Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country.

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Teschovirus and other swine and human enteric viruses in Brazilian watersheds impacted by swine husbandry.

Several emerging viral agents related to gastroenteritis are distributed in human and animal populations and may contaminate the environment due to anthropic activities. The objective of this study was to analyze the seasonal contamination by enteric virus and coliforms in water from streams in the Vale do Taquari, draining a large number of pig farms. Microbiological contamination was evidenced by the detection of total and thermotolerant coliforms, reaching their peak in December. Hepatitis E virus (HEV), Enterovirus-G (EV-G) genome, and Sapelovirus-A (SV-A) genome were not detected. On the other hand, Rotavirus (RV) was detected in 3% (1/32) of the samples, whereas Teschovirus-A (PTV) was detected in 6% (2/32). This is the first detection of PTV in environmental samples in Brazil, pointing that the virus is being shedded from swine herds to watersheds. Human mastadenovirus (HAdV) was the most frequent detected viral agent in 9.3% (3/32) with values of 2.54 × 105, 7.13 × 104, and 3.09 × 105 genome copies/liter (gc/L). The circulation of coliforms and viral pathogens is noticeable due to anthropic activities and to the management of animal waste from the pig farming. In this way, enteric viruses can assist in monitoring the quality of watersheds and in tracking sources of contamination.

Is bipolar disorder a risk factor for HIV infection?

HIV/AIDS is an extremely important public health challenge. Bipolar disorder spectrum has a significant prevalence, reported to be around 2.6%. This study analyses the relationship between sexual behaviors among MDQ positive and MDQ negative patients and its influence in HIV infection, and the impact of HIV diagnosis in both groups. Two hundred outpatients from a specialized clinic for HIV-care located in Walter Cantídio's University Hospital in Fortaleza, Brazil answered to a demographic questionnaire, the Mood Disorder Questionnaire (MDQ) and a sexual behavior questionnaire based on WHO's Behavioral Surveillance Surveys (BSS). Fifteen percent (N=30) of all HIV positive patients were MDQ+. The MDQ+ group was more likely to: be or have been married, have offspring, have sex with commercial and non-regular partners, have infrequent condom use with non-regular partners and of not have used condom in their first sex. Despite more sexual practices among MDQ+ patients before HIV diagnosis, these patients had a more significant reduction of all behaviors after HIV diagnosis than the MDQ- group.

Alcoolismo em mulheres operárias no Ceará: um estudo preliminar / Alcoholism in work women in Ceará: a preliminary study

Este trabalho tem por objetivos: 1) avaliar as relaçöes e as condiçöes de trabalho e o reflexo do uso indevido de drogas em um grupo de mulheres trabalhadoras em uma indústria de confecçöes; 2) analizar o impacto do uso de drogas por seus familiares em suas condiçöes de vida. Aplicou-se um questionário individual com as seguintes categorias: dados demográficos, dinâmica familiar, as relaçöes e condiçöes de trabalho, uso de psicotrópicos e o MAST (Michigam alcoholism Screening Test). A amostra constitui-se de 67 mulheres com idade média de 31 anos, escolaridade média sétima série do primeiro grau, renda familiar média 2,6 salários mínimos, casadas (51,5 por cento) e número médio de dependentes 2,2. O significado do trabalho foi considerado por 65 por cento como "preciso muito" o retorno financeiro foi considerado péssimo por 54 por cento. Os períodos mais estressantes foram noite (24,2) e fim de semana (22,7 por cento). Apenas 6 (9 por cento) mulheres obtiveram um índice de 5 no MAST mas 20,3 por cento têm problemas com familiares todos os finais de semana devido ao álcool. Outros 19,4 por cento tiveram separaçöes provocadas pelo álcool enquanto 94,9 por cento afirmam näo terem tido problemas relacionados com outras drogas. Conclui-se, portanto, que o alcool é uma droga que mais interfere na vida deste grupo de operárias

Alcoolismo em mulheres operarias no Ceara: um estudo preliminar

Este trabalho tem por objetivos: 1) avaliar as relacoes e as condicoes de trabalho e o reflexo do uso indevido de drogas em um grupo de mulheres trabalhadoras em uma industria de confecoes; 2) analisar o impacto do uso de drogas por seus familiares em suas condicoes de vida. Aplicou-se um questionario individual com as seguintes categorias: dados demograficos, dinamica familiar, as relacoes e condicoes de trabalho, uso de psicotropicos e o MAST (Michigan Alcoholism Screening Test). A amostra constituiu-se de 67 mulheres com idade media de 31 anos, escolaridade media setima serie do primeiro grau, renda familiar media de salario 2,6 minimos, casadas (51,5 por cento) e numero medio de dependentes 2,2. O significado do trabalho foi considerado por 65 por cento como 'preciso muito' e o retorno financeiro foi considerado pessimo por 54 por cento. Os periodos mais estressantes foram noite (24,2 por cento) e fim de semana (22,7 por cento). Apenas 6 (9 por cento) mulheres obtiveram um indice acima de 5 por cento no MAST mas 20,3 por cento tem problemas com familiares todos os finais de semana devido ao alcool. Outros 19,4 por cento tiveram separacoes provocadas pelo alcool enquanto 94,9 por cento afirmam nao terem tido problemas relacionados com outras drogas. Conclui-se, portanto, que o alcool e a droga que mais interfere na vida deste grupo de operarias.

