Acute and Chronic Anti-ganglioside Neuropathies: From Theory to Practice in Buenos Aires, Argentina.

BACKGROUND AND AIMS: During the last two decades important advances have been made regarding the knowledge of immunomediated neuropathies, which entitled them to evolve from a theoretical existence to subtype differentiation. Nevertheless, questions regarding antigen topography or antibody's pathogenicity still need to be answer. Moreover, antibody typification is not necessarily available during clinical practice and usually diagnostic decisions or follow-up are done without it. The aim of this study is to raise awareness of the importance of divergent clinical findings in patients with immunomediated neuropathies. METHODS: We present an acute and a chronic case of anti-ganglioside neuropathy immunologically studied with the best anti-ganglioside antibody panel available nowadays in our country along with an update of the current knowledge of these entities. RESULTS: Although there is no consensus regarding the pathogenicity of these antibodies, diverging clinical features (mainly ataxia and ophthalmoparesis) and disease prognosis (as markers of axonal damage) are known to be associated with different antibodies. CONCLUSIONS: Antibody characterization in anti-ganglioside neuropathies is an evolving field, which we believe should periodically updated and minded for patient's diagnosis and follow-up, even if laboratory confirmation is not immediate, if available at all.

In vitro sensitivity of antagonistic Trichoderma atroviride to herbicides

Trichoderma atroviride was tested in vitro for its sensitivity to different herbicides. The dosages tested were recommended dosage (RD), half dosage (½RD), and double dosage (2RD). Germination, colony-forming units (CFU), radial growth, and spore production were evaluated. Carfentrazone-ethyl and sulfentrazone inhibited the germination at RD and 2RD. A reduction in the CFU was observed for glufosinate-ammonium, atrazine, carfentrazone-ethyl, diuron + paraquat dichloride, imazapyr, oxyfluorfen, and sulfentrazone at each of the tested dosages. Radial growth was influenced by ametryn, atrazine, carfentrazone-ethyl, oxyfluorfen, and sulfentrazone herbicides, with an 80% reduction of the colonial area. Spore production was affected by carfentrazone-ethyl, oxyfluorfen, and sulfentrazone with colonial area reductions of over 70%. It was concluded that 2,4 D, clomazone, and imazapyr herbicides showed the least toxicity to T. atroviride and should be used in the crops where the fungus has been applied for phytopathogen control.

The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis.

BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on medical evidence and may interfere with disease control by immunomodulatory drugs. The present study was designed to help discuss the effect of DMT for MS on pregnancy and on disease course. PATIENTS AND METHODS: Retrospective data from 152 pregnancies of 132 women with MS were collected by the physician in charge of the case. All data were entered into a specific file for qualitative and quantitative statistical analysis. RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of obstetric and neonatal complications was similar in both groups, except for the newborn weight and height which was smaller for mothers receiving medications. Mothers' post-delivery relapse rate and EDSS scores in the follow-up period were significantly higher in the absence of treatment. CONCLUSION: It is possible that, with further such supportive data, international guidelines on MS treatment in young women who intend to get pregnant may need to be revised.

Otolaryngology and speech therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal.

UNLABELLED: Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. AIM: The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital. MATERIALS AND METHODS: Retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50%) males and 606 (45.50%) females, between 22 days and 99 years old. RESULTS: We found: 427 (32.08%) cases of normal swallowing, 273 (20.48%) mild dysphagia, 224 (16.81%) moderate dysphagia, 373 (27.99%) severe dysphagia and 35 (2.64%) inconclusive exams. CONCLUSION: The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.

Otolaryngology and speech therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal / Avaliação otorrinolaringológica e fonoaudiológica na abordagem da disfagia orofaríngea: proposta de protocolo conjunto

Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. AIM: The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital. MATERIALS AND METHODS: Retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50 percent) males and 606 (45.50 percent) females, between 22 days and 99 years old. RESULTS: We found: 427 (32.08 percent) cases of normal swallowing, 273 (20.48 percent) mild dysphagia, 224 (16.81 percent) moderate dysphagia, 373 (27.99 percent) severe dysphagia and 35 (2.64 percent) inconclusive exams. CONCLUSION: The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.

