Natural history and predictors for progression in pediatric keratoconus.

We studied the demographic and clinical predictors associated with keratoconus progression in a pediatric population. Retrospective cohort study. We evaluated 305 eyes without previous surgeries from 168 patients, 9 to < 18 years old, and with a minimum 36-month follow-up in a hospital corneal ambulatory. We used Kaplan-Meyer survival curves; the dependent variable (main outcome measure) was the interval time (months) until the event, defined as an increase of 1.5 D in the maximum keratometry (Kmax), obtained with Pentacam. We evaluated the predictors: age (< or ≥ 14 years), sex, keratoconus familial history, allergy medical history, and the baseline tomographic parameters: mean keratometry (Km), Kmax (< or ≥ 55 D); and thinnest pachymetry (TP). We used log-rank tests and compared median survival times for right (RE)/left eyes (LE) and better (BE)/worse eyes (WE). A p value < 0.05 was considered significant. The patients' mean ± SD age was 15.1 ± 2.3 years old; 67% were boys, 30% were < 14 years, 15% had keratoconus familial history, and 70% were allergic. The general Kaplan-Meyer curves showed no differences between RE/LE or BE/WE. RE with allergy and LE with Kmax ≥ 55 D had smaller survival times ((95%CI 9.67-32.1), p 0.031 and (95%CI 10.1-44.1), p 0.042, respectively). For BE and WE, Kmax ≥ 55 D had smaller survival times ((95% CI 6.42- ), p 0.031 and (95%CI 8.75-31.8), p 0.043, respectively). Keratoconus progression was similar between RE/LE and BE/WE. Steepest corneas are predictors of faster progression. Allergy is also a predictor of keratoconus progression in RE.

Intraluminal esophageal pressures in speaking laryngectomees.

OBJECTIVES: The objective of the present study was to evaluate intraluminal esophageal pressure during voice and speech emission in speaking laryngectomees with a tracheoesophageal prosthesis. METHODS: In our prospective analysis in a tertiary-care academic hospital, 25 laryngectomees were divided into 2 groups: 11 speaking individuals with a tracheoesophageal prosthesis and a control group of 14 nonspeaking laryngectomees. All patients were subjected to manometry during voice and speech emission tests. We determined the pressures achieved in the distal, middle, and proximal parts of the esophagus. RESULTS: Statistical analysis revealed that the amplitude of pressure in the distal esophagus during sound emission was higher in speaking laryngectomees; in the middle esophagus, intraluminal pressure during emission of the sentence was higher in speaking subjects, and in the proximal esophagus there was no difference between the groups. CONCLUSIONS: During the manometric evaluation of the distal and middle esophagus in the presence of voice and speech emission, the intraluminal pressure revealed a significant difference for the speaking laryngectomees with a tracheoesophageal prosthesis. The proximal esophagus behaved similarly in the groups of speakers and nonspeakers. Speaking laryngectomees with a tracheoesophageal prosthesis depend on a differentiated performance of the middle and distal parts of the esophagus.

Behavior of the cricopharyngeal segment during esophageal phonation in laryngectomized patients.

BACKGROUND: After total laryngectomy, the interruption of the upper digestive tube and the section of the cricopharyngeal segment alter the high-pressure zone of the pharyngoesophageal transition, which will not only start to have a digestive function, but also be stimulated to take on the production of voice and speech. The pressure observed in the cricopharyngeal segment seems to act as a critical factor for the development of esophageal sound production, and manometry is the procedure capable of quantifying the pressure observed in this region. OBJECTIVE: The objective of the current study was to assess the upper esophageal sphincter pressure in laryngectomized patients who are either successful or unsuccessful esophageal speakers, both at rest and during esophageal phonation, using manometry. METHODS: Twenty laryngectomized persons aged 32 to 83 years (mean, 44.2 years) were submitted to evaluation by a speech pathologist and divided into two groups, ie, successful esophageal speakers (N=12) and unsuccessful esophageal speakers (N=8), according to a scale validated by Wepman et al (1953). The upper esophageal sphincter (UES) pressure was assessed by manometry both at rest and during the following voice emissions in Portuguese: the vowel "a," the monosyllable "pa," and the sentence "papai papou pipoca." The amplitude, the duration of the pressure wave, and the area under the curve were measured. RESULTS: At rest, the mean UES pressure was 11.83 mm Hg for successful esophageal speakers and 9.92 mm Hg for unsuccessful esophageal speakers, with no significant difference between groups; the mean for the two groups as a whole was 11.06 mm Hg. During the voice and speech sequence tests, no significant difference was observed when the emissions in Portuguese of "a," "pa," and the sentence were analyzed separately. CONCLUSION: As the pressure observed at rest did not differ between the successful esophageal speakers and the unsuccessful esophageal speakers, and the amplitude, the duration of the pressure wave, and the area under the amplitude x duration curve were also equal for both groups, we conclude that the cricopharyngeal segment pressure is not a preponderant factor for the acquisition of esophageal voice and speech.

