Ablation of multifocal premature ventricular contractions using automated pace-mapping software.

INTRODUCTION AND OBJECTIVES: Ablation of multifocal premature ventricular complexes (PVCs) is challenging. Activation mapping can be performed for the predominant morphology, but may be useless for other less prevalent ones. We aimed to describe the efficacy of an automated pace-mapping software-based ablation strategy for ablating the site of origin of multiple PVC locations. METHODS: Consecutive patients referred for ablation of multifocal PVCs were prospectively enrolled. Spontaneous PVC templates were recorded and a detailed pace-mapping map was generated to spot the site of origin of PVCs. RESULTS: A total of 47 PVCs were targeted in 21 patients (five and 16 patients with three or two PVCs morphologies each, respectively). Detailed pace-mapping comprising 73.5±41.6 different pacing locations was performed (best matching 97.2% [IQR 95.9-98.3%] similar to the clinical PVC). Activation points were acquired if possible, although ablation was only based on pace-mapping in 13 (27.6%) foci. Complete acute procedural success was obtained in 14 (66.7%) patients, while one PVC morphology was deliberately not ablated in five patients (23.8%). After 12.3±9.4 months of follow-up, PVC burden decreased from 24.4±10.4% to 5.6±5.0% (p<0.001). Interestingly, patients with acute procedural failures or with some PVCs deliberately not targeted during the procedure also experienced a significant decrease in PVC burden (30.0±8.9% to 11.9±3.5%, p=0.002). CONCLUSION: Quantitative morphology-matching software can be used to obtain a detailed map identifying the site of origin of each single PVC, and successful ablation can be performed at these sites, even if activation points cannot be obtained due to the paucity of ectopic beats.

Portuguese National Registry on Cardiac Electrophysiology, 2017 and 2018. / Registo Nacional de Eletrofisiologia Cardíaca 2017­2018.

INTRODUCTION: The authors present the results of the national cardiac electrophysiology registry of the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) and the Portuguese Institute of Cardiac Rhythm (IPRC) for 2017 and 2018. METHODS: The registry is annual, voluntary, and observational. Data are collected retrospectively. Developments over the years and their implications are analyzed and discussed. RESULTS: In the 22 electrophysiology centers, 3407 ablations were performed in 2017 and 3653 ablations in 2018. Atrial fibrillation (AF) ablation was the most frequently performed procedure: 1017 ablations in 2017 and 1222 procedures in 2018. Of the patients undergoing AF ablation, 63% were male, 60% were between 50 and 69 years old and 74% had paroxysmal AF. Clinically relevant complications were reported in 0.8% of the procedures. In 2017, 216 ventricular tachycardia (VT) ablation procedures were performed in 15 centers. In 2018, 19 centers performed 249 VT ablations. About 45% of VT ablations were performed in patients with structural heart disease. Complications were reported in 3.2% of the procedures, including one death (0.2%). CONCLUSIONS: The national electrophysiology registry showed a sustained increase in the number of catheter ablations. In addition, procedural complexity increased and AF ablation assumed a dominant position among the procedures performed.

Portuguese National Registry of Cardiac Electrophysiology (2015/2016). / Português Registo Nacional de Eletrofisiologia Cardíaca (2015/2016).

INTRODUCTION: Knowledge of the activity performed in a country enables it to be positioned within the community of which it is part. OBJECTIVE: We present the results of the National Registry of Cardiac Electrophysiology of the Portuguese Association for Arrhythmology, Pacing and Electrophysiology (APAPE) for 2015 and 2016. METHODS: This is a voluntary, observational, annual registry collected retrospectively. RESULTS: The data on the electrophysiological studies and ablations performed in these two years are presented. CONCLUSION: Changes in these data over the years are analyzed and the relation of the Portuguese data in the European panorama and possible implications are discussed.

Brainstem auditory evoked potentials in children with autism spectrum disorder.

OBJECTIVES: This study aimed to analyze the neural encoding of verbal and nonverbal stimuli in individuals with autism spectrum disorder using brainstem auditory evoked potentials. METHODOLOGY: Thirty individuals between 7 and 12 years of age and of both genders participated in this study. Fifteen were diagnosed with autism spectrum disorder, and 15 had typical development. All subjects had normal hearing and no other impairments. An electrophysiological hearing assessment was performed using brainstem auditory evoked potentials with click and speech stimuli. RESULTS: In the brainstem auditory evoked potentials with click stimuli, the mean wave I latency was longer for the right ear in both groups, and interpeak intervals III-V were greater for the individuals with autism spectrum disorder. For brainstem auditory evoked potentials with speech stimuli, wave V latency was shorter in individuals with autism spectrum disorder. CONCLUSION: These data suggest that individuals with autism spectrum disorder may have a dysfunction of the central auditory nervous system for nonverbal stimuli and faster neural encoding of the initial part of the verbal stimulus, suggesting hypersensitivity to complex sounds such as speech.

Cortical auditory evoked potential in assessment of neonates: a study about minimum level of responses in term and preterm newborns.

