Interest Groups as an Alternative for Medical Education in Sleep Medicine: Experience Report at a Brazilian Medical School.

Sleep medicine classes and teachings are usually deficient and insufficient during undergraduate medical education. In order to circumvent the educational deficits in sleep medicine, students at a Brazilian Medical School created a sleep medicine interest group-an academic organization for teaching purposes whose administration is carried out by the undergraduate students themselves. This study aims to describe the establishment of a sleep medicine interest group, as well as to evaluate the results of its first edition on the knowledge about sleep medicine among undergraduate medical students. Classes were taken biweekly and consisted of lectures by invited professors, presentation of clinical cases, and discussion with the students. By the end of the course, both attendees and non-attendees were invited to fill out a questionnaire including an objective assessment of knowledge (15 multiple choice questions). The questionnaire was filled out by 32 participants, of which 18 were attendees and 14 were non-attendees. The average result on the final exam was significantly higher among the attendees (6.1 ± 1.2) in comparison with non-attendees (4.9 ± 1.3-p = 0.015). The results demonstrate that an interest group proved to be feasible as a source of complementary information to undergraduate medical students and a valid alternative to circumvent the educational deficits.

Sleep in Older Adults and Its Possible Relations With COVID-19.

Since the beginning of the COVID-19 pandemic, older adults have been found to be a highly vulnerable group, with a higher prevalence of severe cases and negative outcomes. Research has focused on the reasons why older adults are at greater risk; Sleep-related factors have been suggested as one possible explanation for this. An individual's sleep pattern undergoes significant changes over the course of their life. In older adults a specific sleep profile can be observed, one characterized by advanced sleep timing, a morningness preference, longer sleep-onset latency, shorter overall sleep duration, increased sleep fragmentation, reduced slow-wave sleep and, increased wake time after sleep onset. Additionally, an increased prevalence of sleep disorders can be observed, such as obstructive sleep apnea and insomnia. Previous research has already linked sleep disorders (especially sleep apnea) with COVID-19, but few studies have focused specifically on the older population. We believe that the intrinsic sleep patterns of older adults, and the prevalence of sleep disorders in this population, may be important factors that could explain why they are at a greater risk of negative COVID-19 outcomes. In this review, we discuss the relationship between sleep and COVID-19 among older adults, focusing on three different aspects: (1) Sleep-related issues that might increase the likelihood of getting infected by SARS-COV-2; (2) Sleep disturbances that might increase the predisposition to worse COVID-19 prognosis and outcomes; and (3) COVID-19-related aspects affecting community-dwelling older adults, such as social isolation, quarantine, and home confinement, among others, that might impact sleep.

Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux.

STUDY OBJECTIVES: The aim of the current study was to test the hypothesis that there is a temporal correlation between reflux episodes and respiratory events in patients with laryngopharyngeal reflux and obstructive sleep apnea. METHODS: Adults with clinically diagnosed laryngopharyngeal reflux confirmed by two validated instruments (reflux symptom index ≥ 13 and reflux finding score ≥ 7) and obstructive sleep apnea (OSA) underwent full polysomnography with concomitant and synchronized multichannel intraluminal impedance-pH esophageal monitoring. The apnea-hypopnea and arousal indexes that occurred 15, 30, and 45 minutes before and after each reflux episode were recorded and compared to full-night apnea and hypopnea and arousal index. RESULTS: We studied 27 patients (14 males, age 51.7 ± 9.1 years, body mass index 32.4 ± 4.2 kg/m²) with laryngopharyngeal reflux (reflux symptom index 16 ± 2 and reflux finding score 12 ± 3) and OSA (apnea-hypopnea index = 32.3 ± 28.4 events/h). We evaluated 102 reflux episodes. Almost half of the reflux episodes occurred while awake (43.1%) and only five reflux episodes (4.9%) occurred during an obstructive respiratory event. The apnea and hypopnea and arousal indexes 15, 30, and 45 minutes before and after reflux episodes were lower than full-night apnea and hypopnea and arousal indexes, respectively. CONCLUSIONS: Among patients with well-established laryngopharyngeal reflux and OSA, there is no temporal association between reflux and obstructive respiratory events. Even though the data comprised a small sample size, it seems that a more complex mechanism is involved with these two highly prevalent diseases.