Disfagia é um sintoma que envolve uma gama de alterações anatômicas e funcionais, que deve ser abordado de maneira multidisciplinar para garantir melhor avaliação e tratamento, prevenindo as complicações potenciais. OBJETIVO: utilização do protocolo de avaliação clínica e videoendoscopia da deglutição, realizado em conjunto por otorrinolaringologistas e fonoaudiólogos, no Ambulatório de Disfagia da Divisão de Clínica Otorrinolaringológica da instituição. MATERIAL E MÉTODO: Estudo retrospectivo da utilização do protocolo de anamnese e exame físico otorrinolaringológico e fonoaudiológico, complementados pela videoendoscopia da deglutição. Foram avaliados 1332 pacientes no período de maio de 2001 a dezembro 2008, sendo 726 (54,50 por cento) indivíduos do sexo masculino e 606 (45,50 por cento) do sexo feminino. As idades variaram de 22 dias a 99 anos, com uma média de idade de 59,4 anos. RESULTADOS: Foram identificados 427 (32,08 por cento) pacientes com deglutição normal, 273 (20,48 por cento) com disfagia leve, 224 (16,81 por cento) com disfagia moderada e 373 (27,99 por cento) pacientes com disfagia grave, além de 35 (2,64 por cento) exames inconclusivos. CONCLUSÃO: O protocolo de avaliações otorrinolaringológica e fonoaudiológica integrado permitiu uma abordagem minuciosa e complementar do paciente disfágico, em relação a classificações do distúrbio de deglutição, além de auxiliar na abordagem terapêutica.

[Carcinops troglodytes (Erichson) (Coleoptera: Histeridae) preying on Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae) in poultry houses]. / Carcinops troglodytes (Erichson) (Coleoptera: Histeridae) predando larvas de Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae) em aviários.

We first record Carcinops troglodytes (Paykull) as a predator of Alphitobius diaperinus (Panzer) larvae in poultry houses in North and Northwest regions of the state of Paraná. Carcinops spp. are commonly recorded as predators of dipterans, and this record in poultry houses indicates the possibility of exploiting such predator for future studies aiming the development of management strategies for A. diaperinus.

Carcinops troglodytes (Erichson) (Coleoptera: Histeridae) predando larvas de Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae) em aviários

We first record Carcinops troglodytes (Paykull) as a predator of Alphitobius diaperinus (Panzer) larvae in poultry houses in North and Northwest regions of the state of Paraná. Carcinops spp. are commonly recorded as predators of dipterans, and this record in poultry houses indicates the possibility of exploiting such predator for future studies aiming the development of management strategies for A. diaperinus.

Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children.

OBJECTIVE: To compare videofluoroscopy swallowing study (VFSS) with the fiberoptic endoscopic evaluation of swallowing (FEES) in children and to determine the accuracy of FEES in the diagnosis of specific swallowing disorders. STUDY DESIGN: Cross-sectional study. SETTING: Hospital da Criança Santo Antônio, affiliated with Santa Casa de Misericórdia Hospital Complex, Porto Alegre, RS, Brazil. SUBJECTS AND METHODS: FEES findings were compared to those of VFSS in 30 children. Kappa coefficients for interobserver agreement were calculated. Thereafter, these coefficients were evaluated in terms of agreement between FEES and VFSS. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of FEES were calculated for four swallowing parameters (posterior spillover, pharyngeal residues, laryngeal penetration, and laryngotracheal aspiration). RESULTS: Interobserver agreement rates greater than 70 percent were obtained for all FEES parameters analyzed, except for pharyngeal residues with puree consistency (agreement = 66.7%, kappa = 0.296, P = 0.091). Laryngeal aspiration and penetration yielded the best level of agreement (100%, kappa = 1) for the laryngeal aspiration of puree residues. CONCLUSION: The diagnostic agreement between FEES (both observers) and VFSS was low. Regarding the analyzed parameters, laryngeal penetration and aspiration yielded the highest interobserver agreement in terms of FEES, and also showed the highest specificity and positive predictive value when compared to VFSS.