Lithium augmentation in antidepressant-resistant patients. A quantitative analysis.

A quantitative analysis was used to examine the efficacy of lithium augmentation in the acute treatment of depressed patients resistant to a standard trial of an antidepressant. Effect sizes were measured by the odds ratio using the Mantel-Haenszel method. Only controlled trials were included in order to minimise bias in method. A highly statistically significant effect for lithium augmentation was found, the pooled odds ratio being 0.146 and its 95% confidence interval 0.05-0.44 (i.e. the odds of remaining ill are reduced by between 56% and 95% with the use of lithium treatment). While these results support the case for lithium augmentation in treatment-resistant depression, there remains considerable uncertainty over the duration of treatment necessary to see and sustain the treatment response.

The effects of lithium discontinuation and the non-effect of oral inositol upon thyroid hormones and cortisol in patients with bipolar affective disorder.

Thyroid and adrenal function was assessed in euthymic bipolar patients, stable on prophylactic lithium for at least 1 year, before and after lithium discontinuation in a randomised double-blind placebo-controlled trial. All hormonal measurements were within the reference range, but a significant increase (P less than 0.001) in plasma thyroxine (T4) levels and a decrease (P less than 0.01) in TSH levels were observed 1 month after lithium withdrawal; cortisol concentrations showed a non-significant decrease in the same period. No relationship could be demonstrated between the magnitude of the change in hormone levels and the probability of relapse of manic symptoms. In the second part of this study, inositol was added for 11 days to the diets of bipolar patients being treated with prophylactic lithium and normal controls. No modification was shown in T4 and TSH in either group before or after inositol administration. Inositol did not alleviate other side-effects such as tremor and thirst in the patient group. This result suggests that short-term dietary inositol is not equivalent to lithium withdrawal and is of no value in reducing hormonal and other adverse effects of lithium prophylaxis.

Lithium treatment and prophylaxis in unipolar depression: a meta-analysis.

Meta-analysis was used to establish the efficacy of lithium in acute treatment and prophylaxis of depressive illness from existing published clinical trials. Effect sizes were measured by the odds ratio using the Mantel-Haenszel method and the Pearson product-moment correlation coefficient. Some benefit from lithium, compared with other treatments, emerged from trials of acute treatment. Lithium was clearly superior to placebo in the acute treatment of bipolar depressed patients. In controlled studies of lithium prophylaxis over five months to three years, an impressive effect was found for lithium when compared with placebo. For uncontrolled studies there was a similar-sized effect, corresponding to an improvement in the rate of favourable outcome from 35% for placebo to 70% with lithium treatment. The comparison of lithium with other antidepressants in prophylaxis showed no conclusive advantage for lithium in unipolar illness. There is no reason to doubt the efficacy of lithium in the prophylaxis of unipolar depressive illness.

The efficacy of lithium in prophylaxis of unipolar depression Evidence from its discontinuation.

Forty unipolar patients satisfying DSM-III criteria for major depression who discontinued lithium therapy were retrospectively compared with 105 similar patients who continued the drug and served as a control group. The time to readmission from starting lithium was compared while both groups were still on lithium, and after discontinuation in one group and further continuation in the control group. The progressive increase in the probability of recurrence over two years was the greatest after discontinuation of lithium. For the patients who eventually discontinued lithium, the cumulative probability of recurrence in two years was 0.08 on lithium and 0.58 after stopping it. The probability of recurrence was unchanged over the duration of the study for patients who continued to take lithium. There was no evidence of a lithium withdrawal syndrome within three months of stopping the drug. The results support the view that the everyday clinical use of lithium as prophylaxis is beneficial in unipolar depression.

Isolation and characterization of human brain aminopeptidase which hydrolysis enkephalin-containing peptides.

A human brain aminopeptidase, which hydrolyses low molecular weight enkephalin-containing peptides (ECPs), was purified to apparent homogeneity from the homogenate of human brain. The enzyme purification involved DEAE-cellulose chromatography and preparative polyacrylamide gel electrophoresis. The purified aminopeptidase hydrolyses only the Tyr1-Gly2 bond of enkephalines and of ECPs. The rate of hydrolysis of Met-enkephalin and Leu-enkephalin was higher than the rate of hydrolysis of ECPs containing 7 to 13 aminoacid residues. Large ECPs such as peptide E and beta-endorphin were not hydrolysed. The molecular weight of this enzyme is about 100,000 daltons, as determined by gel filtration on Sephadex G-200 and by polyacrylamide gel electrophoresis in presence of sodium dodecyl sulfate. The enzyme has an isoelectric point of pH 4.9, is activated by dithiothreitol (DTT) and inhibited by puromycin, bacitracin, p-mercuryacetate, Zn++, Cu++ and Ni++. The optimum pH for enzyme activity is 7.5.