health problem for pregnant women and a potentially serious medical condition that may complicate pregnancy. Most complications are related to lack of disease control, which can adversely affect both maternal quality of life and perinatal outcomes. In this article, we review recent literature concerning asthma in pregnancy, describing the course of the disease and associated complications. Furthermore, we review and discuss asthma monitoring and management during pregnancy, labor and post-partum. The course of asthma symptoms during pregnancy is unpredictable but exacerbations are more common during the second trimester. The causes are multifactorial and asthma phenotype may have a role. It has been proposed that combined use of CARAT (Control of Allergic Rhinitis and Asthma Test) and lung function tests can be used to monitor and adjust therapy during pregnancy in patients with asthma. As a complement, an approach that considers airway inflammation assessment using fractional exhaled nitric oxide (FeNO), a noninvasive marker of inflammation, may improve asthma control during pregnancy. It is important to consider a few but relevant differences in asthma management and treatment regarding pregnancy and the peri-partum period to safely achieve optimal management of asthma during all these phases for both mother and offsprings.

New onset autoimmune diabetes mellitus and hypothyroidism secondary to pembrolizumab in a patient with metastatic lung cancer.

SUMMARY: Immunotherapy has become an important pillar for the management of advanced cancer. Immune-related adverse events including endocrinopathies have been well described with programmed cell death 1 inhibitors such as pembrolizumab. While thyroid dysfunction is the most common endocrinopathy associated with pembrolizumab, new-onset autoimmune diabetes mellitus (DM) is extremely rare. The authors report a case of pembrolizumab-induced primary hypothyroidism and type 1 diabetes mellitus presenting with diabetic ketoacidosis (DKA). A 59-year-old female patient was treated with pembrolizumab for a stage 4 lung adenocarcinoma. She presented to the emergency department with hyperglycaemia-related signs and symptoms, such as polyuria, polydipsia, weight loss, vomiting, asthenia and dehydration, 3 weeks after her first dose of pembrolizumab. Laboratory evaluation revealed hyperglycaemia, hyperketonaemia and high anion gap metabolic acidaemia consistent with DKA. After prompt and adequate treatment of DKA, she transitioned to s.c. basal-bolus insulin. The diagnose of autoimmune DM was established based on the undetectable C-peptide levels and seropositivity for antiglutamic acid decarboxylase antibodies. Additional hormonal parameters revealed overt hypothyroidism and levothyroxine therapy was initiated. This case highlights the importance of blood glucose and thyroid function monitoring as an integral part of cancer treatment protocols for pembrolizumab and other immune checkpoint inhibitors. LEARNING POINTS: Programmed cell death 1 (PD1) inhibitors such as pembrolizumab can cause endocrine immune-related adverse events (irAE), including thyroid dysfunction and type 1 diabetes mellitus (T1DM). Thyroid dysfunction is the most frequent endocrine irAE secondary to PD1 inhibitors. Autoimmune diabetes and possible resultant diabetic ketoacidosis are rare, but life-threatening adverse events associated with pembrolizumab. Pembrolizumab-induced T1DM often present with relatively low HbAlc levels, reflecting the fulminant onset of ß-cell destruction. Patients treated with pembrolizumab and other immune checkpoints inhibitors should be monitored regularly for hyperglycaemia and thyroid dysfunction.

Intraocular Lymphoma: When to Suspect a Sinister Cause of Ocular Haemorrhage.