Associação de pós inertes com fungo entomopatogênico para o controle do cascudinho (Alphitobius diaperinus) / Association of inert powders with the entomopathogenic fungi for darkling beetle (Alphitobius diaperinus) control

O objetivo deste trabalho foi avaliar a eficiência de Beauveria bassiana (Bb), da terra diatomácea (TD) e dos pós de rocha Protesyl e Rocksil, isoladamente ou em associações, para o controle de Alphitobius diaperinus. Os agentes de controle foram aplicados na forma sólida misturados à cama de frango. A concentração de conídios de Bb foi de 0,08 por cento e, para os pós inertes, as concentrações foram de 0,5; 1,0 e 1,5 por cento. Testaram-se 20 tratamentos, com cinco repetições de 200 insetos, por 10 dias. Os tratamentos que apresentaram maior eficiência foram TD 1,5 por cento e Bb 0,08 por cento + TD 1,5 por cento, com 60,2 e 57,8 por cento de mortalidade, respectivamente. Protesyl e Rocksil, nas três concentrações, e TD 0,5 por cento não diferiram da testemunha. Na interação entre os agentes de controle, ocorreu efeito aditivo para Bb + TD e Bb + Rocksil, nas três concentrações, e para Bb + Protesyl a 1,5 por cento. A eficiência do fungo foi reduzida na associação com Protesyl, com efeito não aditivo antagônico nas concentrações de 0,5 e 1,0 por cento. A terra diatomácea, isolada ou associada à B. bassiana, apresenta-se como boa alternativa para controle de A. diaperinus. Já os pós de rocha Protesyl e Rocksil não foram eficientes para o controle da praga.

The objective of this study was to evaluate the efficacy of Beauveria bassiana (Bb) of diatomaceous earth (TD) and the dust of rock Protesyl and Rocksil, alone or in combinations, for Alphitobius diaperinus to control. The control agents were applied in dried by mixing with the poultry liter. The concentration of Bb conidia was 0.08 percent on the weight of the substrate, and for the dust inert were 0.5, 1.0 and 1.5 percent. Twenty treatments with five repetitions of 200 insects were tested for 10 days. The treatments with highest efficiency were TD 1.5 percent and Bb 0.08 percent + TD 1.5 percent, with 60.2 and 57.8 percent, respectively. Protesyl and Rocksil in the three concentrations and TD 0.5 percent did not differ from control. For the interaction between control agents no advantage was observed for the association. Additive effect occurred for Bb + TD and Bb + Rocksil at the three concentrations and for Bb + Protesyl at 1.5 percent. The action of the fungus was reduced in association with Protesyl with antagonistic non-additive effect in 0.5 and 1.0 percent. Diatomaceous earth, isolated our in association with B. bassiana its a good alternative for A. diaperinus control. Just rock dust Protesyl and Rochsil were not efficient for insect control.

Avaliação polissonográfica e de videoendoscopia da deglutição de pacientes portadores da sequência de Pierre-Robin / Polysomnography evaluation and swallowing endoscopy of patients with Pierre Robin sequence