INTRODUCTION: The study of the threshold level of cortical auditory response in adults has been investigated in previous studies. Due to maturational issues, little is known about these responses in neonates. Technological advances with automatic analysis devices now allow investigation in specific populations. Thus, new studies are needed to establish the feasibility of using this auditory potential to identify the lowest levels of responses in children. OBJECTIVE: Verify and compare latency and amplitude in 80dBnNA and the minimum level of cortical auditory response in term and preterm neonates. METHODS: A cross-sectional, comparative study involving 59 neonates, 35 full-term births and 24 preterm births, with positive results in the Neonatal Hearing Screening. The Hearlab system was used to investigate the P1i auditory potential with tone burst stimulus at frequencies of 500, 1000, 2000 and 4000Hz. The minimum response level search ranged from 80 to 0dBNA and was detected automatically. The results were compared between groups, evaluating the latency and amplitude in 80dBNA and the minimum level of cortical auditory response. RESULTS: The mean values obtained for the minimum level of cortical auditory response in term group were 26±8.81; 26.14±6.97; 29±7.65 and 29.43±7.04dBNA and for preterm neonates of 31.96±10.41; 34.13±11.34; 33.64±11.03 and 37.73±11.92dBNA, for the frequencies of 500, 1000, 2000 and 4000Hz, respectively. There was a difference between groups for the latency of P1i at 4000Hz and the minimum response levels at 500, 1000 and 4000Hz, with higher values for preterm infants. CONCLUSION: It was possible to obtain latency and amplitude values at 80dBnNA and the minimum level of cortical response in term and preterm newborns, with different results between groups, with higher values in those born preterm.

Cortical auditory evoked potential in babies and children listeners.

INTRODUCTION: Cortical auditory evoked potentials have been increasingly used in research and audiological routines. However, there is a lack of studies with a large number of children who are stratified by age group. These would help clarify the variations in latency and amplitude of cortical auditory evoked potentials, and thus help establish reference values in children of different ages. OBJECTIVE: To identify the variation in latency and amplitude of the cortical auditory evoked potentials and to establish reference values for the pediatric population. METHODS: This was a cross-sectional study. Subjects were born at term and presented with no auditory complaints. A total of 105 children, of up to 6 years and eleven months old, who were divided into 7 age groups, named 1, 2, 3, 4, 5, 6 and 7, participated in the study. The tests were carried out using Biologic Navigator Pro. Initially, brainstem auditory evoked potential testing was performed in order to investigate the electrophysiological threshold of the subjects. Then, cortical auditory evoked potentials were elicited through oddball paradigm with tone burst differing in frequency, 750Hz (frequent) and 1000Hz (rare), and stimuli differing in speech: /ba/ (frequent) and /da/ (rare). In this study, descriptive and comparative analyzes of tonal and speech stimuli were performed for the age groups. RESULTS: Significant differences were observed when comparing cortical auditory evoked potentials with speech stimulus in the right ear for P2 amplitude, for P1 latency the left ear, for P2 amplitude of the left ear; and for P1 amplitude of the left ear when performed with tonal stimuli. CONCLUSION: The obtained results can be considered as reference values of latency and amplitude of cortical auditory potentials in infants and children, and be used for monitoring their cortical auditory development.

Study of brainstem auditory evoked potentials in early diagnosis of congenital toxoplasmosis.

INTRODUCTION: Congenital toxoplasmosis is an infectious disease with high prevalence in tropical countries. It is characterized by neurological, ophthalmological and auditory sequelae. OBJECTIVE: The aim of this study was to evaluate and describe the brainstem auditory evoked potential in infants aged 1-3 months diagnosed with congenital toxoplasmosis and to compare them with infants of the same age group without the infection. METHODS: This is an observational, analytical and cross-sectional study in which brainstem auditory evoked potential was investigated in infants with congenital toxoplasmosis. The following audiological exams were performed: transient-evoked otoacoustic emissions, clinical and automatic brainstem auditory evoked potential. RESULTS: 100 children participated in the study, but the final sample consisted of 76 children. Of the 37 children with toxoplasmosis included in the study, 28 completed the neurological imaging evaluation, and of these, 3 (10.7%) showed an altered neurological examination. At the brainstem auditory evoked potential assessment, two children without toxoplasmosis and 10 children with congenital toxoplasmosis had results suggestive of alterations in the brainstem auditory pathway maturation. CONCLUSION: 10 (27%) children were identified with a possible unilateral alteration in the electrophysiological assessment. There was a 5-fold higher risk for a child between 1 and 3 months of age with toxoplasmosis to have an altered brainstem auditory evoked potential compared to a child of the same age range without the infection.

Automated cortical auditory evoked potentials threshold estimation in neonates.

INTRODUCTION: The evaluation of cortical auditory evoked potential has been the focus of scientific studies in infants. Some authors have reported that automated response detection is effective in exploring these potentials in infants, but few have reported their efficacy in the search for thresholds. OBJECTIVE: To analyze the latency, amplitude and thresholds of cortical auditory evoked potential using an automatic response detection device in a neonatal population. METHODS: This is a cross-sectional, observational study. Cortical auditory evoked potentials were recorded in response to pure-tone stimuli of the frequencies 500, 1000, 2000 and 4000Hz presented in an intensity range between 0 and 80dB HL using a single channel recording. P1 was performed in an exclusively automated fashion, using Hotelling's T2 statistical test. The latency and amplitude were obtained manually by three examiners. The study comprised 39 neonates up to 28 days old of both sexes with presence of otoacoustic emissions and no risk factors for hearing loss. RESULTS: With the protocol used, cortical auditory evoked potential responses were detected in all subjects at high intensity and thresholds. The mean thresholds were 24.8±10.4dB NA, 25±9.0dB NA, 28±7.8dB NA and 29.4±6.6dB HL for 500, 1000, 2000 and 4000Hz, respectively. CONCLUSION: Reliable responses were obtained in the assessment of cortical auditory potentials in the neonates assessed with a device for automatic response detection.