Intraocular lymphoma (IOL) is a rare and life-threatening condition whose aetiology is unclear. Blurred vision, reduced vision, and floaters are common initial symptoms. Posterior vitreous detachment and haemorrhage rarely occur. The authors present the case of a 79-year-old man who initially presented with a 3-month history of fever, night sweats, significant weight loss, bilateral peri-orbital haematoma, red eyes and retro-orbital headache. Physical examination revealed fever, bilateral peri-orbital haematoma, subconjunctival haemorrhage and palpable cervical lymphadenopathy. CT scans detected conical intra-orbital lesions, cervical adenomegalies, expansive lesions in the adrenal glands, and thrombosis of the splenomesenteric confluent and posterior segment of the right branch of the portal vein. These findings were suggestive of a lymphoproliferative disorder. Aspiration cytology of the adrenal mass and inguinal adenopathies was compatible with diffuse large B-cell lymphoma with areas of transformation to Burkitt's lymphoma. We describe a rare form of lymphoma, and a very unusual presentation of primary intraocular lymphoma with atypical symptoms. LEARNING POINTS: Intraocular lymphoma is a rare disease and can mimic common infectious or non-infectious uveitis.Bleeding or periocular haematoma are suggestive of intraocular lymphoma.

Decision-Making Process for the Implementation of the Child Therapeutic Support Limitation Plan: Nurses' Experiences.

Aim: To present nurses' experience in the decision-making process for implementing a therapeutic support limitation plan in the PICU. Method: Qualitative exploratory research was conducted through semi-structured interviews with 25 intensive care nurses from January to June 2019. The textual corpus was then submitted for content analysis. Results: Two categories emerged: the nurse and decision-making process of the TSLP and ambivalence of the participating nurse's feelings in implementing the TSLP. These categories are interrelated in that the decision-making process mobilizes the ambivalence of the participating nurses' feelings. Final considerations and implications for practice: The starting point of communication between the health teams consists of acquiring information about the concerned child's end-of-life care plan with no prospect of cure and with some form of therapeutic limit admitted to the PICU. Therefore, this study helps to map possible research gaps on the topic and mobilize researchers to build educational materials, protocols, and tools for comprehensive care that can be used by nurses when faced with ethical dilemma, such as decision-making through TSLP.

Chemical profiling of Cannabis varieties cultivated for medical purposes in southeastern Brazil.

Cannabis cultivation for medical purposes in Brazil has been increased in the last years. While cannabis crops are prohibited, hundreds patients have been granted with judicial authorizations and there is little information about the cultivation conditions, yields and chemical profiles of the plants. Cannabis plants contain hundreds of compounds, with cannabinoids and terpenes the main drivers of their toxicological and pharmacological properties. Besides the cannabinoids, terpene contents are useful for the chemotaxonomic classification of different varieties, and their role in forensic analyses should be further delineated. The present study monitored cannabis crops of fifteen participants who were granted special licenses by the Brazilian Courts in Rio de Janeiro and São Paulo. The cultivation conditions were monitored and five cannabinoids (tetrahydrocannabinol acid-THCA, tetrahydrocannabinol-THC, cannabidiolic acid-CBDA, cannabidiol-CBD and cannabinol-CBN) and nineteen terpenes were quantified in cannabis flowers. The total grow cycle of thirty-five cannabis plants ranged from 10 to 24 weeks. The dry flower yields ranged 22-90 g per plant. Most cannabis specimens were CBD-rich varieties (CBD levels from 1.6% to 16.7%, and THC levels from 0.0% to 2.6%, n = 22) used to treat epileptic patients. The THC-rich varieties contained CBD levels ranging from 0.03% to 0.8%, and THC levels from 0.7% to 20.1%, n = 11. Fewer of the samples contained THC:CBD ratios of approximately 1:1 (CBD levels of 3.3-3.8% and THC levels of 2.2-3.7%, n = 2). The most abundant terpenes in the cannabis flowers were beta-caryophyllene, alpha-humulene, guaiol and alpha-bisabolol. CBD-rich varieties showed significant higher levels of beta-caryophyllene and alpha-humulene in comparison with THC-rich varieties. Overall, the study herein provides data concerning medical cannabis crops grown in a region of Brazil that not only guide individual medical cannabis cultivation methods but also aid forensic analyses.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease.

OBJECTIVE: To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease. METHOD: Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed. RESULTS: After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise. CONCLUSION: In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

Pleuroparenchymal fibroelastosis as a complication of chemotherapy: A case report.