Auditory behavior and auditory temporal resolution in children with sleep-disordered breathing.

OBJECTIVE: Intermittent hypoxia caused by obstructive sleep apnea syndrome (OSAS) may lead to damage in brain areas associated to auditory processing. The aim of this study was to compare children with OSAS or primary snoring (PS) to children without sleep-disordered breathing with regard to their performance on the Gaps-in-Noise (GIN) test and the Scale of Auditory Behaviors (SAB) questionnaire. METHODS: Thirty-seven children (6-12 years old) were submitted to sleep anamnesis and in-lab night-long polysomnography. Three groups were organized according to clinical criteria: OSAS group (13 children), PS group (13 children), and control group (11 children). They were submitted to the GIN test and parents answered SAB questionnaire. The Kruskal-Wallis statistical test was used to compare the groups; p < 0.05 was considered statistically significant. RESULTS: The OSAS group performed significantly worse than PS (p = 0.011) and Control (p = 0.029) groups on gap detection percentage, while PS and Control groups showed no significant differences. The three groups showed similar gap detection thresholds. Regarding SAB questionnaire, PS group had significantly worse scores when compared to Control (p = 0.011), but not to OSAS (p = 0.101) groups. No statistical difference between OSAS and Control groups were found. CONCLUSION: Children with OSAS showed worse performance on GIN test in comparison to children with PS and children without sleep-disordered breathing. PS negatively affected auditory behavior in children. These findings suggest that sleep-disordered breathing may lead to auditory behavior impairment.

Prevalence of signs and symptoms of laryngopharyngeal reflux in snorers with suspected obstructive sleep apnea.

OBJECTIVE: To study the prevalence of signs and symptoms of reflux in snorers with suspected OSA. METHOD: This cross-sectional study enrolled 74 patients assessed positive for OSA with the Berlin questionnaire. The subjects were followed up at the sleep disorder ward of a university center. Studied variables included the BMI, the Epworth sleepiness scale, the reflux symptom index (RSI), the reflux finding score (RFS), and their subdomains related to increased inflammation. The correlations between sleep questionnaires, reflux scales, and their subdomains were deemed statistically significant when p < 0.05. RESULTS: Ninety-eight percent of the subjects had symptoms and signs suggestive of LPR; prevalence was significantly higher among obese individuals (p = 0.002). CONCLUSION: The significant difference seen in the prevalence of signs of inflammation suggestive of LPR when obese and non-obese subjects with suspected OSA were compared indicates that obesity may affect inflammatory findings of the pharynx and larynx. The high prevalence of symptoms and signs of reflux in patients with suspected OSA calls for more studies on the matter.

Prevalencia de sintomas e sinais de refluxo laringofaringeo em pacientes roncadores com suspeita de sindrome da apneia obstrutiva do sono / Prevalence of signs and symptoms of laryngopharyngeal reflux in snorers with suspected obstructive sleep apnea

Acredita-se que haja uma associação entre síndrome da apneia obstrutiva do sono (SAOS) e refluxo laringofaríngeo (RLF). OBJETIVO: Estudar a prevalência de sintomas/sinais de refluxo em pacientes roncadores com suspeita de SAOS. MÉTODO: Estudo clínico corte transversal de 74 adultos Berlim positivo acompanhados em ambulatório de distúrbios do sono de centro universitário. As variáveis estudadas foram IMC, Epworth, índice de sintomas de refluxo (RSI) e escala de achados endolaríngeos de refluxo (RFS), bem como seus subdomínios que podem traduzir maior inflamação. Correlações entre questionários de sono e escalas de refluxo, bem como seus subdomínios, foram feitas com significância estabelecida em p < 0,05. RESULTADOS: Noventa e oito porcento dos pacientes apresentaram sintomas e sinais sugestivos de RLF, sendo esta prevalência significativamente maior nos obesos (p = 0,002). CONCLUSÃO: A diferença significativa nos sinais inflamatórios sugestivos de RLF entre obesos e não obesos com suspeita de SAOS sugere que a obesidade pode interferir nos achados inflamatórios na faringe e laringe. A altíssima prevalência destes sintomas e sinais de refluxo nos pacientes com suspeita de SAOS demonstra a importância de aprofundar estudos nesta área. .