Chloride and sodium ion concentrations in saliva and sweat as a method to diagnose cystic fibrosis.

OBJECTIVE: Cystic fibrosis diagnosis is dependent on the chloride ion concentration in the sweat test (≥60mEq/mL - recognized as the gold standard indicator for cystic fibrosis diagnosis). Moreover, the salivary glands express the CFTR protein in the same manner as sweat glands. Given this context, the objective was to verify the correlation of saliva chloride concentration and sweat chloride concentration, and between saliva sodium concentration and sweat sodium concentration, in patients with cystic fibrosis and healthy control subjects, as a tool for cystic fibrosis diagnosis. METHODS: There were 160 subjects enrolled: 57/160 (35.70%) patients with cystic fibrosis and two known CFTR mutations and 103/160 (64.40%) healthy controls subjects. Saliva ion concentration was analyzed by ABL 835 Radiometer® equipment and, sweat chloride concentration and sweat sodium concentration, respectively, by manual titration using the mercurimetric procedure of Schales & Schales and flame photometry. Statistical analysis was performed by the chi-squared test, the Mann-Whitney test, and Spearman's correlation. Alpha=0.05. RESULTS: Patients with cystic fibrosis showed higher values of sweat chloride concentration, sweat sodium concentration, saliva chloride concentration, and saliva sodium concentration than healthy controls subjects (p-value<0.001). The correlation between saliva chloride concentration and sweat chloride concentration showed a positive Spearman's Rho (correlation coefficient)=0.475 (95% CI=0.346 to 0.587). Also, the correlation between saliva sodium concentration and sweat sodium concentration showed a positive Spearman's Rho=0.306 (95% CI=0.158 to 0.440). CONCLUSIONS: Saliva chloride concentration and saliva sodium concentration are candidates to be used in cystic fibrosis diagnosis, mainly in cases where it is difficult to achieve the correct sweat amount, and/or CFTR mutation screening is difficult, and/or reference methods for sweat test are unavailable to implement or are not easily accessible by the general population.

Neurophysiology in between the interests of Dom Pedro II of Brazil, and Charles Brown-Séquard (Historical Note) / Neurofisiologia entre os interesses de Dom Pedro II do Brasil e Charles Brown-Séquard (Nota Histórica)

This article presents our historical research regarding Charles Brown-Séquard, a famous scientist with important contributions to the medical field, in particular for neurology, and endocrinology, and his relationship with Dom Pedro II, the second and last Brazilian Emperor, and an enlightened ruler. The Emperor contacted several illustrious personages in support of State policy, such as for the development of experimental physiology at the Imperial Museum of Natural History, but also for personal purposes given his health problems and those of the Empress. Charles Brown-Séquard and his pilgrimage between different worlds as a physician and physiologist are presented until his definitive establishment in Paris, where he replaces Claude Bernard in the chair of experimental medicine at the Collège de France. Jacques-Arsene d'Arsonval took over after this chair, and together with Brown-Séquard, he electrophysiologically examined the Emperor's diabetic peripheral neuropathy. In this article, the Emperor´s relationship with Brown-Séquard was studied mainly from the correspondence sent to Dom Pedro II and retrieved from the Imperial Museum in Petrópolis, Brazil, and from the accounts of his meetings that included scientific sessions and clinical consultations. This article can be used to understand the progress of knowledge in the field of neurology/clinical neurophysiology, the tracking of emerging ideas in the field of science in the past and the threat to the credibility of researchers.

Este artigo apresenta nossa pesquisa histórica a respeito de Charles Brown-Séquard, famoso cientista com importantes contribuições para a área médica, em especial para a neurologia e endocrinologia, e sua relação com Dom Pedro II, segundo e último Imperador brasileiro, e governante esclarecido. O Imperador contactou várias personalidades ilustres no apoio à política de Estado, como para o desenvolvimento da fisiologia experimental no Museu Imperial de História Natural, mas também para fins pessoais dados os seus problemas de saúde e os da Imperatriz. Charles Brown-Séquard e sua peregrinação entre diferentes mundos como médico e fisiologista são apresentados até seu estabelecimento definitivo em Paris, onde substitui Claude Bernard na cadeira de medicina experimental no Collège de France. Jacques-Arsene d'Arsonval assumiu após esta cadeira e, juntamente com Brown-Séquard, examinou eletrofisiologicamente a neuropatia periférica diabética do imperador. Neste artigo, a relação do Imperador com BrownSéquard foi estudada principalmente a partir da correspondência enviada a Dom Pedro II e recuperada no Museu Imperial de Petrópolis, Brasil, e dos relatos de seus encontros que incluíam sessões científicas e consultas clínicas . Este artigo pode ser usado para entender o progresso do conhecimento no campo da neurologia/neurofisiologia clínica, o rastreamento de ideias emergentes no campo da ciência no passado e a ameaça à credibilidade dos pesquisadores.