Pleuroparenchymal fibroelastosis (PPFE) is a rare and recently described distinct pattern of lung apical fibrosis involving the upper lobe parenchyma and pleural dome. PPFE has definable and reproducible clinical, radiological and histopathological criteria, which allowed its classification as an independent interstitial lung disease. Several factors have been associated with PPFE, such as chemotherapy, especially with alkylating agents. The authors present a case of a 34-year-old female with previous history of Hodgkin lymphoma treated with first line chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine). The patient had no other known comorbidities or relevant exposure to lung irritants. A total of 2 years after completing cancer treatment, the patient developed clinical and radiological features of PPFE. Given their previous history of malignancy, a biopsy of the lesion was obtained, which confirmed the diagnosis of PPFE. The authors present this case to raise awareness of this disease and to demonstrate that PPFE can develop months to years following chemotherapy treatment. Moreover, to date, none of these chemotherapy agents have been associated with the development of PPFE.

Surfactant deficiency in transient tachypnea of the newborn.

OBJECTIVE: To evaluate surfactant production and function in term neonates with transient tachypnea of the newborn (TTN). STUDY DESIGN: Samples of gastric aspirates collected within 30 minutes of birth from 42 term newborns with gestational age ≥ 37 weeks (21 patients with TTN and 21 control subjects), delivered via elective cesarean delivery, were analyzed with lamellar body count and stable microbubble test. RESULTS: Results of lamellar body counts and stable microbubble tests were significantly lower in the TTN group than in control subjects (P = .004 and .013, respectively). Lamellar body counts were significantly lower in infants with TTN requiring oxygen for ≥ 24 hours after birth than in infants requiring oxygen for < 24 hours (P = .029). When the cutoff point was 48 hours, the stable microbubble count was significantly lower in the group requiring oxygen for ≥ 48 hours than in the group requiring oxygen for < 48 hours (P = .047). CONCLUSIONS: Term infants with TTN had low lamellar body counts associated with decreased surfactant function, suggesting that prolonged disease is associated with surfactant abnormalities.

Nurses' participation in the end-of-life process in two paediatric intensive care units in Brazil.

The aim of this study was to evaluate the medical and nursing care provided to children in the last 24 hours of life in two Brazilian paediatric intensive care units and analyse the nurses' participation in the decision-making process for life support limitation (LSL). The study was based on an analysis of the patients' medical charts, looking at the medical and nursing care provided in the last 24 hours of life during a 6-month period in the two units, and on semi-structured interviews with 20 nurses to evaluate their participation in LSL decisions. The children were classified into two groups: those who were to receive full cardiopulmonary resuscitation (CPR) and a non-CPR group. A total of 34 deaths occurred during the study period. Of these, 17 (50%) were children that had been in the non-CPR group; there were only 10 recorded LSL plans in their medical charts. In the interviews, only 30% of the nurses mentioned active participation in LSL decisions. In conclusion, the paediatric intensive care nurses in these two Brazilian units did not participate much in LSL decisions, and the care offered in the last hours of life to children with terminal and irreversible illness was not primarily directed toward comfort and alleviating suffering.

"Be sweet to babies": Use of Facebook as a method of knowledge dissemination and data collection in the reduction of neonatal pain.