HIV prevalence and risk factors in a Brazilian penitentiary.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

Understanding alterations on blood and biochemical parameters in athletes that use dietary supplements, steroids and illicit drugs.

In recent years it was verified there are an alarming growing number of teenagers and young adults using a combination of dietary supplements (DS) anabolic androgenic steroids (AAS) and drugs of abuse. This practice is used to improve physical fitness and appearance, may cause serious side effects. This article shows the alterations in the hematological and renal function parameters associate with these substances in 40 athletes. This research involved three steps: 1-the administration of a self-completion questionnaire ; 2-the assessment of hematological and biochemical parameters of renal function and; 3-toxicological urinalysis. Hematological and biochemical tests were conducted in an accredited laboratory and the toxicological urinalysis was validated in our laboratory using liquid-liquid extraction (LLE) and gas chromatography-mass spectrometry (GC-MS). The testosterone levels in the participants who consumed steroids increased 20-60% and alterations in serum creatinine, urea and uric reached values of up to 1.9; 60.6 and 7.5mg/dL, respectively. The toxicological urinalysis supports self-reports confirming the use of AAS and recreational drugs, putting at risk the health of those athletes increasing the chances of kidney diseases.

[Respiratory dynamics measurements in children with four to ten years of age]. / Medidas da dinâmica respiratória em crianças de quatro a dez anos.

BACKGROUND: respiratory dynamics measurements are frequently used in the speech-language pathology practice, but few are the scientific data for children. AIM: to study the respiratory dynamics in children with nasal breathing. METHOD: the study was performed with a stratified random sample of 106 nasal breathing children, male and female, from schools of the city of Marília-SP, with ages between four and ten years. The following measurements were obtained: vital capacity (VC) in both standing and sitting positions, with and without nasal occlusion; maximum phonation time (MPT) of sustained vowels and consonants and also of speech when counting numbers. RESULTS: the mean values for VC in the standing position with and without nasal occlusion were of 1515.56ml and 1538.67ml respectively and for the sitting position of 1524ml and 1539.15ml respectively. MPT of vowels in seconds were: /a/ = 8.32, /i/ = 8.61 and /ul = 8.42; of consonants: /s/ = 6.64 and /z/ = 7.65; and when counting numbers: 7.76. It was observed that the mean values of these measurements progressively increased according to age. There was a statistically significant difference (p<0.05) not only for the MPT of vowels but also for the MPT of consonants in older children, i.e. between 4 and 10 year olds, 4 and 9 year olds and 4 and 8 year olds. There was no significant statistical difference for the VC values in consecutive age groups. There was a strong association between VC and the child's physical development. CONCLUSION: this study presented respiratory dynamics measurements in children that can be used for the spech-language diagnosis and therapy. Other studies should be developed in order to bring additional information on the subject.

Predictive markers for hepatitis C virus infection among Brazilian inmates.

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40%. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7% (95% CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Violência contra a mulher na rede de atenção básica: o que os enfermeiros sabem sobre o problema? / Violence against women in the basic care network: what do nurses know about the problem?

Descrever o conhecimento dos enfermeiros das Unidades Distritais Básicas de Saúde do município de Ribeirão Preto, SP, Brasil, acerca da violência contra a mulher, particularmente aquela cometida pelo parceiro íntimo. MÉTODOS: estudo quantitativo, transversal e descritivo. Participaram 51 enfermeiros, extraídos de um estudo maior com 221 profissionais de saúde. Os dados foram coletados por meio de questionário que investigava o conhecimento em relação à violência cometida contra as mulheres. RESULTADOS: os enfermeiros acertaram de 76 por cento a 90,2 por cento das questões sobre definição de violência de gênero e 78 por cento obtiveram altos escores em questões sobre epidemiologia da violência; no entanto, 70,6 por cento demonstraram desconhecer sua epidemiologia nos serviços de pré-natal. 83,7 por cento dos enfermeiros demonstraram bom conhecimento sobre como abordar as vítimas para obter a revelação da violência ocorrida e 52 por cento demonstraram conhecimento elevado sobre o manejo dos casos. CONCLUSÕES: os enfermeiros conhecem bem a definição de violência, têm conhecimentos sobre o manejo de casos, a necessidade de notificação e encaminhamentos de casos em situação de risco. Entretanto, desconhecem características epidemiológicas importantes da violência contra a mulher, o que pode ser uma barreira para a atuação dos enfermeiros no atendimento a mulheres em situação de risco, principalmente durante a atenção no pré-natal...