OBJECTIVE: To study the prevalence of signs and symptoms of reflux in snorers with suspected OSA. METHOD: This cross-sectional study enrolled 74 patients assessed positive for OSA with the Berlin questionnaire. The subjects were followed up at the sleep disorder ward of a university center. Studied variables included the BMI, the Epworth sleepiness scale, the reflux symptom index (RSI), the reflux finding score (RFS), and their subdomains related to increased inflammation. The correlations between sleep questionnaires, reflux scales, and their subdomains were deemed statistically significant when p < 0.05. RESULTS: Ninety-eight percent of the subjects had symptoms and signs suggestive of LPR; prevalence was significantly higher among obese individuals (p = 0.002). CONCLUSION: The significant difference seen in the prevalence of signs of inflammation suggestive of LPR when obese and non-obese subjects with suspected OSA were compared indicates that obesity may affect inflammatory findings of the pharynx and larynx. The high prevalence of symptoms and signs of reflux in patients with suspected OSA calls for more studies on the matter. .

Prevalence of human papillomavirus (HPV) DNA in oral mucosa of men with anogenital HPV infection.

OBJECTIVE: The aim of the present study was to determine the prevalence of concurrent oral and anogenital human papillomavirus (HPV) infection in male patients using polymerase chain reaction and reverse hybridization. STUDY DESIGN: Thirty consecutive men were recruited among those attending the Clinic for Sexually Transmitted Diseases of the Outpatient Department of Dermatology and Sexually Transmitted Diseases, Santa Casa Hospital, São Paulo. The criteria for enrollment in the study were: age between 15 and 60 years, negative human immunodeficiency virus (HIV) status, and the presence of HPV anogenital lesion(s) confirmed by polymerase chain reaction and reverse hybridization. As a part of their management, all patients were subjected to punch biopsy of the anogenital lesions to confirm HPV and an HIV blood test to ensure that they were HIV negative. All patients had their oral mucosa examined with an artificial light. All oral lesions were sampled by biopsy, and subjects with no detectable lesions were sampled by oral mucosal scraping for HPV testing by polymerase chain reaction and reverse hybridization. All patients also completed a questionnaire that recorded their sexual preferences (heterosexual or homosexual, monogamous or polygamous), frequency of sexual activity, practice of oral and/or anal sex, and the use of condoms. RESULTS: Only 3 patients presented with a clinically detectable oral lesion. Among them, just 1 was HPV positive by the molecular assay. In all of the other patients (27 out of 30), oral clinical lesions were not detected and scrapings were all negative for HPV infection. CONCLUSION: The prevalence of concurrent oral and anogenital HPV infection was very low in this study (1 out of 30).

HPV detection in the oral and genital mucosa of women with positive histopathological exam for genital HPV, by means of the PCR.

UNLABELLED: Infection by the Human Papilloma Virus (HPV) is one of the most frequent sexually transmitted diseases all over the world. The relationship between oral and genital HPV remains uncertain, as it is with its role on oral carcinogenesis. The goal of the present investigation was to check for the presence of HPV DNA in the oral and genital mucosas of women with HPV genital infection, using the polymerase chain reaction (PCR). STUDY METHOD: Cross-sectional cohort. MATERIALS AND METHODS: This is a pilot and prospective study involving 30 women, aged between 14 and 51 years, with HPV genital infection, confirmed by histopathology. All the patients were submitted to the exam and sample collection by swabbing the oral and genital mucosas in order to test for HPV DNA through the PCR technique. RESULTS: None of the oral cavity samples were positive for HPV, while in the genital tract, HPV was detected in 17 (57%) of the 30 patients, especially HPVs 6b and 16. CONCLUSION: Results show a higher percentage of genital HPV in comparison to the oral cavity, and suggest that genital HPV does not seem to be a predisposing factor for the oral infection in the same patient.