Asequência de Pierre Robin é caracterizada por micrognatia, glossoptose e obstrução das vias aéreas superiores. A gravidade dos sintomas é muito variável, o que torna o tratamento destes pacientes um desafio. Objetivos: Identificar a presença de apneia-hipopneia obstrutiva do sono e avaliar a presença de alterações da deglutição em pacientes portadores da sequência de Pierre-Robin. Material e métodos: Estudo retrospectivo em que foram avaliadas 14 crianças com sequência de Pierre-Robin, sendo oito do sexo feminino. As crianças foram submetidas à videoendoscopia da deglutição e polissonografia. Resultado: Oito pacientes foram incluídos no estudo. Seis apresentaram polissonografia normal e apenas 1 paciente apresentou apneia-hipopneia leve de origem central. A videoendoscopia da deglutição mostrou-se normal em cinco pacientes e disfagia moderada foi detectada em três pacientes sendo submetidos à gastrostomia. A distração da mandíbula foi realizada em quatro pacientes que também foram submetidos à traqueostomia no mesmo tempo cirúrgico. Conclusões: Disfagia foi mais prevalente do que a apneia do sono. A videoendoscopia da deglutição mostrou ser um exame dinâmico e eficaz na detecção de distúrbios alimentares em pacientes com a sequência de Pierre Robin.

The Pierre Robin sequence is characterized by micrognathia, glossoptosis and upper airway obstruction. Symptom severity varies, and this makes the treatment of these patients a true challenge. AIM: to identify the presence of sleep hypopneaapnea in patients with Pierre-Robin sequence. Materials and methods: retrospective study in which we assessed 14 children with Pierre-Robin sequence, eight girls. The children were submitted to swallowing video-endoscopy study and polysomnography. Results: eight patients were included in this study. Six had normal polysomnography and only one patient had mild central hypopnea-apnea. Swallowing video-endoscopy was normal in five patients and moderate dysphagia was detected in three patients, who were then submitted to gastrostomy. Mandible distraction was carried out in four patients who were also submitted to tracheostomy during the same procedure. Conclusions: dysphagia was more prevalent than sleep apnea. Swallowing video-endoscopy proved to be a dynamic test and one able to detect feeding disorders in patients with Pierre Robin sequence.

Polysomnography evaluation and swallowing endoscopy of patients with Pierre Robin sequence.

UNLABELLED: The Pierre Robin sequence is characterized by micrognathia, glossoptosis and upper airway obstruction. Symptom severity varies, and this makes the treatment of these patients a true challenge. AIM: to identify the presence of sleep hypopnea-apnea in patients with Pierre-Robin sequence. MATERIALS AND METHODS: retrospective study in which we assessed 14 children with Pierre-Robin sequence, eight girls. The children were submitted to swallowing video-endoscopy study and polysomnography. RESULTS: eight patients were included in this study. Six had normal polysomnography and only one patient had mild central hypopnea-apnea. Swallowing video-endoscopy was normal in five patients and moderate dysphagia was detected in three patients, who were then submitted to gastrostomy. Mandible distraction was carried out in four patients who were also submitted to tracheostomy during the same procedure. CONCLUSIONS: dysphagia was more prevalent than sleep apnea. Swallowing video-endoscopy proved to be a dynamic test and one able to detect feeding disorders in patients with Pierre Robin sequence.

Disfagia orofaríngea na dermatomiosite: relato de caso e revisão de literatura / Oropharyngeal dysphagia in dermatomyosites: case report and literature review

Os autores apresentam um caso raro de dermatomiosite, cursando com disfagia orofaríngea grave. Paciente do sexo feminino, branca, 13 anos, acompanhada no ambulatório de Reumatologia, foi encaminhada à Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da FMUSP, com queixa de dificuldade para deglutição de sólidos. Conforme o protocolo do grupo de disfagia, realizou avaliação fonoaudiológica e otorrinolaringológica, com anamnese dirigida, ênfase para os órgãos fonoarticulatórios, integridade dos pares cranianos e complementação diagnóstica com exame de videoendoscopia da deglutição. Diagnosticado quadro de disfagia orofaríngea grave, com aspiração de saliva e alimentos em todas as consistências testadas. Orientado suspender a alimentação por boca e introduzir dieta por sonda nasoenteral. Iniciou fonoterapia e indução medicamentosa de xerostomia, associado ao tratamento da doença de base. Evoluiu com melhora clínica, comprovada pela videoendoscopia da deglutição, com possibilidade de retorno à alimentação via oral. Os autores atentam para a ocorrência de disfagia orofaríngea associada a quadro de dermatomiosite, ressaltam a importância da avaliação clínica e apresentam a videoendoscopia da deglutição como um bom exame para refinamento diagnóstico e seguimento destes pacientes.