Electrocardiographic changes and changes in cardiac lactate and troponin I levels associated with search and rescue physical activity in military dogs / Alterações eletrocardiográficas e nos níveis de lactato e troponina I cardíaca associadas à atividade física de busca e salvamento em cães militares

Rescue and recovery dogs intercalate the activity intensity developed, which also triggers significant metabolic changes in cardiac physiology. Thus, we evaluated the changes that search simulation causes in glucose, lactate, and cardiac troponin I level (cTnI) and the electrocardiographic and heart rate during the activity and recovery phase to predict the physiological adaptation to the exercise. Five healthy adult dogs from the Rescue and Recovery Service of Military Firefighters Corps were submitted to 60 minutes search operation simulation in the woods. They covered a forest area of approximately 50,000 m2. The dogs were loose and accompanied by their driver, and they could perform any physical activity. Were evaluated serum biochemical analysis of glucose, lactate, cardiac troponin I, electrocardiographic, and heart rate (rest, exercise phase, and recovery time). No changes in glucose levels, heart rate, and cardiac rhythm were detected. In comparison to baseline values, there is an increase: in lactate at the end of the exercise phase [EXER] (60'EXER), and in the recovery phase [RCT] at 30'RCT and 60'RCT, and cTnI at 60'RCT, 120'RCT, and 4hRCT. P wave duration was significantly higher at 60'EXER, 15'RCT, and 30'RCT, with no alterations in wave amplitude. QRS interval duration significantly increased at 30'RCT, and the ST segment presented a significant difference at 60'EXER, 15'RCT, and 60'RCT compared to the rest moment. The moderate alterations in lactate and cTnI and few alterations in the electrocardiographic and heart rate maintenance suggest the adaptation of rescue and recovery dogs to the type, intensity, and duration of search operation simulation performed.(AU)

Cães de busca e resgate intercalam a intensidade da atividade desenvolvida que desencadeia alterações metabólicas significativas, bem como na fisiologia cardíaca. Assim, foram avaliadas as alterações que a simulação de busca produz nos níveis de glicose, lactato, troponina I cardíaca (cTnI), bem como na frequência cardíaca e atividade eletrocardiográfica durante a fase de atividade e recuperação, a fim de predizer a adaptação fisiológica ao exercício. Cinco cães adultos saudáveis do Serviço de Resgate e Salvamento do Corpo de Bombeiros Militares foram submetidos à simulação de operação de busca de 60 minutos na mata e cobriram uma área florestal de aproximadamente 50.000 m2. Os cães estavam soltos, acompanhados pelo condutor e estavam livres para realizar qualquer tipo de atividade física. Foram avaliados os níveis séricos de glicose, lactato e troponina I cardíaca, atividade eletrocardiográfica e frequência cardíaca em repouso, na fase de exercício e no tempo de recuperação. Não foram detectadas alterações nos níveis de glicose, frequência cardíaca e ritmo cardíaco. Em comparação com os valores basais houve aumento de lactato ao final da fase de exercício [EXER] (60'EXER) e na fase de recuperação [RCT] aos 30'RCT e 60'RCT; e cTnI aos 60'RCT, 120'RCT e 4hRCT. Duração da onda P foi significativamente maior em 60'EXER, 15'RCT e 30'RCT, sem alterações na amplitude da onda. Duração do intervalo QRS teve aumento significativo em 30'RCT e o segmento ST apresentou diferença significativa em 60'EXER, 15'RCT e 60'RCT quando comparado ao basal. As alterações moderadas nos níveis de lactato e cTnI, bem como a pouca alteração na atividade eletrocardiográfica e manutenção da frequência cardíaca sugerem boa adaptação dos cães de busca e resgate ao tipo, intensidade e duração da operação de busca simulada realizada.(AU)

Occult macular dystrophy: brief literature review / Distrofia macular ocular: breve revisão da literatura

ABSTRACT Occult macular dystrophy is characterized by a slowly progressive bilateral reduction of visual acuity in patients with normal fundus and fluorescein angiography. We describe a case of a 36-year-old male patient diagnosed with this condition, after extensive investigation with multimodal imaging, electrophysiology tests, and systemic screening.

RESUMO A distrofia macular oculta é caracterizada por perda visual, lentamente progressiva, em pacientes com fundoscopia e angiografia fluoresceínica normais. Relatamos o caso de um paciente de 36 anos do sexo masculino diagnosticado com essa condição após extensa investigação com exames de imagem multimodais, eletrofisiológicos e rastreio de doenças sistêmicas.

Ocorrência de alterações nos potenciais evocados auditivos de fumantes: revisão sistemática da literatura / Occurrence of changes in the auditory evoked potentials of smokers: systematic review of the literature

RESUMO Objetivo Verificar a ocorrência de alterações nos exames de potencial evocado (PEA) auditivo em adultos fumantes normo-ouvintes. Estratégia de pesquisa Revisão sistemática da literatura de acordo com recomendações do PRISMA, buscando responder à pergunta: "Há alterações nos resultados do exame de PEA em adultos fumantes?", estratégia PECOS. Pesquisa realizada nas bases de dados PubMed, Embase, CINAHL, LIVIVO, Scopus, Web of Science, LILACS e Scielo. Busca adicional da literatura cinzenta: Google Scholar e ProQuest e busca manual das referências dos estudos incluídos. Critérios de seleção Foram selecionados estudos com delineamento transversal, sem restrição do ano de publicação e idioma. Análise dos dados Primeiramente foram analisados os títulos e resumos de todos os estudos encontrados, seguido da leitura na íntegra dos estudos elegíveis. Resultados Foram obtidos 898 artigos, que após remoção dos duplicados e análise cega por três pesquisadores, foram selecionados oito trabalhos. Grande parte dos estudos encontrou uma associação entre tabagismo ativo e alterações nos testes eletrofisiológicos. Conclusão Adultos fumantes normo-ouvintes apresentam alterações nos exames de PEA de curta e longa latência. No potencial evocado auditivo de tronco encefálico, os principais componentes alterados foram o aumento das latências das ondas I e III e nos interpicos I - III e III - V, bem como diminuição da amplitude das ondas. No Mismatch Negativity, houve aumento significativo da amplitude da onda e da latência. No potencial de longa latência, P300, houve aumento das latências e redução das amplitudes nos componentes N1 (em Fz) e P3.