Detecção de HPV na mucosa oral e genital pela técnica PCR em mulheres com diagnóstico histopatológico positivo para HPV genital / HPV detection in the oral and genital mucosa of women with positive histopathological exam for genital HPV, by means of the PCR

A infecção do papilomavírus humano (HPV) é uma das mais freqüentes doenças sexualmente transmissíveis em todo o mundo. A relação entre o HPV genital e oral permanece incerta, assim como o seu papel na carcinogênese oral. O objetivo deste estudo foi verificar a presença do DNA do HPV na mucosa oral e genital de mulheres com infecção genital por HPV, pela técnica de reação em cadeia de polimerase (PCR). FORMA DE ESTUDO: Coorte transversal. MATERIAL E MÉTODO: Trata-se de um estudo piloto, prospectivo, com 30 mulheres, idade de 14 a 51 anos, portadoras de infecção genital por HPV confirmada pelo exame de histopatológico. Todas as pacientes foram submetidas a exame e coleta por raspagem da cavidade oral e genital para pesquisa do DNA do HPV pela técnica PCR. RESULTADOS: Nenhuma das amostras da cavidade oral foi positiva para HPV, enquanto no genital, o HPV foi detectado em 17 (57 por cento) das 30 pacientes, principalmente o HPV 6b e 16. CONCLUSÃO: Os resultados mostraram maior porcentagem do HPV genital em relação à cavidade oral, e sugerem que o HPV genital não parece ser fator predisponente para a infecção oral no mesmo paciente.

Infection by the Human Papilloma Virus (HPV) is one of the most frequent sexually transmitted diseases all over the world. The relationship between oral and genital HPV remains uncertain, as it is with its role on oral carcinogenesis. The goal of the present investigation was to check for the presence of HPV DNA in the oral and genital mucosas of women with HPV genital infection, using the polymerase chain reaction (PCR). STUDY METHOD: Cross-sectional cohort. MATERIALS AND METHODS: this is a pilot and prospective study involving 30 women, aged between 14 and 51 years, with HPV genital infection, confirmed by histopathology. All the patients were submitted to the exam and sample collection by swabbing the oral and genital mucosas in order to test for HPV DNA through the PCR technique. RESULTS: none of the oral cavity samples were positive for HPV, while in the genital tract, HPV was detected in 17 (57 percent) of the 30 patients, especially HPVs 6b and 16. CONCLUSION: Results show a higher percentage of genital HPV in comparison to the oral cavity, and suggest that genital HPV does not seem to be a predisposing factor for the oral infection in the same patient.

Macroglossia secondary to systemic amyloidosis: case report and literature review.

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different tissues and organs, where it usually causes some type of dysfunction. Its cause is unknown. The two main forms of amyloidosis are systemic and localized; the latter is rare. No satisfactory treatment for systemic amyloidosis has been discovered, and mean survival is poor, ranging from 5 to 15 months depending on the presence or absence of multiple myeloma. We report a case of primary systemic amyloidosis in a 71-year-old man. The diagnosis of amyloidosis was established by tongue biopsy, and its systemic nature was identified by analysis of aspirated abdominal fat. At the 1-year follow-up, the patient's clinical condition had not changed, and he was thereafter lost to follow-up.

Prevalência de achados sugestivos de papilomavírus humano (HPV) em biópsias de carcinoma espinocelular de cavidade oral e orofaringe: estudo preliminar / Prevalence of histological findings of human papillomavirus (HPV) in oral and oropharyngeal squamous cell carcinoma biopsies: preliminary study

O papilomavírus humano (HPV) é universalmente aceito como agente causal do câncer de colo uterino e, recentemente, vem se especulando sobre sua possível relação com câncer oral e de orofaringe. O carcinoma espinocelular (CEC) oral representa 90 por cento de todos os tumores malignos que afetam a cavidade bucal. Estudos sobre a prevalência de HPV em pacientes com CEC variam de 0 a 100 por cento. O efeito citopático viral mais conhecido é a coilocitose, considerado "critério maior" na infecção pelo HPV do ponto de vista histopatológico. OBJETIVO: O objetivo deste estudo foi verificar a prevalência de achados sugestivos de HPV - coilocitose - em CEC oral e de orofaringe. FORMA DE ESTUDO: coorte transversal. MATERIAL E MÉTODO: Foram examinadas no microscópio 20 lâminas com o diagnóstico de CEC de cavidade oral ou orofaringe sendo que em 15 delas foi encontrada coilocitose, correspondendo a 75 por cento. RESULTADO: Apesar de termos conhecimento que o método com maior sensibilidade atual para pesquisa de HPV ser a reação de polimerase em cadeia (PCR), iniciamos esta pesquisa com a investigação de coilocitose, o que é muito sugestivo de infecção por HPV. CONCLUSÃO: O estudo em questão trata-se de um projeto-piloto pois será dada continuidade a esta pesquisa através da realização de PCR a fim de confirmar a alta prevalência de infecção por HPV em CEC oral e de orofaringe.