We present a rare case of dermatomyosites associated with severe oropharyngeal dysphagia. A 13 year old female patient, being followed at the Rheumatologic Department, was referred to the Otolaryngology Department of the University of São Paulo School of Medicine Hospital. She complained of swallowing problems, especially with solids. Following our dysphagia study protocol, we employed a speech pathologist and otolaryngology evaluation, mainly for clinical history, examination of anatomical structures involved with swallowing events, cranium nerves integrity and videoendoscopic swallowing study. We diagnosed severe oropharyngeal dysphagia, with aspiration of saliva and food of all consistencies. We advised against oral feeding and recommended a diet through a gastric tube. She started with therapy and xerostomia medication, together with the treatment of the base disease. The patient showed a significant improvement, noticed by the clinical evaluation and the control videoendoscopic swallowing study, with the possibility of returning to oral feeding. The authors stress the incidence of oropharyngeal dysphagia in dermatomyosites and suggest the videoendoscopic swallowing study as a good exam for diagnosis and follow-up of these patients.

Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Amiloidose com múltiplos focos em trato aéreo-digestivo superior: relato de caso e revisão de literatura / Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1 por cento dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Oropharyngeal dysphagia in dermatomyosites: case report and literature review.

We present a rare case of dermatomyosites associated with severe oropharyngeal dysphagia. A 13 year old female patient, being followed at the Rheumatologic Department, was referred to the Otolaryngology Department of the University of São Paulo School of Medicine Hospital. She complained of swallowing problems, especially with solids. Following our dysphagia study protocol, we employed a speech pathologist and otolaryngology evaluation, mainly for clinical history, examination of anatomical structures involved with swallowing events, cranium nerves integrity and videoendoscopic swallowing study. We diagnosed severe oropharyngeal dysphagia, with aspiration of saliva and food of all consistencies. We advised against oral feeding and recommended a diet through a gastric tube. She started with therapy and xerostomia medication, together with the treatment of the base disease. The patient showed a significant improvement, noticed by the clinical evaluation and the control videoendoscopic swallowing study, with the possibility of returning to oral feeding. The authors stress the incidence of oropharyngeal dysphagia in dermatomyosites and suggest the videoendoscopic swallowing study as a good exam for diagnosis and follow-up of these patients.

Selection of Beauveria bassiana isolates to control Alphitobius diaperinus.

This paper presents results on isolates of the entomopathogenic fungus Beauveria bassiana for Alphitobius diaperinus (Coleoptera: Tenebrionidae) control. Of the 30 isolates tested, four (CG 71, CG 152, UNIOESTE 4, and UNIOESTE 40) resulted in mortality rates >or= 40% within 10 days. These mortality rates could be considered high because of the resistance of these species to B. bassiana. Tests were conducted using these isolates to estimate LC(50), mortality rate over time, vegetative growth, and conidial production on artificial medium and on insects. Isolates CG 71, CG 152, and UNIOESTE 4 showed the best performance and great potential to be used in an integrated management program in poultry farms to control A. diaperinus. Also, the molecular profiles of 12 isolates were analyzed using the RAPD technique. The high-virulence isolates presented a more homogeneous RAPD pattern than the others. Genetic sequencing of the ITS region was performed for one of the virulent isolates (UNIOESTE 4) and compared with sequences deposited at the NCBI database, confirming its taxonomical position as belonging to B. bassiana Clade A.