ABSTRACT Purpose To verify the occurrence of abnormal auditory evoked potentials (AEP) tests in adult smokers. Research strategies Systematic review of the literature according to the PRISMA guidelines, to answer the question: "Are there any changes in the AEP results in adult smokers?", PECOS strategy. Research carried out on PubMed, Embase, CINAHL, LIVIVO, Scopus, Web of Science, LILACS and Scielo databases. Additional search of gray literature: Google Scholar and ProQuest hand searching of reference lists of the included studies. Selection criteria Cross-sectional studies were selected, without restriction on the year of publication and language. Data analysis First, the titles and abstracts of all the studies were analyzed, followed by the full reading of the eligible studies. Results 898 articles were collected, after the duplicate studies were removed and after blind analysis by three researchers, 8 studies of the observational type were selected. Most studies have found an association between active smoking and changes in electrophysiological tests. Conclusion Normal hearing adult smokers present alterations in short and long AEP. In the auditory brainstem response, the main altered components were the increase in waves latencies of I and III and in the interpeaks I - III and III - V, as well as a decrease in the amplitude of the waves. In Mismatch Negativity, there was a significant increase in wave amplitude and latency. In the long latency potential, P300, there was an increase in latencies and decreased amplitudes in the components N1 (in Fz) and P3.

O benefício do mascaramento modulado nos potenciais evocados auditivos corticais com estímulo de fala / Masking release in cortical auditory evoked potentials with speech stimulus

RESUMO Objetivo analisar o efeito do mascaramento estável e modulado no Potencial Evocado Auditivo Cortical com estímulo de fala em adultos-jovens. Método participaram 14 indivíduos com idades entre 19 e 28 anos de ambos os sexos e sem perda auditiva. O exame de Potencial Evocado Auditivo Cortical foi realizado com estímulo de fala sintética /ba/ simultâneo ao ruído Speech Shaped Noise apresentado em três condições: ruído estável com intensidade de 30 dB NPSpe (ruído estável fraco), ruído estável com intensidade de 65 dB NPSpe (ruído estável forte) e ruído modulado em intensidade de 30 dB NPSpe e 65 dB NPSpe em 25Hz e com período de modulação de 40 ms. Resultados foram observadas maiores latências nos componentes corticais, exceto P2, na condição de ruído estável forte e medidas mais robustas de amplitude dos componentes corticais P1, N1 e P2 na condição de ruído modulado com diferença estatística significativa na comparação com a condição de ruído estável forte. Houve pior morfologia na condição de ruído estável forte, quando comparado aos demais registros. Os limiares eletrofisiológicos médios para as condições de ruído estável forte e ruído modulado foram 60 dB NPSpe e 49 dB NPSpe, respectivamente, mostrando 11,7 dB de diferença média. Conclusão podemos inferir que houve um menor efeito mascarante do ruído modulado, comparado à condição de ruído estável forte, nas medidas de amplitude dos componentes corticais e uma diferença média de 11,7 dB entre os limiares eletrofisiológicos (interpretado como a medida do Benefício do Mascaramento Modulado).

ABSTRACT Purpose To analyze the effect of masking on the Cortical Auditory Evoked Potential with speech stimulus in young adults. Methods Fourteen individuals aged between 19 and 28 years of both sexes with no hearing loss participated in the study. The Cortical Auditory Evoked Potential examination was performed with synthetic speech stimulus /ba/ simultaneous to Speech Shaped Noise presented under three conditions: steady noise with a 30 dB SPLep intensity (weak steady noise), steady noise with a 65 dB SPLep intensity o (strong steady noise) and modulated noise with 30 dB SPLep and 65 dB SPLep intensities at 25Hz and modulation period of 40 ms. Results Higher latencies were observed in the cortical components, except P2, in the condition of strong steady noise and more meaningful measures of amplitude of the cortical components P1, N1 and P2 in the condition of modulated noise with statistically significant difference in comparison to the strong steady noise condition. There was worse wave morphology in the condition of strong steady noise, when compared to the other records. The average electrophysiological thresholds for the conditions of strong steady noise and modulated noise were 60 dB SPLep and 49 dB SPLep, respectively, showing a 11.7 dB mean difference. Conclusion We could infer that there was a lower masking effect of modulated noise when compared to the strong steady noise condition, in the amplitude measurements of the cortical components and an average difference of 11.7 dB between the electrophysiological thresholds (interpreted as the measure of the Masking Release).