Prevalence of histological findings of human papillomavirus (HPV) in oral and oropharyngeal squamous cell carcinoma biopsies: preliminary study.

UNLABELLED: Human papillomavirus (HPV) is considered to be an etiologic agent of cervical cancer and, recently its relation to oral and oropharyngeal cancer has also been investigated. Oral squamous cell carcinoma (SCC) represents 90% of all malignant tumors that affect the oral cavity. The prevalence of HPV in patients with SCC ranges from 0 to 100%. The most known viral cytopathic effect is koilocytosis, considered to be a major characteristic of HPV infection. AIM: The aim of this study was to verify the prevalence of some peculiar characteristics of HPV--koilocytosis--in oral and oropharyngeal SCC. STUDY DESIGN: Transversal cohort. MATERIAL AND METHOD: Twenty slides with oral and/or oropharyngeal SCC were examined under microscopy. RESULTS: In 15 of them, koilocytosis was found, amounting to 75%. Although we know that polymerase chain reaction (PCR) is the method with the best sensitivity for HPV detection, we began this research looking for koilocytosis, which is highly suggestive of HPV infection. CONCLUSION: This study is a trial project and we will continue this research with PCR measures to confirm this high prevalence of HPV infection in oral and oropharyngeal SCC.

Mucormicose rinocerebral: apresentação de caso com sobrevida e revisão de literatura / Rhinocerebral mucormycose: case presentation and literature review

As sinusites fúngicas são divididas em 2 grandes grupos: (1) Forma invasiva, que se divide em aguda e crônica; (2) Forma não-invasiva, que consta da bola fúngica (micetoma) e a sinusite fúngica alérgica. O desenvolvimento das diferentes formas de sinusite fúngica depende do estado imunológico do paciente, sendo que a forma invasiva aguda ocorre na grande maioria das vezes em imunodeprimidos. Os autores apresentam um caso de uma paciente do sexo feminino, diabética que iniciou quadro clínico com as características de sinusite fúngica invasiva, com febre alta, comprometimento ocular que evoluiu para amaurose à esquerda. Submetida à cirurgia, não apresentou boa evolução, com a manutenção de fístula nasocutânea. Após a introdução de medicação antifúngica (anfotericina B), seu quadro clínico estabilizou-se, com cessação da rinorréia fétida, febre e sinais flogísticos periorbitais. No exame anatomo-patológico foi encontrado mucosa revestida por epitélio respiratório com processo inflamatório tendo em meio hifas septadas com diagnóstico final de zigomicose. Após um ano de total desaparecimento dos sintomas, a paciente foi encaminhada ao Serviço de Cirurgia Plástica onde foi realizada cirurgia estética na região naso orbitária esquerda, estando a paciente atualmente satisfeita com aspecto facial.

Macroglossia decorrente de amiloidose sistêmica: relato de caso e revisão de literatura / Macroglosia due to sistemic amyloidosis: case report and literature review

Amiloidose é caracterizada por deposição extracelular anormal de amilóide em diferentes tecidos e órgãos, geralmente associada com disfunção do tecido ou órgão envolvido, cuja causa não é ainda conhecida. Pode ser dividida em amiloidose sistêmica e localizada. A forma sistêmica é dividida em: (1) primária; (2) amiloidose associada ao mieloma múltiplo; (3) secundária; (4) amiloidose heredofamiliar. Há uma considerável diferença de sobrevida entre os pacientes com forma localizada e sistêmica de amiloidose, e também com mieloma múltiplo. Não há tratamento satisfatório para amiloidose sistêmica. O presente estudo relata um caso de amiloidose sistêmica primária, com revisão de literatura. O diagnóstico de amiloidose foi conseguido com biópsia de língua e o envolvimento sistêmico confirmado através de aspirado de gordura abdominal. Apesar de a amiloidose não ser a principal hipótese diagnóstica que deva ser aventada quando nos deparamos com um paciente com macroglossia, esta doença não pode ser esquecida, uma vez que o suporte clínico é essencial para o controle das doenças que podem estar associadas, como falência renal, cardíaca e o mieloma múltiplo.