The Be Sweet to Babies video demonstrates the analgesic effects of breastfeeding, skin-to-skin care, and sweet-tasting solutions as interventions to reduce pain during blood sampling in newborns. Although effective and safe, these strategies are implemented inconsistently in clinical settings. Given the increasing popularity of social media, there is a potential to disseminate and promote health information through it. The study aim was to  evaluate the use of Facebook as a means of disseminating the Be Sweet to Babies video in Portuguese, and to evaluate respondents' prior knowledge, previous use of the three pain management strategies and intent to use the strategies in the future. We conducted a cross-sectional study, using the "virtual snowball" sampling method. A Facebook webpage was created, in which the video was posted along with a brief survey. Data analyzed included number of views and visits to the page, number of views of the video, likes, dislikes, and survey responses. One year after posting, the page had 70 753 views and 2199 accesses; there were 1553 "likes", no dislikes, and 43 positive comments. The survey was completed by 930 respondents (42% response rate based on the page access). Over two thirds of the respondents had previous knowledge about breastfeeding, skin-to-skin care, and sweet solutions for pain relief. After watching the video, 87% of the respondents intended to use breastfeeding or skin-to-skin care in the future, and 71% intended to use sweet solutions. Almost all viewers rated the video as very useful (n = 917, 99%), easy to understand (n = 926, 99%), and easy to apply in real-life situations (n = 903, 97%). Using Facebook to deliver and evaluate an intervention is feasible, rapid in obtaining responses, low cost, and it is promising for data collection and knowledge dissemination. Further studies are warranted to evaluate the actual impact of the use of social media in practice change.

How to translate scientific knowledge into practice? Concepts, models and application.

OBJECTIVES: to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle. RESULTS: we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination. CONCLUSIONS: in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders.

Electrical activity of the masseter and supra hyoid muscles during swallowing of patients with multiple sclerosis. / Atividade elétrica dos músculos masseter e supra-hióideo durante a deglutição do paciente com esclerose múltipla.

PURPOSE: characterize the swallowing muscles electromyographic activity in EM. METHODS: we evaluated 60 individuals being 30 with definitive diagnosis in EMG and 30 without neurologic changes. Volunteers provided personal data through interview, and we also obtained data from clinical records on the time of diagnosis, disease clinic form and the EDSS scale score. We then administered the DYMUS questionnaire. All evaluations occurred according to the Swallowing Electromyographic Evaluation Protocol. RESULTS: Saliva swallowing, liquid swallowing with comfortable volume and continuous swallowing showed differences in the groups at the masseter, with higher averages in the comparison group. We verified differences between masseter and supra hyoid in each group, at rest, in saliva swallowing, liquid swallowing with comfortable volume and continued swallowing. In all situations the averages were higher in the supra hyoid, being that the smaller difference occurred at rest and the higher at continuous swallow. We recorded correlations between EDSS and the activity of supra hyoid at saliva swallow, liquid swallow with comfortable volume and swallow continuous. With the DYMUS, we observed correlations with the masseter activity and with the swallowing time. The high punctuation at the DYMUS presented correlations with the increase electrical activity of the masseter. CONCLUSION: patients with more severe conditions show lower supra hyoid electric activity, and the electric activity of the masseter is related to difficulty in swallowing.

OBJETIVO: caracterizar a atividade eletromiográfica dos músculos da deglutição na EM. MÉTODO: foram avaliados 60 indivíduos, sendo 30 com diagnóstico definitivo de EM e 30 sem alterações neurológicas. Foram levantados os dados pessoais dos voluntários e, em seguida, coletados em prontuário tempo de diagnóstico, forma clínica da doença e escore da escala EDSS. Em seguida foi administrado o questionário DYMUS. Todos foram submetidos à realização do Protocolo de Avaliação Eletromiográfica da Deglutição. RESULTADOS: na deglutição de saliva, deglutição de líquido com volume confortável e deglutição contínua, foram verificadas diferenças entre os grupos no músculo masseter, e as médias foram mais elevadas no grupo de comparação. Foram registradas diferenças entre masseter e supra-hióideo no repouso, na deglutição de saliva, na deglutição de líquido com volume confortável e na deglutição contínua, e em todas as situações as médias foram mais elevadas no supra-hióideo, sendo que a menor diferença ocorreu no repouso, e a maior na deglutição contínua. Foram registradas correlações do EDSS com a atividade do supra-hióideo na deglutição de saliva, na deglutição de líquido com volume confortável e na deglutição contínua. Com o DYMUS foram observadas correlações com a atividade do masseter e com o tempo de deglutição. As pontuações elevadas no DYMUS apresentaram correlações com o aumento da atividade elétrica do masseter. CONCLUSÃO: quanto pior o estado clínico do paciente, menor será a atividade elétrica do supra-hióideo, e o aumento da atividade elétrica do masseter está relacionado com a dificuldade de deglutição.

Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema.

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases.

Pleuroparenchymal Fibroelastosis in association with Connective Tissue Disease: a new interstitial pneumonia to be aware of.

Pleuroparenchymal fibroelastosis (PPFE) is a rare and recently described interstitial pneumonia. It consists of progressive fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes, with defined and reproducible clinical, radiological and histopathological criteria. No effective treatment has yet been shown to modify the natural course of the disease, which vary greatly in the literature. Several conditions have been associated with PPFE, including connective tissue diseases (CTD). The authors present two cases of female patients with a CTD (rheumatoid arthritis and limited cutaneous systemic sclerosis, respectively) who presented with typical bilateral upper lobe thickening in chest-HRCT. In the first case, diagnosis was based on "definite" radiological and histopathological criteria for PPFE, while in the second case diagnosis was established on clinical grounds after discussion in a multidisciplinary team meeting. The authors present these cases of CTD-associated PPFE in order to raise awareness of this entity among clinicians.

Characterization of aphasia in aneurysmal subarachnoid hemorrhage. / Caracterização das afasias na hemorragia subaracnóidea aneurismática.

PURPOSE: Characterize the profile of aphasic syndromes determined by aneurysmal subarachnoid hemorrhage (aSAH) of the left middle cerebral artery (LMCA). METHODS: An analytical, retrospective, cross-sectional study was conducted using a database of cognitive assessments of 193 patients with aSAH admitted to Hospital da Restauração between March 2007 and November 2009. Of these, a total of 26 patients with aSAH in the LMCA territory confirmed by digital angiography were selected. Aphasia was assessed through the Montreal-Toulouse Language Assessment Alpha Version Protocol (Alpha Version) and the CERAD Neuropsychological Test Battery (Verbal fluency). RESULTS: Language and verbal fluency impairments were identified in patients with aSAH in the LMCA territory when compared with the control population (50 individuals). Of the 26 patients with aSAH, 11 presented aphasic characteristics preoperatively. CONCLUSION: The results of this research corroborate the literature, showing that the aSAH frame causes cognitive impairments even in the preoperative phase for aneurysm occlusion. Considering the observed aspects, the predominant aphasic syndromes characterize comprehension aphasia due to sequels in the posterior cerebral artery territory.

OBJETIVO: Caracterizar o perfil dos quadros afásicos determinados pela hemorragia subaracnóidea aneurismática (HSA) da artéria cerebral média esquerda. MÉTODO: Estudo analítico, retrospectivo, transversal, tendo como banco de dados as avaliações cognitivas de 193 pacientes do Hospital da Restauração com HSA aneurismática no período de março de 2007 a novembro de 2009. Destes, foram selecionados 26 pacientes com HSA em território da ACM-E, confirmada por angiografia digital. Os quadros afásicos foram classificados através do desempenho da linguagem dos pacientes através do Protocolo Montreal Toulose - Versão Alpha e a tarefa de fluência verbal da bateria CERAD. A pesquisa foi realizada no período de junho a agosto de 2015. RESULTADOS: Foi identificado comprometimento da linguagem e fluência verbal nos pacientes com HSA em território de ACM­E quando comparados com a população controle (50 indivíduos). Dos 26 pacientes com HSA, 11 apresentaram quadros afásicos ainda no período pré-operatório. CONCLUSÃO: Os resultados da pesquisa corroboram com a literatura, mostrando que o quadro da HSA promove comprometimentos cognitivos ainda na fase pré-operatória para oclusão de aneurisma. Tendo em vista os aspectos observados, os quadros afásicos predominantes caracterizam afasia de compreensão por sequelas nas áreas cerebrais posteriores.