Auditory central pathways in children and adolescents with multiple sclerosis / Sistema auditivo central em crianças e adolescentes com esclerose múltipla

Abstract Background Multiple sclerosis (MS) is an inflammatory demyelinating disease. Auditory evoked potential studies have demonstrated conduction and neural processing deficits in adults with MS, but little is known about the electrophysiological responses in children and adolescents. Objective to evaluate the central auditory pathway with brainstem auditory evoked potentials (BAEP) and long-latency auditory evoked potentials (LLAEP) in children and adolescents with MS. Methods The study comprised 17 individuals with MS, of both sexes, aged 9 to 18 years, and 17 healthy volunteers, matched for age and sex. All individuals had normal hearing and no middle ear impairments. They were assessed with click-BAEP and LLAEP through oddball paradigm and tone-burst stimuli. Results Abnormal responses were observed in 60% of electrophysiologic assessments of individuals with MS. In BAEP, 58.82% of MS patients had abnormal responses, with longer wave V latency and therefore longer III-V and I-V interpeak latencies than healthy volunteers. In LLAEP, 52.94% of MS patients had abnormal responses. Although statistical differences were found only in P2-N2 amplitude, MS patients had longer latencies and smaller amplitudes than healthy volunteers in all components. Conclusion Children and adolescents with MS had abnormal BAEP responses, with delayed neural conduction between the cochlear nucleus and the lateral lemniscus. Also, abnormal LLAEP results suggest a decrease in neural processing speed and auditory sensory discrimination response.

Resumo Antecedentes A esclerose múltipla (EM) é uma doença inflamatória desmielinizante. Estudos com potenciais evocados auditivos têm demonstrado déficits de condução e processamento neural em adultos com EM, mas pouco se sabe sobre as respostas electrofisiológicas em crianças e adolescentes. Objetivo avaliar a via auditiva central por meio dos potenciais evocados auditivos de tronco encefálico (PEATE) e dos potenciais evocados auditivos de longa latência (PEALL) em crianças e adolescentes com EM. Métodos Foram avaliados17 indivíduos com EM, de ambos os sexos, com idades entre 9 e 18 anos, e 17 voluntários saudáveis, pareados por sexo e idade. Todos os indivíduos tinham audição normal sem alterações de orelha média. Os indivíduos foram avaliados por meio do PEATE com estímulo clique e do PEALL com paradigma de oddball e estímulo tone-burst. Resultados Foram observadas alteração em 60% das avaliações dos indivíduos com EM. No PEATE, 58,82% dos pacientes com EM apresentaram alteração, com aumento da latência da onda V, e interpicos III-V e I-V aumentados em comparação aos voluntários saudáveis. No PEALL, 52,94% dos pacientes com EM apresentaram alteração. Embora diferenças estatísticas foram observadas apenas na amplitude P2-N2, os pacientes com EM apresentaram latências prolongadas e amplitudes menores em comparação aos voluntários saudáveis para todos os componentes. Conclusão Crianças e adolescentes com EM apresentaram alteração das respostas do PEATE, com atraso de condução neural entre o núcleo coclear e o lemnisco lateral. Além disso, os resultados alterados do PEALL sugeriram uma diminuição na velocidade de processamento neural e de discriminação sensorial da audição.

LS CE-Chirp® vs. Click in the neuroaudiological diagnosis by ABR.

INTRODUCTION: The chirp stimulus was developed seeking to counterbalance the delay of the sound wave on its journey through the cochlea, allowing the hair cells to depolarize at the same time. The result is a simultaneous stimulation providing better neural synchrony and, consequently, the recording of responses with greater amplitudes. OBJECTIVE: To compare the absolute latency of waves I, III and V, the interpeak intervals I-III, III-V and I-V, amplitude values of wave V and its association with the amplitude of wave I, and the interaural difference V-V in the auditory brainstem response (ABR) using Click and LS CE-Chirp® stimuli to determine whether the responses evoked by LS CE-Chirp® could be applied to neuroaudiological diagnosis. METHODS: Cross-sectional study with 30 normal-hearing individuals. The parameters used were: intensity of 85dBnHL, alternating polarity; 17.1 stimuli/s and 100-3000Hz filters. RESULTS: The absolute latencies of waves I, III and V observed with LS CE-Chirp® and click did not show significant differences. Significantly higher amplitudes of wave V were observed with the LS CE-Chirp®. The interaural difference between the wave V latencies between stimuli showed no significant difference. CONCLUSION: The LS CE-Chirp® stimulus was shown to be as efficient as the click to capture ABR at high levels of stimulation, with the advantage of producing greater-amplitude V waves.

Amplitude das Ondas F como Preditor de Tromboembolismo e de Sucesso da Cardioversão Elétrica em Pacientes com Fibrilação Atrial Persistente / F Wave Amplitude as a Predictor of Thromboembolism and Success of Electrical Cardioversion in Patients with Persistent Atrial Fibrillation

Resumo Fundamento A fibrilação atrial (FA) é classificada, de acordo com a amplitude das ondas fibrilatórias (f), em ondas finas (FAf) e ondas grossas (FAg). Objetivos Correlacionar a amplitude das ondas f com variáveis clínicas, laboratoriais, eletrocardiográficas e ecocardiográficas que indiquem alto risco de tromboembolismo e avaliar o seu impacto no sucesso da cardioversão elétrica (CVE). Métodos Estudo retrospectivo, observacional, que incluiu 57 pacientes com FA não valvar persistente submetidos a CVE. A amplitude máxima das ondas f foi aferida na derivação V1. FAg foi definida quando f≥1,0 mm e FAf quando f<1,0mm. Os achados foram correlacionados com as variáveis indicadas. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados FAg (n=35) associou-se a maior sucesso na CVE (94,3% vs. 72,7%, p=0,036) mesmo após ajuste para variáveis como idade e IMC (p=0,026, OR=11,8). Pacientes com FAf (n=22) necessitaram mais choques e maior energia para reversão ao ritmo sinusal (p=0,019 e p=0,027, respectivamente). Não houve associação significativa entre a amplitude das ondas f e parâmetros clínicos, ecocardiográficos e laboratoriais. Conclusões A amplitude de f não se associou a parâmetros ecocardiográficos, clínicos e laboratoriais que indicam alto risco de tromboembolismo. FAg associou-se a maior chance de sucesso na reversão ao ritmo sinusal por meio da CVE. Maior número de choques e energia foram necessários para reversão ao ritmo sinusal em pacientes com FAf.