To outline what nurses from the District Basic Care Units of the municipality of Ribeirão Preto, in the Brazilian State of São Paulo, know about violence against women, especially that perpetrated by an intimate partner. METHODS: a quantitative, cross-sectional, descriptive study was carried out with 51 nurses drawn from a larger study of 221 health workers. The data were collected using a questionnaire that asked about their knowledge regarding violence against women. RESULTS: the nurses correctly answered 76 percent to 90.2 percent of the questions on the definition of gender violence and 78 percent obtained high scores on questions relating to the epidemiology of violence. However, 70.6 percent showed no knowledge of the epidemiology of violence in prenatal services. 83.7 percent of the nurses showed good knowledge of how to deal with victims to get them to report the abuse and 52 percent showed a good knowledge of case management. CONCLUSIONS: nurses are well aware of what violence is and have knowledge about how to manage cases and the need to report abuse and refer women who are at risk. However, they are unaware of important epidemiological features of violence against women, which may pose an obstacle to their ability to attend women at risk, especially during prenatal care...

Soroprevalência da infecção pelo vírus da Hepatite B em uma prisão brasileira / Seroprevalence of Hepatitis B virus infection in a Brazilian jail

Esta pesquisa objetivou estimar a prevalência do marcador do HBV e seus fatores de risco na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, Brasil. De 1.030 presidiários, foram sorteados 333 participantes, os quais foram submetidos à aplicação de um questionário e à coleta de sangue, no período de maio a agosto de 2003. Para diagnóstico de exposição ao HBV foi utilizado o ensaio imunoabsorvente de ligação de enzimas (ELISA) para detecção dos marcadores HBsAg, anti-HBsAg e anti-HBc total. A prevalência total de infecção pelo HBV nos presidiários foi de 19,5 por cento (IC95 por cento: 15,2 - 23,8). A média de idade dos participantes foi de 30,1 anos. Na análise univariada, a infecção pelo HBV esteve associada à idade acima de 30 anos (p<0,001), uso prévio de drogas injetáveis (p<0,001) e compartilhamento de agulhas prévio (p<0,001). Em um modelo multivariado, de regressão logística, a infecção pelo HBV foi associada à idade acima de 30 anos (OR = 3,3: IC95 por cento: 1,8 - 6.1) e uso prévio de droga injetável (OR = 2,7; IC95 por cento: 1.9 - 6.4). Infecção pelo HBV nas prisões representa grave problema de saúde pública, principalmente relacionado à idade acima de 30 anos e uso prévio de drogas injetáveis.

This survey aimed to estimate the prevalence of HBV serological markers and risk factors for this infection in male inmates at the Penitentiary of Ribeirão Preto, State of São Paulo, Brazil. Out of 1030 inmates, a simple random sample of 333 participants answered a questionnaire and had blood samples collected, from May to August 2003. Enzyme-linked immunosorbent assay (ELISA) was used to diagnose HBV infection (HBsAg, anti-HBsAg, and total anti-HBc). The overall prevalence for HBV markers in inmates was 19.5 percent (CI95 percent: 15.2 - 23.8). The participants' mean age was 30.1 years. In univariate analysis, HBV infection was associated with age > 30 years (p<0.001), previous injecting drug use (p<0.001) and previous sharing of needles (p<0.001). In a logistic regression multivariate model, HBV infection was associated with age > 30 years (OR = 3.3; CI95 percent: 1.8 - 6.1) and previous injecting drug use (OR = 2.7; CI95 percent: 1.9 - 6.4). HBV infection on prisons represents a major health problem, mainly associated with age over 30 years and previous injecting drug use.

Predictive markers for hepatitis C virus infection among Brazilian inmates / Marcadores preditivos para infecção do vírus da hepatite C em presidiários brasileiros

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40 percent. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7 percent (95 percent CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Infecção pelo vírus da hepatite C no sistema prisional apresenta elevada prevalência, chegando a atingir cifras superiores a 40 por cento. Esta pesquisa objetivou estimar a prevalência do HCV e avaliar fatores de risco para esta exposição na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, no período de maio a agosto de 2003. Um total de 333 participantes foi submetido à aplicação de um questionário padronizado e a ensaio imunoenzimático para pesquisa de anti-HCV. A prevalência encontrada de infecção pelo HCV nos presidiários foi de 8,7 por cento (IC 95 por cento: 5,7-11,7). A média de idade dos participantes foi de 30,1 anos, com a prevalência predominando nos indivíduos acima de 30 anos. Na análise multivariada, as variáveis que se mostraram associadas de forma independente à infecção pelo HCV foram idade > 30 anos, tatuagem, história prévia de hepatite, passado de uso de droga injetável e passado de compartilhamento de agulhas.