Abstract Background Atrial fibrillation (AF) is classified according to the amplitude of fibrillatory waves (f) into fine waves (fAF) and coarse waves (cAF). Objectives To correlate the amplitude of f waves with clinical, laboratory, electrocardiographic, and echocardiographic variables that indicate a high risk of thromboembolism and to assess their impact on the success of electrical cardioversion (ECV). Methods Retrospective, observational study that included 57 patients with persistent non-valvular AF who underwent ECV. The maximum amplitude of f waves was measured in lead V1. cAF was defined when f ≥ 1.0mm and fAF when f < 1.0mm. The findings were correlated with the indicated variables. Values of p < 0.05 were considered statistically significant. Results cAF (n = 35) was associated with greater success in ECV (94.3% vs. 72.7%, p = 0.036) even after adjusting for variables such as age and BMI (p = 0.026, OR = 11.8). Patients with fAF (n = 22) required more shocks and more energy to revert to sinus rhythm (p = 0.019 and p = 0.027, respectively). There was no significant association between f-wave amplitude and clinical, echocardiographic, and laboratory parameters. Conclusions The amplitude of f wave was not associated with echocardiographic, clinical and laboratory parameters that indicate a high risk of thromboembolism. cAF was associated with a higher chance of success reverting to sinus rhythm employing ECV. A greater number of shocks and energy were required for reversion to sinus rhythm in patients with fAF.

Assessment of hearing threshold in adults with hearing loss using an automated system of cortical auditory evoked potential detection.

INTRODUCTION: The use of hearing aids by individuals with hearing loss brings a better quality of life. Access to and benefit from these devices may be compromised in patients who present difficulties or limitations in traditional behavioral audiological evaluation, such as newborns and small children, individuals with auditory neuropathy spectrum, autism, and intellectual deficits, and in adults and the elderly with dementia. These populations (or individuals) are unable to undergo a behavioral assessment, and generate a growing demand for objective methods to assess hearing. Cortical auditory evoked potentials have been used for decades to estimate hearing thresholds. Current technological advances have lead to the development of equipment that allows their clinical use, with features that enable greater accuracy, sensitivity, and specificity, and the possibility of automated detection, analysis, and recording of cortical responses. OBJECTIVE: To determine and correlate behavioral auditory thresholds with cortical auditory thresholds obtained from an automated response analysis technique. METHODS: The study included 52 adults, divided into two groups: 21 adults with moderate to severe hearing loss (study group); and 31 adults with normal hearing (control group). An automated system of detection, analysis, and recording of cortical responses (HEARLab®) was used to record the behavioral and cortical thresholds. The subjects remained awake in an acoustically treated environment. Altogether, 150 tone bursts at 500, 1000, 2000, and 4000Hz were presented through insert earphones in descending-ascending intensity. The lowest level at which the subject detected the sound stimulus was defined as the behavioral (hearing) threshold (BT). The lowest level at which a cortical response was observed was defined as the cortical electrophysiological threshold. These two responses were correlated using linear regression. RESULTS: The cortical electrophysiological threshold was, on average, 7.8dB higher than the behavioral for the group with hearing loss and, on average, 14.5dB higher for the group without hearing loss for all studied frequencies. CONCLUSION: The cortical electrophysiological thresholds obtained with the use of an automated response detection system were highly correlated with behavioral thresholds in the group of individuals with hearing loss.

Correlação entre ausculta cervical e eletromiografia de superfície na fase faríngea da deglutição / Correlation between cervical auscultation and electromyography in the pharyngeal phase of swallowing / Correlación entre auscultación cervical y electromiografía de superficie en la fase faríngea de la deglución

Objetivo: Correlacionar os dados acústicos da ausculta cervical com a atividade elétrica dos músculos envolvidos na fase faríngea da deglutição. Métodos: Trata-se de um estudo observacional, transversal, de abordagem quantitativa, aprovado em janeiro pelo CEP/UFSCPA (número 1.389.050). Todos os participantes do estudo assinaram o termo de consentimento livre e esclarecido. A fase faríngea da deglutição foi avaliada por meio de ausculta cervical e eletromiografia de superfície. Os indivíduos ingeriram 90 ml de água. Os dados da ausculta foram transferidos para o DeglutiSom® software, a duração e amplitude da atividade eletromiográfica foram mensuradas durante a deglutição com aparelho de eletromiografia de superfície Miotec®. O nível de significância adotado foi de 5%. Resultados:Cinquenta e sete mulheres participaram deste estudo. A média de idade foi de 23,4 anos. Ressalta-se que quanto maior a frequência média do pico da ausculta, menor é a média do pico do músculo supra-hióideo e quanto maior a intensidade, maior é o pico, assim como a média dos picos supra-hióideos. Foi possível demonstrar que o pico de atividade do músculo supra-hióideo foi significativamente maior do que o pico de atividade do músculo infra-hióideo para a deglutição de 90 ml de água. Conclusão:Os parâmetros acústicos da deglutição em indivíduos saudáveis estão correlacionados com a atividade elétrica dos músculos envolvidos na fase faríngea da deglutição.