HIV prevalence and risk factors in a Brazilian penitentiary

A infecção pelo HIV em presidiários alcança uma das maiores prevalências entre subgrupos populacionais específicos, com taxas de até 17 por cento, já tendo sido descritas no Brasil e no mundo. Esta pesquisa objetivou estimar a prevalência do marcador do HIV e fatores de risco para essa infecção na população masculina carcerária da Penitenciária de Ribeirão Preto, São Paulo, Brasil, no período de maio a agosto de 2003. Do total de 1.030 presidiários, foram sorteados 333 participantes por amostragem aleatória simples, os quais foram submetidos à aplicação de um questionário padronizado e coleta de sangue. Para diagnóstico sorológico do HIV foi utilizado o ensaio imunoenzimático (ELISA) e reação de imunofluorescência indireta. A prevalência global do HIV nos presidiários foi de 5,7 por cento (IC95 por cento: 3,2-8,2). Todas as variáveis que mostraram associação com presença do anti-HIV, por meio de análise univariada, foram submetidas a modelo multivariado de regressão logística não condicional. As variáveis que se mostraram preditoras de forma independente da infecção pelo HIV foram: tempo total da pena a ser cumprida inferior a cinco anos e compartilhamento de agulhas e seringas.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17 percent in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7 percent (95 percentCI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

Medidas da dinâmica respiratória em crianças de quatro a dez anos / Respiratory dynamics measurements in children with four to ten years of age

TEMA: medidas da dinâmica respiratória são freqüentemente utilizadas na clínica fonoaudiológica, mas poucos são os dados científicos destas na população infantil. OBJETIVO: estudar a dinâmica respiratória entre crianças que respiram pelo modo nasal. MÉTODO: o estudo foi realizado com uma amostra aleatória estratificada de 106 crianças respiradoras nasais de escolas da cidade de Marília / SP, entre quatro e dez anos de ambos os sexos. Foram realizadas as medidas de capacidade vital (CV), nas posições em pé e sentada, com e sem oclusão nasal; de tempo máximo de fonação (TMF) de vogais e consoantes sustentadas, além de fala em seqüência com a contagem de números. RESULTADOS: a medida média da CV na posição em pé com e sem oclusão nasal foi 1515,56 ml e 1538,67 ml respectivamente e na posição sentada, 1524 ml e 1539,15 ml respectivamente; o TMF das vogais em segundos foi: /a/ = 8,32 , /i/ = 8,61 e /u/ 8,42; o de consoantes foi: /s/ = 6,64 e /z/ = 7,65 e o de seqüência de números foi de 7,76 segundos. Resultados: observou-se que o tempo médio destas medidas aumentou progressivamente conforme as faixas etárias. Tanto para o TMF das vogais como, para o das consoantes, houve diferença estatística significante (p < 0,05) nas idades mais distantes, ou seja, entre quatro e dez anos, quatro e nove, e quatro e oito anos. Em faixas etárias consecutivas não houve diferença estatística significante nos valores de CV. Houve forte associação entre a CV e o crescimento físico da criança. CONCLUSÃO: esse estudo mostrou medidas de dinâmica respiratória em crianças que podem ser úteis no diagnóstico e terapia fonoaudiológica. Outras pesquisas deveriam ser desenvolvidas para adicionais informações sobre o assunto.

BACKGROUND: respiratory dynamics measurements are frequently used in the speech-language pathology practice, but few are the scientific data for children. AIM: to study the respiratory dynamics in children with nasal breathing. METHOD: the study was performed with a stratified random sample of 106 nasal breathing children, male and female, from schools of the city of Marília-SP, with ages between four and ten years. The following measurements were obtained: vital capacity (VC) in both standing and sitting positions, with and without nasal occlusion; maximum phonation time (MPT) of sustained vowels and consonants and also of speech when counting numbers. RESULTS: the mean values for VC in the standing position with and without nasal occlusion were of 1515.56ml and 1538.67ml respectively and for the sitting position of 1524ml and 1539.15ml respectively. MPT of vowels in seconds were: /a/ = 8.32, /i/ = 8.61 and /u/ = 8.42; of consonants: /s/ = 6.64 and /z/ = 7.65; and when counting numbers: 7.76. It was observed that the mean values of these measurements progressively increased according to age. There was a statistically significant difference (p<0.05) not only for the MPT of vowels but also for the MPT of consonants in older children, i.e. between 4 and 10 year olds, 4 and 9 year olds and 4 and 8 year olds. There was no significant statistical difference for the VC values in consecutive age groups. There was a strong association between VC and the child's physical development. CONCLUSION: this study presented respiratory dynamics measurements in children that can be used for the speech-language diagnosis and therapy. Other studies should be developed in order to bring additional information on the subject.