Objective: Correlate the acoustic data of cervical auscultation to the electrical activity of the muscles involved in the pharyngeal phase of swallowing. Methods: This is an observational, cross-sectional study involving a quantitative approach and was approved on January by CEP/UFSCPA (number 1.389.050). All participants of the study signed an informed consent form. The pharyngeal phase of swallowing was assessed by employing auscultation and surface electromyography. Individuals ingested 90 ml of water. The auscultation data were transferred to DeglutiSom® software, the duration and amplitude of electromyographic activity was measured during swallowing using a Miotec® surface electromyography device. The level of significance adopted was 5%. Results: Fifty-seven women participated in this study. The average age was 23.4 years on average. It must be highlighted that the greater the average peak frequency of auscultation, lower was the average peak of the suprahyoid muscle and the greater the intensity, the greater was the peak, as well as the average of the suprahyoid peaks. It was possible to demonstrate that the peak of suprahyoid muscle activity was significantly higher than the peak of infra hyoid muscle activity for swallowing 90 ml of water. Conclusion: The acoustic swallowing parameters in healthy individuals are correlated with the electrical activity of muscles involved in the pharyngeal phase of swallowing.

Objetivo: Correlacionar los datos acústicos de la auscultación cervical con la actividad eléctrica de los músculos involucrados en la fase faríngea de la deglución. Métodos: Se trata de un estudio observacional, transversal, de abordaje cuantitativo y aprobado en enero por CEP/UFSCPA (número 1.389.050). Todos los participantes del estudio firmaron un formulario de consentimiento informado. La fase faríngea de la deglución se evaluó mediante auscultación y electromiografía de superficie. Los individuos ingirieron 90 ml de agua. Los datos de auscultación fueron cargados em el software DeglutiSom®, la duración y la amplitud de la actividad electromiográfica se midió durante la deglución utilizando un dispositivo de electromiografía de superficie Miotec®. El nivel de significancia adoptado fue del 5%. Resultados: Cincuenta y siete mujeres participaron en este estudio. La edad promedio fue 23,4 años. Cabe destacar que a mayor frecuencia de pico promedio de auscultación, menor fue el pico promedio del músculo suprahioideo y a mayor intensidad, mayor fue el pico, así como el promedio de los picos suprahioideos. Fue posible demostrar que el pico de actividad del músculo suprahioideo era significativamente más alto que el pico de actividad del músculo infrahioideo para tragar 90 ml de agua. Conclusión: Los parámetros de deglución acústica en individuos sanos se correlacionan con la actividad eléctrica de los músculos involucrados en la fase faríngea de la deglución.

Frequency-Following Response (FFR) em usuários de implante coclear: uma revisão sistemática dos parâmetros de aquisição, análise e resultados / Frequency-Following Response (FFR) in cochlear implant users: a systematic review of acquisition parameters, analysis, and outcomes

RESUMO Objetivo Caracterizar os parâmetros de aquisição, análise e resultados do exame Frequency Following Response (FFR) em usuários de implante coclear. Estratégia de pesquisa As buscas foram realizadas nas bases Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science e na literatura cinzenta. Critérios de seleção Foram incluídos estudos sobre o FFR em usuários de implante coclear ou que os comparassem à indivíduos com audição normal, sem restrição de idade. Foram excluídos estudos secundários e experimentais. Não houve restrição de idioma e ano de publicação. Análise dos dados Os dados foram analisados e redigidos de acordo com as etapas do Preferred Reporting Items for Systematic Reviews and Meta-Analyse (PRISMA) 2020. Para análise da qualidade metodológica foi utilizado o instrumento Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. As divergências foram resolvidas por um terceiro pesquisador. Resultados Seis estudos atenderam aos critérios de inclusão. Apenas um estudo foi do tipo comparativo com grupo controle de indivíduos com audição normal. As variações nos parâmetros de aquisição foram comuns e as análises predominaram no domínio do tempo. Usuários de implante coclear apresentaram diferenças nos resultados do FFR quando comparados a indivíduos com audição normal, considerando a literatura existente. A maioria dos artigos teve baixa qualidade metodológica. Conclusão Não existe padronização de um protocolo de aquisição e análise para o FFR em usuários de implante coclear. Os resultados são de alto risco de viés.

ABSTRACT Purpose To characterize the acquisition parameters, analysis, and results of the frequency-following response (FFR) in cochlear implant users. Research strategies The search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science, and gray literature. Selection criteria Studies on FFR in cochlear implant users or that compared them with normal-hearing people, with no restriction of age, were included. Secondary and experimental studies were excluded. There was no restriction of language or year of publication. Data analysis The data were analyzed and reported according to the stages in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020. The methodological quality was analyzed with the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Divergences were solved by a third researcher. Results Six studies met the inclusion criteria. Only one study was comparative, whose control group comprised normal-hearing people. The variations in acquisition parameters were common and the analysis predominantly approached the time domain. Cochlear implant users had different FFR results from those of normal-hearing people, considering the existing literature. Most articles had low methodological quality. Conclusion There is no standardized FFR acquisition and analysis protocol for cochlear implant users. The results have a high risk of bias.